Urinary and bowel weakness can affect both men and women of all ages. It can be an uncomfortable as well as an embarrassing problem, but with the right help and guidance, it is a problem that can be effectively treated.
If you have been experiencing incontinence for an extended period, it is important to see your GP to discuss what treatment options may be available.
Types of incontinence
Incontinence is a broad term that can relate to either the inability to control the passing of urine (urinary incontinence) or the inability to control the passing of faeces (bowel incontinence). People can experience varying symptoms with each of these types which may be either small leaks, or a more serious problem.
In addition, incontinence can be an inevitable part of ageing, so it is important to speak to someone if you're elderly and experiencing symptoms of incontinence.
Urinary incontinence occurs when you're unable to store and control the passing of urine. There could be many reasons why urinary incontinence occurs, but it is important that the problem is investigated early to determine whether there may be an underlying issue. Often, by treating any underlying conditions, urinary incontinence can be alleviated.
Types of urinary incontinence
Stress incontinence is when small amounts of urine are involuntarily released when you cough, sneeze, laugh or exercise. Even gentle exercise like walking or lifting small items can cause leakage.
The most common cause of stress incontinence is a weak bladder outlet or weak pelvic floor muscles. Weak pelvic floor muscles are more common in postnatal women due to the strain childbirth puts on the pelvis, but men who have had prostate surgery (prostatectomy) can also be affected. Other factors such as obesity can put significant strain on the pelvic floor muscles, making them weak and ineffective.
Treating Stress Incontinence
It is always recommended that you visit your GP if you're in doubt about the potential underlying causes of stress incontinence.
Pelvic floor exercises are an easy and effective way to alleviate stress incontinence. There are several resources available to learn how to do these, but if you’re having trouble getting started, speak to your GP or continence physiotherapist as they may have the equipment to help you learn which muscles to use. Sometimes, very mild electrical stimulation is also used to help exercise and strengthen the muscles.
For moderate to severe cases of stress incontinence that don’t respond to conservative treatment, medication may an option. Duloxetine is the medication of choice and often works best when used with pelvic floor exercises as it helps increase the muscle tone of the urethra. Your GP would be able to advise you if this medicine is appropriate for you.
Losing weight may also help control stress incontinence. Again, if done alongside pelvic floor exercises, this can be an effective way to combat the problem.
In severe cases of stress incontinence, where there is significant leakage or prolapse, surgery may be an option. Surgery is voluntary, and you may prefer to see if medication will work first, but results have proved effective.
Urge incontinence is the second most common form of incontinence after stress incontinence. The condition is often caused by an overactive bladder. The muscles in the wall of the bladder contract too often which causes a sudden, urgent need to pass urine.
One of the main symptoms of urge incontinence is needing to pass urine more often than usual. This is known as frequency. If it affects you mostly at night, it is called nocturia.
The reasons for an overactive bladder are not always fully understood. However, drinking too much alcohol or caffeine, or not drinking enough water, have been shown to irritate the bladder, causing symptoms of overactivity. Constipation has also been shown to be a cause, as have urinary tract infections, neurological conditions, and certain medications.
Treating Urge Incontinence
Bladder training can be an effective way to treat urge incontinence. Combined with pelvic floor exercises, it increases the time between feeling the need to urinate and passing urine. This allows you to ‘hold on’ longer, which will help decrease stressful situations.
If the bladder training fails to work, your doctor may prescribe medicines that can help to calm an overactive bladder. These medicines work directly on the muscles in the walls of the bladder, allowing urine to be stored in the bladder for longer periods of time. Remember, it’s important to speak to your GP about this type of incontinence, as there may be various underlying reasons that could be causing it.
Overflow incontinence is caused by a blockage or obstruction to the bladder. The bladder fills up normally, but you will usually not feel the need to pass urine. This results in leakage. Overflow incontinence is more common in men than in women. One of the most common causes is an enlarged prostate gland, which restricts the flow of urine from the bladder.
Overflow incontinence may also be caused by the detrusor muscles in your bladder not fully contracting. This means that your bladder does not completely empty when you go to the toilet. As a result, the bladder becomes stretched, which results in leakage.
There may be a few reasons why your detrusor muscles do not fully contract. Nerve damage may be one of the reasons, which can occur following bowel or spinal cord surgery. Diseases such as Multiple Sclerosis, Stroke or Parkinson’s Disease may also make the bladder less efficient at emptying.
Treating Overflow Incontinence
In most cases, overflow incontinence can be cured completely. To be able to treat the condition effectively, you should see your GP to determine the underlying cause. Once this has been established, you would have several options available to you. For example, if it was medication causing the incontinence, simply stopping the medication would sort the problem out.
Sometimes, an underlying cause cannot be found. If this is the case, bladder training and pelvic floor exercises may be effective in reducing the severity of the condition. Bladder training is a simple and easy way to get your bladder to empty regularly, while also allowing you to hold on longer. It is done in the following way:
- Schedule your visits to the bathroom
- Extend these scheduled times by 5 minutes, eventually increasing it to 15 minutes. For example, if you go to the bathroom every hour, schedule to go every 1 hour and 5 minutes, building up to every 1 hour and 15 minutes
- Avoid caffeine and fizzy drinks while you're training your bladder
What is Bowel Incontinence?
Also, known as faecal incontinence, bowel incontinence occurs when you are unable to control bowel movements, resulting in the involuntary passing of faeces. It is often the symptom of an underlying medical condition, so it is important that you see your GP if you're experiencing any kind of bowel incontinence.
Bowel incontinence is often passive. This means that there is an involuntary passing of faeces without the sensation or need to. This is mostly likely to happen when trying to pass wind.
It is thought that approximately 1 in 10 people will be affected by bowel incontinence at some point in their lives, and it can affect people of any age.
Causes of Bowel Incontinence
One of the most common causes of bowel incontinence is damage to one or both anal sphincter muscles. This is most common in women as their anal sphincters are more prone to tears following childbirth.
The external anal sphincter delays bowel emptying until you feel the urge to go the toilet. If you have a weak or damaged external sphincter muscle, you’re unable to hold on until you get to the loo, resulting in the leaking of faecal content.
In addition to the external sphincter, the internal anal sphincter can also become damaged. This problem is most often associated with passive soiling where faeces leaks out without the person realising.Other common causes of bowel incontinence are constipation, diarrhoea and some medicines. Diseases such as Parkinson’s, Multiple Sclerosis, Stroke and Alzheimer’s can also result in this type of incontinence.
Treating Bowel Incontinence
Less invasive treatment is often the best way to combat bowel incontinence. This can include dietary changes and various exercise programmes. Medication and surgery are usually only considered if other treatments haven't worked.
It might be helpful to keep a bowel diary before going to your GP. This will detail frequency and accidents, which will be useful to your doctor as it may highlight any underlying causes of your incontinence.
If you don't want to see your GP about the problem you're having, you might be able to make an appointment at your local NHS continence service without a referral. These clinics have specialist nurses who can offer useful advice about incontinence.
Personal Care and Odour Control
If you have bladder or bowel problems, personal hygiene is important. This is not only to remain discreet and comfortable but is important for health reasons as well. Involuntary leakage can quickly lead to skin irritation if not cleaned and can make you more susceptible to various complications such as bladder infections.
Using a cotton cloth with a cleansing lotion that is specifically for sensitive areas is an easy way to keep any affected areas clean and dry. Avoiding normal soap and baby wipes is recommended as they often contain alcohol which will irritate the area and make it worse. After cleansing, it’s important to moisturise and use a barrier cream. This forms a protective layer that prevents any additional moisture building up.
Odour problems can be a major concern to people with incontinence. Fortunately, there are a number of things you can do to combat this problem.
Fresh urine shouldn’t smell offensive. If it does, there may be an underlying infection. Urine that has been exposed to air for long periods of time, can start to smell, so if you've had a leak, change your clothes or sheets as soon as you can.
Good quality discreet pads are an effective way of absorbing leaks and containing smells. There are a few these available on the market from a variety of sources.
If you’ve had a spill at home, beds, chairs or carpets should be quickly cleaned with a mild detergent or disinfectant - allow fresh air to circulate where you can. You can also use deodorising sprays to keep the room smelling fresh.
If you have bowel incontinence, you may be more worried about the potential for unpleasant smells. Change any soiled pads quickly, placing them in an airtight container or sealed bag. If you use your bathroom bin for used pads, make sure you transfer them to the dustbin regularly.
What to Eat and Drink to Help Incontinence
Simple lifestyle changes can be an effective and easy way to cure incontinence. For example, if you're suffering from urinary incontinence, you may feel the need to cut down on drinking fluids to avoid any leaking. The opposite is true. Drink normal amounts of fluid unless a healthcare professional tells you otherwise, as drinking less will usually make incontinence worse. If you, however, suffer from nocturia, try restricting how much you drink in the few hours before bedtime.
Replace tea and coffee with the decaffeinated versions, and replace fizzy drinks with water. Avoid alcohol and artificial sweeteners, as they can often make symptoms worse.
It may also be helpful to keep a record of what you’re drinking. This will help determine what type of drinks affect your symptoms most.
Certain foods can also irritate the bladder, making symptoms worse. Tomato based products and spicy foods are particularly bad, as are chocolate and fizzy drinks.
If you have an overactive bladder, it can be helpful to increase your intake of fibre as constipation can make the condition worse.
Keeping a healthy weight is useful in beating incontinence. This is because being overweight puts additional strain on your pelvic floor muscles, making them weak. This, in turn, can lead to a lack of control of your bowels and bladder.
Getting regular exercise and eating a healthy, balanced diet will help you lose weight. Talk to your GP or practice nurse to ensure you are healthy enough to undertake any new diets or exercise regimes. The NHS Choices website is a great resource for anyone wanting to lose weight, as it can advise on diet as well as other lifestyle changes.