What Is Incontinence And Why Does It Happen?
Incontinence is very common although it’s still got a massive stigma attached to it meaning people are not open with talking about it. Studies estimate that around 300 million people worldwide are suffering with some form of incontinence, with many of them never seeking help possibly through embarrassment or because of how incontinence has been normalised by our society and certain pads companies.
What does incontinence mean?
Incontinence is the unintentional release of urine or stool. This might be when you cough, sneeze or laugh, you may have a sudden urge to use the toilet and not make it in time or not have any idea you are leaking. The severity can range from a slight loss of control (a few drops of urine or some gas) to a complete loss of control where you are leaking from the bladder of bowel constantly.
Different types of incontinence
There are different types of incontinence, and within them different subtypes.
Urinary Incontinence
Stress Incontinence - Leaking urine when the bladder is under stress like when you sneeze, cough, laugh or lift something heavy. Anything that puts pressure on the bladder leads to stress incontinence.
Urge Incontinence - More commonly known as an overactive bladder. You may get a strong urge to urinate, especially when you touch or hear running water. You may not make it to the toilet in time.
Functional Incontinence - A physical or cognitive reason you are unable to get to the toilet. There may not be anything wrong with the bladder.
Bowel Incontinence
Faecal Incontinence - Involuntary loss of faeces.
Flatus Incontinence - Involuntary loss of gas.
Mucous Incontinence - Involuntary loss of mucus from the rectum.
Then each type can also be one of the following:
Urge Incontinence - A strong urge to pass a stool, you may not make it to the toilet in time.
Passive Incontinence - When you are unaware of liquid or soft stool leaking from the anus.
Functional Incontinence - A physical or cognitive reason you are unable to get to the toilet. There may not be anything wrong with the bowel.
What causes incontinence?
Due to the nature of incontinence, the causes are varied and complex. There can also be a combination of things causing or making incontinence worse. Here are some of the main causes but this list is by no means exhaustive.
Causes of urinary incontinence
Weak pelvic floor - This can be caused by a variety of things such as pregnancy and childbirth or high impact sports. A weak pelvic floor means less support for the bladder, bowel and uterus.
Menopause - The menopause causes a sudden drop in Estrogen. Estrogen helps keep the bladder, pelvic muscles and urethra healthy.
Infection - A urinary tract infection can irritate the bladder leaving you with incontinence.
Being overweight - Extra weight can put pressure on the bladder, causing leakage.
Causes of bowel incontinence
Weak pelvic floor - As mentioned above, this can be caused by many things and means less support for the pelvic organs including the bowel.
Muscle damage - Any muscle damage in that region including the muscles at the rectum can make it harder to hold back stool properly.
Nerve damage - Injury to the nerves that sense stool in the rectum or those that control the anal sphincter can lead to incontinence.
Chronic constipation - Chronic constipation can weaken the pelvic floor and lead to a dry hard mass to form in the rectum and become too large to pass.
Treatment for incontinence
There are a selection of treatment options available and the most appropriate ones depend on the type and the cause. Surgical options should always be a last resort with all non-surgical options being exhausted before surgery is even considered.
For both urinary and bowel incontinence, pelvic floor strengthening can be an effective treatment when done correctly and consistently. Other non-surgical options include bladder and bowel training and lifestyle changes. We thoroughly recommend seeing a pelvic floor physio as they are the experts in all things pelvic floor and can give you the best chance of a successful non-surgical treatment for incontinence.
Surgery for urinary incontinence
One surgical option for urinary incontinence is a colposuspension, where your bladder is lifted and stitched into this lifted position. Other options include sling surgery where a sling of tissue is used to support the bladder. Another common procedure is mesh surgery, where a piece of synthetic mesh is inserted behind the urethra to support it. Many people have come forward with severe negative effects as a result of mesh surgery with long lasting pain and irreversible nerve damage so you should do your own research and ask lots of questions if this option is presented to you.
Surgery for bowel incontinence
A sphincteroplasty is an operation to repair any damaged muscles in the anus. Other options include placing a small electrical device under the skin to help the muscles and nerves work more effectively and this is called Sacral Nerve Stimulation.
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References
https://www.nhs.uk/conditions/bowel-incontinence/
https://www.nhs.uk/conditions/urinary-incontinence/surgery/
https://www.mayoclinic.org/diseases-conditions/fecal-incontinence/symptoms-causes/syc-20351397
https://www.nhsggc.org.uk/media/252477/bowel-incontinence-v4.pdf
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