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What is incontinence?
Incontinence is the inability to control the bladder or bowel. Incontinence is not just a problem for older people. It can affect men and women of any age. It should not be considered normal. It can often be a sign of other health problems.
It can often be cured and other times it can be managed better with the right advice or treatment.
Urinary incontinence
Urinary incontinence can be either transient or established.Transient incontinence is urinary incontinence that has appeared suddenly in a person who otherwise has good bladder and bowel control. Some medications, constipation, urinary tract infection, immobility, uncontrolled diabetes, delirium or acute confusion may cause transient incontinence, but if these factors are correctly treated or managed, the urinary incontinence disappears.
Established incontinence includes any of the following types of incontinence:
- stress incontinence (more information)
- urge incontinence (more information)
- overflow incontinence (more information)
- functional incontinence (more information), and
- reflex incontinence (more information).
Stress incontinence
Stress incontinence is a small leak of urine associated with a physical activity such as coughing, laughing or physical exertion, such as getting up and bending over. The cause is weak pelvic floor muscles.Urge incontinence
Urge incontinence is a leak of urine associated with the feeling of needing to go to the toilet quickly. The feeling is very strong and the person just can’t make it to the toilet on time. Other symptoms that may be present are:- urgency – a very strong feeling of needing to go to the toilet now
- frequency – needing to go to the toilet too often
- going to the toilet more often than twice a night, or
- wetting the bed at night when asleep.
Overflow incontinence
Overflow incontinence is a small leak of urine associated with an overfull bladder that does not empty properly. Symptoms can be:- dribbling
- frequency
- poor stream
- diminished stream or intermittent stream
- a feeling of incomplete emptying
- dribbling after finishing, or
- going to the toilet more often than twice a night.
Functional incontinence
Functional incontinence occurs when a person does not recognise the need to go to the toilet, or doesn’t remember where the toilet is, or is unable to loosen clothing in time. Causes of functional incontinence include confusion, dementia, poor eyesight, poor mobility, poor hand movements, or unwillingness to toilet because of depression, anxiety or anger.Environmental factors also contribute to functional incontinence, such as poor lighting, low chairs that are difficult to get out of, or toilets that are difficult to access.
Reflex incontinence
Reflex incontinence is usually due to spinal cord or brain injury. It is a leak of urine and all the urine in the bladder is emptied out. The leak happens without a feeling of needing to go to the toilet.Faecal incontinence
People with faecal incontinence have difficulty controlling their bowel. As a result, they pass faeces, or stools, at the wrong time or in the wrong place. They may also pass wind without control.Faecal incontinence (or bowel incontinence) affects as many as one in 100 people. It is more common as you get older, but a lot of younger people are also affected.
There are several causes of bowel incontinence such as: constipation and impaction, muscle weakness, severe diarrhoea, disorders of the nervous system, and disorders of the lower bowel.
Constipation and impaction
This is probably the most common cause of bowel incontinence among older and disabled people. It is usually characterised by hard bowel actions passed infrequently, along with unpredictable episodes of incontinence or diarrhoea.A number of factors can contribute to constipation. These include:
- a diet that is low in fibre
- poor fluid intake
- poor mobility
- some medicines; for example, some painkillers, or
- various medical conditions.
Muscle weakness
Weakness of your anal muscles or sphincter may be due to:- childbirth
- some types of surgery – for example, for haemorrhoids (piles), or
- injury.
Severe diarrhoea
This may be intermittent or constant depending upon the cause. It may be due to:- infection – the most common cause, e.g. gastroenteritis
- side-effects of some medication, such as antibiotics
- irritable bowel syndrome
- diverticulitis
- some specific (and relatively uncommon) diseases, such as ulcerative colitis or Crohn's disease, or
- previous radiotherapy.
Disorders of the nervous system
Bowel incontinence can sometimes be the result of disease or injury to the nerves leading to:- a lack of sensation so that you do not feel the need to empty your bowel, or
- loss of nerve input to keep the sphincter muscles contracted and so keep the anus closed.
Disorders of the lower bowel
Bowel incontinence can also occur as a result of the following disorders of the lower bowel:- cancer
- anal fissure/fistula, or
- haemorrhoids.
Ask for help
You are not alone. Incontinence can be cured or managed better if treated.Who can help?
- your doctor
- National Continence Helpline 1800 33 00 66 (the Helpline can arrange phone interpreters)
- The Australian Government's Bladder and Bowel Health website www.bladderbowel.gov.au