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Incontinence: Causes & Treatments
Published: 24th September, 2021 in: Health
Incontinence is a condition that can be extremely distressing. It can affect anyone, but is more common in older adults. It is thought to affect millions of people and can occur for a variety of reasons.
Find out what causes incontinence and information on different types of treatment.
What is Incontinence?
Incontinence is the unintentional passing of urine or faeces. Incontinence can be either permanent or temporary and there are two distinct types. The two main types of incontinence are urinary incontinence and bowel incontinence.
Urinary incontinence is a relatively common issue. There are several different types of urinary incontinence. These include:
- Stress Incontinence - this occurs when the bladder is under pressure. Urine may leak when you cough or laugh for example
- Urge Incontinence - this is when leakage occurs when you feel a sudden and intense urge to wee, or shortly after
- Overflow Incontinence - also known as chronic urinary retention, this is when you are unable to empty your bladder fully, resulting in leakage
- Total Incontinence - when the bladder is unable to store any urine, this is known as total incontinence. This results in constant or very frequent leaking.
Bowel incontinence is a serious medical condition. If you are suffering from either urinary or bowel incontinence, you should speak to a medical professional who is able to talk you through treatment options.
The symptoms of bowel incontinence to look out for include:
- The sudden and uncontrollable urge to poo
- Soiling yourself without realising you needed to use the toilet
- Leaking poo, when you pass wind for example
- When bowel incontinence occurs frequently (a one-off accident when you are suffering from diarrhoea is not usually a sign of incontinence)
- When bowel incontinence begins to affect your daily life, for example if it stops you from leaving the house or socialising for fear of incontinence.
What Causes Incontinence?
There is no one direct cause of incontinence; it will depend on the type of incontinence you have. There are many different potential factors that range from medical issues to lifestyle issues.
Find out what some of the most common causes for incontinence are below.
Urinary Incontinence Causes
Stress incontinence is one of the most common types. It usually occurs as a result of the weakening of, or damage to, muscles that prevent urination. This includes the pelvic floor muscles and the urethral sphincter. Urine leaks when the pressure of the bladder outweighs the ability of the urethra to stay closed.
The most common causes of this are:
- Damage to the surrounding muscles due to childbirth
- Damage to the surrounding muscles due to surgeries such as a hysterectomy
- Increased pressure on the tummy due to obesity or pregnancy
- Medication side effects
- Connective tissue disorders such as Ehlers-Danlos syndrome
- Neurological conditions such as Parkinson’s disease or multiple sclerosis
Urge incontinence, on the other hand, is a result of the overactivity of muscles that control the bladder. These muscles are known as the detrusor muscles. They usually contract to allow the bladder to fill with urine and relax to allow urine to be released. For those with urge incontinence, the muscles contract too often, resulting in the urge to go to the toilet. This is also commonly known as having an overactive bladder.
The main causes of this include:
- Not drinking enough fluids - this can result in concentrated urine that irritates the bladder and cause urge incontinence symptoms
- Drinking too much caffeine or alcohol
- Medication side effects
- Conditions affecting the urethra or bladder such as UTIs or tumours in the bladder
- Neurological conditions
Overflow incontinence is when the bladder is prevented from emptying fully. This is usually caused by some kind of obstruction or blockage in the bladder. Blockages could be caused by:
- An enlarged prostate (if you are male)
- Bladder stones
Pressure from the leftover urine in the bladder will then build up resulting in frequent leaks.
Overflow incontinence may also occur if the detrusor muscles do not fully contract. This means that the bladder will not empty fully and can become stretched. They may not contract fully if:
- You have nerve damage as result of surgery or a spinal cord injury, for example
- Medication side effects
Finally, total incontinence causes large amounts of urine to be passed constantly or occasional urine to be passed with frequent leaks in between. The most common causes of this are:
- Issues with the bladder from birth
- Spinal cord injuries that can disrupt the nerve signals between your brain and bladder
- A bladder fistula - this is a small, tunnel-like hole that forms between the bladder and a nearby area such as the vagina
The chances of developing urinary incontinence are increased by:
- Old age
- Pregnancy and vaginal birth
- A family history of incontinence
Certain medications can also increase the chances of urinary incontinence. The medications most related to this are:
- ACE inhibitors
- Certain antidepressants
- Hormone Replacement Therapy (HRT)
Never stop taking medication, speak to your doctor before changing your medication or if you have any concerns. They can advise on the best course of treatment to manage side effects such as incontinence if stopping medication is not an option.
Bowel Incontinence Causes
Bowel incontinence is most commonly caused by a combination of factors. It may occur as a result of:
- Severe constipation or diarrhoea
- Irritable Bowel Syndrome (IBS) - find out more about IBS
- Inflammatory bowel diseases such as Crohn’s disease
- Severe haemorrhoids or piles
- Damage to the surrounding muscles and/or nerves, due to childbirth or surgery
- Conditions that can affect the nerves in the bottom including diabetes, a stroke or spina bifida
You should always visit a doctor if you are suffering from either urinary or bowel incontinence. They will be able to diagnose the underlying cause and detail the best course of treatment to help cure or manage your condition.
How to Treat Incontinence?
The best course of treatment to manage your incontinence will depend on the underlying factors. This is why you should always visit a doctor to have incontinence properly diagnosed and get the best form of treatment for you. They will ask relevant questions and may perform certain tests or physical examinations.
They may also ask you to keep an incontinence diary that details the amount of fluid you drink, the frequency of incontinence episodes etc.
Once the type of incontinence you are suffering from has been diagnosed, your doctor will discuss possible treatment options with you. In some cases, incontinence can be cured completely however, in others it will be a case of managing the issue to improve quality of life.
Incontinence products are not a treatment for incontinence. Instead, they are used to help manage symptoms and give people confidence during their daily activities.
Incontinence products include:
Pads and pants - absorbent pads and pants are worn to soak up any urine to help you feel comfortable and confident. They contain a hydrophobic layer, drawing the urine away from the skin so it stays dry and does not become irritated.
Hartmann services are offered across the globe, providing solutions for wound care, incontinence, disinfection, and surgical efficiency. The Hartmann brand is renowned for their professional expertise and drive to improve healthcare. As part of their services, they have been producing incontinence products for 50 years and also provide the Molicare product range which focuses on quality.
Molicare pads were commonly used by the NHS for incontinence treatment and by healthcare professionals for years. to help manage symptoms, helping people continue their quality of daily life. They offer absorbent, incontinence pads for men and incontinence pads for women. Molicare premium elastic slips also come in a range of sizes for those with more severe incontinence. They are slimline and breathable to make them discrete and comfortable to wear. They also contain a wetness indicator to tell you when it’s time to change.
Tena also provides a variety of products designed for those with incontinence. From discrete pull up pants, made from a cotton like material for ultimate comfort and protection to absorbent pads for night time protection. They also offer pads for men, designed to fit the male anatomy, to help offer protection to those with light bladder weakness.
Skincare and hygiene products - if you suffer from incontinence, hygiene may be a concern of yours. Tena also offer hygiene products such as the TENA ProSkin No Rinse Wash Cream and TENA ProSkin Wet Wipes. They help you to feel clean and hygienic when changing incontinence products, whilst also working to protect and nourish the skin.
Bed and chair protection - you can purchase washable, waterproof covers to help protect your furniture such as beds, chairs and mattresses.
Adapted clothing and swimwear - adapted clothing can help you to feel confident when out and about. This includes loose fitting, easy to remove clothing to make going to the toilet easier, as well as absorbent underwear and clothes able to withstand frequent washing.
Foam plugs (bowel incontinence) - foam plugs are inserted into the bottom to prevent leaks.
If you are suffering from incontinence, make sure to contact your GP to find what type of incontinence you have, as well as the best treatment to manage your symptoms.
Urinary Incontinence Treatment
If incontinence is caused by an underlying medical condition, treatment will be given for this alongside incontinence treatment. Doctor’s will always recommend conservative treatments for incontinence are tried first. These are treatments that do not involve medication or surgery.
These treatments include:
- Lifestyle changes - A doctor may suggest a person to lose weight if they are classified as overweight or obese, as this can put extra pressure on the bladder resulting in incontinence. They may also recommend dietary changes, such as reducing caffeine and alcohol intake, and a change to the amount of fluid drunk each day. Drinking too much or too little can make incontinence worse.
- Pelvic floor muscle exercises - if the pelvic floor is weak or damaged, urinary incontinence is much more common. A GP will assess if an individual is able to contract their pelvic floor muscles at all. If they can, they will then provide a pelvic floor exercise regime based on this. Generally, these exercises are recommended to be performed at least 8 pelvic floor muscle contractions at least 3 times per day, for a minimum of 3 months. If this improves the condition, a person may want to continue with pelvic floor exercises. Biofeedback may also be recommended to determine how well an individual can perform pelvic floor exercises. A probe will be inserted in the vagina or electrodes may be attached to the tummy to determine when the muscles are squeezed, offering feedback via a computer screen. This can help to make sure a person is performing exercises in a way that is most likely to help with urinary incontinence.
- Electrical stimulation - if someone is unable to contract pelvic floor muscles at all, electrical stimulation may be recommended. This is where an electrical probe is placed into the vagina, or into the anus if you are male. An electrical current will run through it, helping to strengthen the pelvic floor muscles. This may be uncomfortable or unpleasant however, it is a good way to train the pelvic floor muscles if someone is unable to contract them on their own.
- Vaginal cones - For people with a vagina, the doctor may recommend vaginal cones. These are small weights placed inside the vagina that hold in place using the pelvic floor muscles. The weight will be steadily increased in order to strengthen the muscles. They are known to help with stress incontinence or mixed incontinence however, some women do find them uncomfortable to use.
- Bladder training - this is often used alongside pelvic floor training. It is used for those with urge incontinence with the aim of increasing the length of time between feeling the urge to urinate and passing urine. Bladder training usually lasts for around 6 weeks.
If conservative treatments are not successful, a doctor may then suggest medication or surgery to help manage the condition.
Different types of incontinence will require different medications. Medication is most commonly used to treat urge and stress incontinence. A GP is able to determine whether medication is the best treatment for incontinence, and which type of medicine is suitable.
For stress incontinence, surgery is often used. For people who are not suitable for surgery, medications may be prescribed by a doctor to help relieve symptoms. This includes types of antidepressants that can sometimes help to improve the muscle tone of the urethra. Antidepressants are prescription only medicines and are not suitable for everyone, to find out the right treatment for incontinence - speak to a GP.
For urge incontinence, there are a few different medications that may be used during treatment:
- A GP may prescribe a medicine if bladder training is not effective or someone has an overactive bladder.
- A GP may prescribe a medicine that helps the muscles in the bladder to relax, to allow the bladder to fill up and store urine.
If non-surgical treatments are not successful, surgery may be recommended. A doctor will discuss all the risks and benefits of surgical procedures prior to treatment and set out any possible alternative treatment options.
They may also recommend that if someone is pregnant or planning to have children, that surgery is postponed until after. This is because pregnancy and childbirth can cause surgical treatments to fail.
Types of Surgical Treatments for Urinary Incontinence
Colposuspension - this involves the neck of the bladder being lifted and sewn into position, and is a common treatment option for females suffering from stress incontinence.
There are two types of colposuspension: open colposuspension and laparoscopic colposuspension. An open colposuspension involves a large cut being made in the tummy whereas a laparoscopic colposuspension is performed through one or more small cuts using small surgical instruments. This is known as keyhole surgery and must be performed by a special laparoscopic surgeon.
A colposuspension may also result in difficulty emptying the bladder fully, frequent UTIs, and discomfort during sex. A doctor should discuss all possible side effects before referring someone for surgical treatment.
Sling surgery - if the person has a vagina, sling surgery involves a cut being made in the tummy and in the vagina so that a sling can be placed around the neck of the bladder to prevent leaks. For those who have a penis, the cut will be made between the scrotum and the anus, and a sling placed around the urethral bulb.
Autologous slings are commonly used. This is tissue taken from another part of the body (usually the layer of tissue that covers the abdominal muscles). Allograft (tissue donated from another person) and xenograft slings (tissue from an animal such as a cow or pig) can also be used but autologous slings are preferred as more is known about the long term safety and effectiveness.
Sling surgery can result in difficulty fully emptying the bladder, and in rare cases can cause people to develop urge incontinence.
Vaginal mesh surgery - this is not usually available on the NHS unless there is no alternative and waiting is not an option. It involves a strip of synthetic mesh being placed behind the urethra in order to support it.
It is usually used for stress incontinence and can result in serious complications in rare cases. Vaginal mesh surgery should never be taken lightly. Complications linked to vaginal mesh surgery include pain, nerve damage, incontinence, constipation, organ damage and sexual problems.
Urethral bulking agents - this is a substance that is injected into either the walls of the urethra for those who have a vagina. It increases the wall size, allowing the urethra to stay closed. This is a treatment usually used for those suffering from stress incontinence and is less invasive than other procedures.
Urethral bulking is thought to be less effective than other treatments however, and must be topped up over time. It could also result in a burning sensation or blood when passing urine for a short time after the procedure.
Artificial urinary sphincter - this is more often used for those suffering from stress incontinence, who have a penis. An artificial sphincter is made up of 3 parts, the cuff, the pump and the reservoir.
The cuff is placed around the urethra and can be filled with fluid to compress the urethra and prevent urine from passing through it. The pump will be placed in the scrotum and contains a mechanism to control the flow of liquid to the cuff. Finally, the reservoir will be placed in the tummy from which fluid will flow to the cuff when the device is activated.
Artificial urinary sphincters often stop working after a certain period of time so it’s important to note that further surgery may be required to remove the device. It can also result in short-term bleeding or a burning sensation whilst weeing.
For urge incontinence, the surgical procedures differ slightly. This is because the underlying cause is different. The most common surgical treatments for urge incontinence are:
Sacral nerve stimulation - the sacral nerves carry signals from the brain to the detrusor muscles when someone goes to the toilet. If the detrusor muscles contract too often, a doctor may recommend this course of treatment. The sacral nerves are positioned at the lower back. A device will be inserted near the sacral nerves which will carry an electrical current to improve the signal between the sacral nerves and the brain.
This can be an uncomfortable course of treatment, however it can improve symptoms substantially, or even cure incontinence completely.
Augmentation cystoplasty - this procedure involves making the bladder bigger by adding tissue from the intestine into the bladder wall.
It does however often mean that a catheter is required to pass urine after the procedure has been performed. It is therefore, only ever recommended for those who are willing to use a catheter. It can also result in frequent UTIs.
Urinary diversion - this is where tubes are connected to the bladder from your kidneys and redirected outside the body. The urine will be collected in a bag without entering the bladder.
This treatment should only be considered when all other treatment options have been exhausted. It can cause complications such as bladder infections that may require surgery to correct.
For overflow incontinence, there are 2 main courses of surgical treatment that can be considered.
- Clean intermittent catheterisation (CIC) - this procedure empties the bladder at regular intervals to reduce the risk of overflow. The person will be required to use a catheter and will be advised on how to do this and how often. In some cases this may be once a day and in others, several times a day.
- Indwelling catheterisation - in some cases, CIC is not enough to relieve symptoms of urge incontinence. Indwelling catheterisation may be required. This works on the same premise but the catheter will be permanently inserted with a bag attached to the end to collect urine.
Bowel Incontinence Treatment
There are a number of different treatment options for bowel incontinence. The best course of treatment for you will depend on the underlying condition. Your doctor will talk through all treatment options with you to decide which method is best.
- Diet and lifestyle changes - if bowel incontinence is thought to be related to constipation then your doctor may recommend eating high fibre foods and drinking more water. If it is related to diarrhoea, your doctor may recommend cutting down on high fibre foods, avoiding alcohol and drinks with caffeine and avoiding any products that contain sorbitol (a sweetener).
- Medication - medications to relieve constipation or diarrhoea may also be able to help with incontinence if this is the underlying cause. Some types of medicine can be bought over the counter at a pharmacy, however, always speak to your doctor before taking them as they are not always suitable for those suffering from bowel incontinence. A doctor may also prefer to prescribe a prescription only medicine in certain cases of incontinence.
- Pelvic floor exercises - this is the same treatment often recommended for urinary incontinence. It aims to strengthen the pelvic floor muscles that control the opening and closing of your bowels.
- Bowel retraining - this is a training programme that involves different things that can help you to control your bowel movement. You may be asked to make changes to your diet, create a regular routine for going to the toilet (for example, you may go to the toilet after each meal) and learn ways to help empty your bowels such as altering the way you sit on the toilet or having a hot drink.
Surgical Treatments for Bowel Incontinence
Surgery should not be taken lightly and is usually only recommended when other treatments for bowel incontinence are not successful.
Surgical treatments for bowel incontinence are carried out to help a person have better control over the muscles in their bottom. The most common surgical procedures for bowel incontinence are:
- Sphincteroplasty - this is an operation that looks to repair damaged muscles in the anus.
- Sacral nerve stimulation - also used for urinary incontinence, this is where an electrical device is placed under the skin to help the muscles and nerves in the anus work more effectively.
- Injectable bulking agents - this is where a substance such as silicone is injected into the muscles in the anus to help strengthen them.
- Colostomy - a colostomy will only be recommended in the most severe cases. This is where the bowel is diverted through a hole in the tummy and faeces are collected in an attached bag.
If you are suffering from incontinence, make sure to contact your GP to find the best course of treatment for you.