Incontinence

What causes incontinence?

Control of urination and bowel function is complex because it involves both voluntary and involuntary nervous activity – holding or passing urine is controlled automatically by the brain and spinal cord but we can voluntarily override this control. Equally, although we can ‘hold things in’, under some circumstances the brain and spinal cord overrides our conscious mind, automatically emptying the bladder or bowel.

Incontinence is more common as we age because of the thinning and weakening of the pelvic muscles, ligaments and other tissues that normally keep the bladder and bowel closed. In addition, certain diseases that are more common with age affect the nerves and brain centres that control the function of the bladder and bowel.

Some types or causes of incontinence include :

• Stress incontinence. One in five women aged over 40 experiences this form of incontinence, which occurs because the bladder sphincters and pelvic floor muscles aren't strong enough to keep the bladder closed when there's increased pressure inside the abdomen. It often occurs when someone laughs, coughs, sneezes or exercises. Common contributory factors include trauma to the area during childbirth and changes during the menopause.
• Oversensitive bladder. If the bladder muscles go into an uncontrollable spasm, it may empty suddenly. This is also known as an overactive bladder or detrusor instability, causing urge incontinence. The cause isn’t well understood but things that irritate the bladder such as an infection or a stone, or problems with the nerves that control the bladder, can be to blame.
• Severe constipation. In some cases, faeces block the bowel but looser stools from higher in the intestines squeeze past the blockage, causing overflow diarrhoea.
• Congenital defect. You may have been born with a defective bladder or sphincter, which means you've always leaked or you start to leak once other factors, such as ageing, add to the problem.
• Infections. Kidney or urinary tract infections can disturb normal bladder control.
• Nerve damage. Urinary and faecal incontinence (and retention) can be caused by damage to the nervous system, such as spinal cord injury, or diseases such as multiple sclerosis.
• Severe constipation. In some cases, faeces block the bowel but looser stools from higher in the intestines squeeze past the blockage, causing overflow diarrhoea.
• Tumours. Anything which disturbs the anatomy of the rectum or anus can cause faecal incontinence, including severe haemorrhoids (piles), cancer or surgery.
• Illness and disease. Any illness that leaves a person weak or confused increases the risk of incontinence, either by disrupting the brain’s conscious control of when to pass urine or open their bowels, or because of reduced muscular tone and strength to hold the sphincters closed.

Who's affected by incontinence?

Incontinence affects up to 20 per cent of the older female population. One factor is declining oestrogen levels after the menopause.

Urinary incontinence is less common in men but still occurs, especially if the man has any sort of prostate disease or is frail and weak.

It's more frequent in people with reduced mobility and other medical problems, as they're less able to get to the toilet when necessary.

It's a common problem among people living in residential or nursing homes.

Incontinence is also common as dementia progresses, because the normal conscious voluntary control of bodily functions is lost.

What you can do?

If you leak a small amount of urine when you cough, laugh or move (or without any obvious trigger), it's worth talking to your doctor. Incontinence isn't an inevitable part of growing older and you don't have to accept it.

Faecal incontinence is even more abnormal and usually requires investigation.

How is incontinence treated?

Your GP will want to discuss the problem with you, perform an examination and arrange for further tests. He or she may also suggest self-help techniques you can try before resorting to medication.

• Retraining the bladder with regular trips to the toilet can help, especially when the bladder has been overstretched by 'holding on' or failing to empty it completely.
• Bowel retraining can help some forms of faecal incontinence. It's also important to make motions as formed and regular as possible, using dietary changes and medication as necessary.
• Exercises can help women to strengthen pelvic floor muscles that have been damaged or stretched during childbirth.
• Some women find it hard to become aware of, and so exercise, their pelvic floor muscles. There are a number of devices that doctors, incontinence nurses or physiotherapists can recommend which can help. These are put in the vagina where they either mechanically or electrically trigger the muscles to contract automatically. They are fairly simple to use, very discreet and have been shown to improve continence.
• It can be helpful to treat any problems that increase pressure on the bladder, such as constipation and fibroids. Losing excess weight may also help.
• Drugs are available to treat urinary incontinence, depending on the cause. Most improve the muscle tone of the bladder. These may have to be taken for at least several months.
• Surgery - a number of different operations may be done depending on the nature of the problem and the cause. For example, surgery may help to give extra internal support to the bladder or rectum, tighten sphincters or inject botulinum toxin (Botox) to reduce muscular spasms.

For most people urinary incontinence isn't a serious disease that will threaten life, but it can seriously disrupt quality of life, causing people to become embarrassed, withdrawn and isolated. With the appropriate treatment it may be cured or improved dramatically. There's no need for anyone to suffer in silence.

Faecal incontinence may reflect more serious disease but while it’s more difficult to treat there is plenty of help available.