Everything you wanted to know about incontinence

Incontinence is a condition that can cause considerable embarrassment and discomfort. This often prevents many of its sufferers from seeking help

Steroplast wanted to provide information and support to incontinence sufferers. It can be comforting to learn that others are going through the same challenges you are. To understand what others with this condition are contending with. Then hopefully banishing the taboo so that the condition can be discussed openly.

Incontinence is a condition that can affect anybody. Even Hollywood star Kate Winslet has admitted that she is an incontinence sufferer. There is so much information and options available to incontinence sufferers. If you are already on your way to managing your incontinence or if you still need more encouragement, this blog should provide you with some useful help and advice on how things can be better.

Firstly, what exactly is it?

Incontinence is the term given to an involuntary or accidental passing of urine from the bladder (urinary incontinence) or a bowel motion, wind, faeces from the bowel (faecal or bowel incontinence). The condition is so widespread, that it ranges in severity from small leaks to complete loss of bladder/bowel control.

Many sufferers simply put up with the symptoms for years. Feeling uncomfortable in admitting their problem or see the problem as a natural sign of age. However, this is not the case, with professional help, incontinence and bladder control problems can be treated and managed, and in many cases - cured.

Due to the taboo surrounding this problem, many people hide their ailment, so it's not seen as a common problem. However, this is far from the truth, incontinence is actually a surprisingly common issue. The Bladder and Bowel Foundation (B&BF) estimate that 1 in 4 people will incur bladder control problems at some time, and 1 in 10 will have bowel control problems. This actually equates to more people suffering from incontinence than asthma, diabetes and epilepsy combined! So sufferers, you are definitely not on your own;

• The World Health Organisation stated that bladder problems affect over 200 million people worldwide.
• The NHS have estimated 3-6 million people within the UK have some degree of urinary incontinence.
• Half of the female population will, at some time in their lives, experience urinary incontinence.
• Sadly, only 1 in 5 women affected will seek help for incontinence issues.

Are all urinary incontinence problems the same?

Urinary incontinence is so widespread that not everyone suffering from it have the same issues. As such the problem is divided into the following different types:

Stress Incontinence

This name confuses people, this type of incontinence does not have anything to do with stress. It is actually caused by pressure upon the bladder which can be due to many things. Sneezing, pregnancy, an individual's weight, heavy lifting, exercise and other medical conditions can cause it.

Overactive bladder / Urge Incontinence

Occurring when an individual's urge to urinate is so strong that they struggle to reach a toilet in time. Urge incontinence is usually a result of a medical condition. Or an injury to the muscles and nerves which are help to control the flow of urine.

Functional Incontinence

Mostly affecting elderly individuals suffering from a physical or mental disease (such as Arthritis or Alzheimer's). This then prevents them from getting to a toilet in due time.

Overflow Incontinence

This affects individuals who have difficulty emptying their urinary bladder, overflow incontinence is most common in males.

Bedwetting

Most apparent with children and in most cases is simply the result of immaturity of the urinary bladder. As you probably know, this is a normal occurrence with younger children. It can also be an occasional accident by an older child is absolutely no cause for concern either. If bedwetting is persistent please visit the doctors as in rare cases it is a sign of a medical condition.

Mixed Incontinence

As you can imagine, this is a mixture of two of the types of incontinence occurring simultaneously. Most often an overactive bladder and stress incontinence. This will typically affect the female population.

Total Incontinence

This, as it sounds, is the most severe type of incontinence. It is a total loss of control over the urinary bladder which results in a constant urine leakage.

Deducing the type of incontinence an individual is suffering from is very important. It must be established in order to be treated properly and effectively. The treatment is catered to the underlying cause which can only be identified once the type of incontinence has been diagnosed.

Male Incontinence

It is well known that men are less at risk of incontinence than women. However over time they are at risk of developing problems with their prostate. The prostate is a ringed organ that wraps around the urethra, at the base of the bladder. The prostate glands function is to produce a lubricant which assists the passage of sperm from the testes to the urethra during intercourse.

Enlargement of the prostate is very common in older men. As the gland enlarges it then puts pressure on the urethra, resulting in male incontinence. The symptoms include; urgency, hesitancy, frequency and straining. This usually results in visits to the toilet in the night, but also difficulty starting the flow, poor flow and dribble after finishing. In rare occasions, cancer of the prostate gland can develop. This makes it crucial that men with these symptoms seek help. Prostate disease can be successfully treated with medication or surgery.

Female Incontinence

Women being more susceptible to incontinence than men is due to the nature of the female anatomy, the female urethra is much shorter than the male. Statistically women are 5 times more likely to develop urinary incontinence than men.

The effects of pregnancy and childbirth as you can imagine are a common cause of urinary incontinence in women. Giving birth to large babies, birthing more than 4 children or a difficult delivery puts an individual more at risk. This is due to the pelvic floor muscles and ligaments becoming weakened. Pregnancy/childbirth can also damage nerves resulting in bladder symptoms or incontinence.

What's a pelvic floor?

We have spoken about weakening of the pelvic floor muscles resulting in incontinence, but what exactly is the pelvic floor? The pelvic floor is the base of the muscle group, fans of Yoga or Pilates refer to as your 'core'. This group of muscles are located in your pelvis, and they stretch from your pubic bone to your tailbone. These muscles work along with your deep abdominal and back muscles/diaphragm to stabilise and support your spine. They also help to control the pressure inside your abdomen to deal with the force when lifting or straining.

The pelvic floor muscles are also used to support the bowel, bladder and uterus for women, and the bowel and bladder for men, helping to maintain control.

If you have any symptoms, what should you do?

The answer is simple, go to your local GP and get some professional advice. Most sufferers who seek advice and treatment can be cured or their problem greatly improved. It's so important to get professional help for bladder issues or incontinence, you may feel embarrassed. Be assured your local health care professional is discreet and knows exactly what you are going through - and is there to help.

Your doctor will in most cases test your urine for abnormalities and give you a physical examination. If your doctor doesn't think you need referring to a hospital consultant, you can request to be referred for a continence assessment by a specialised nurse at a local service.

What to expect at the assessment?

A continence nurse is an experienced nurse with additional specialist training with assessing and management of bowel and bladder problems, so relax, you're in good hands! The first assessment you will have usually takes around 1 hour and should include:

• A chat about your medical history and the incontinence symptoms you're experiencing.
• Testing a specimen of your urine.
• A review of your "bladder diary" this will be requested of you pre-appointment (usually 3-5 days).
• Vaginal or rectal exam to allow assessment of pelvic floor muscle strength.
• An ultrasound of the bladder

The nurse will then use the findings to give helpful advice and to prescribe the right treatment. Hopefully improving or curing the problem, and arrange a second appointment to assess your progress. In some situations, it can be necessary for referrals to allow further tests/investigations.

If diagnosed with urinary incontinence, what are the treatments?

The actual treatment itself will depend on the type of incontinence you are suffering, its severity and the underlying cause. In many cases it can be treated, however if the underlying cause cannot be cured there are many ways to ease the symptoms and make the issue altogether less unpleasant.

If the cause of the individuals incontinence does not require medical treatment or surgery, then simple and less invasive treatments are suggested. Urinary incontinence not caused by a medical condition can often be managed with these treatments:

Bladder Training

A bathroom diary should be created, noting the times you feel the urge to go, as well as when you experience leakage. Then create a schedule of visits (how often you should be visiting) using the times from your diary. Now visit the toilet at each scheduled time and try, whether you feel the urge or not, and gradually increase the time between breaks. Try to delay urination for around 5 minutes forcing your bladder to hold urine, then gradually increase this time, if possible up to 3-4 hours. When you can't hold it any longer, use the bathroom.

Lifestyle Changes

Many urinary incontinence issues are due to excessive consumption of caffeine or alcohol. In which cases, this will be improved or possibly cured completely if the individual reduces or eliminates their intake. Other lifestyle changes that can eliminate the issue can be avoiding lifting heavy objects, losing weight and regular exercise.

Pelvic Floor Exercises

Sometimes known as 'kegel exercises', these can help strengthen the pelvic floor muscles. Renowned as one of the most effective treatments for childbirth related leakage or stress incontinence. The exercise itself is a muscle exercise, using the muscles you use to stop urination, squeeze them for 3 seconds and then relax for 3 seconds. Add an additional second every week until you can squeeze for 10 second intervals, repeat the exercise 10-15 times each session. You should never do these exercise whilst urinating! It is always best to get advice on kegel exercises, as if done incorrectly they can have a negative effect.

Injections

Injection therapy uses bulking agents composed of synthetic materials to bulk up the tissue surrounding the urethra in order to seal and prevent any leakage.

Improved Toilet Techniques

When sitting at the toilet it is important to sit properly, your feet should be on the floor or supported. Give yourself ample time to fully empty the bladder. 'Double voiding' can help to better empty the bladder. After your first urination, get up and walk around the bathroom (obviously not a long one). Then return to the toilet, this will most likely result in a second urination.

Electrical Stimulation

This is a treatment usually given to women that are not responding to other treatments, and don't worry it isn't as scary as it sounds. The treatment involves using an electric current to strengthen the bladder nerves and pelvic muscles.

Medical Devices

A therapeutic pessary is a device (similar to the outer ring of a diaphragm). It is used for women with stress incontinence due to a prolapsed uterus or bladder. The pessary is then used to support the bladder and prevent the incontinence.

Medication

The type of medication prescribed by your doctor will obviously depend on the type of incontinence and its severity. There are many types that are used to ease or treat the symptoms a patient is incurring.

Surgery

This is obviously the most serious option which is reserved for individuals with severe incontinence issues that have no response to other treatments. The surgery itself will fix the problem responsible for the leakage. It is not however, guaranteed to completely eliminate the incontinence.

Absorbent Pads and Catheters

When possible treatments have been tried, but the incontinence cannot be cured, patients are offered absorbent pads or catheters dependent on the severity of the leakage. The pads will be used for the smaller issues to soak up any leaks. Catheters are for the more severe issues, they will drain the urine from the urinary bladder and store for disposal.

Incontinence Sheets

Incontinence sheets offer the convenience of disposable continence care. Absorbent bed pads provide an economical and low cost alternative to control issues during the night.

What about faecal incontinence?

The first step for sufferers with faecal incontinence is to make changes to their lifestyle and diet; to increase your fluid intake and introduce more high in fibre options into your diet. This will eliminate the issue of faecal leakage due to haemorrhoids and constipation. If you suffer from chronic constipation, stool softeners or laxatives can be prescribed. Alternatively loose stools sufferers can be given medication to help firm.

If there are weakened muscles or loss of sensation, then you will benefit from bowel training. This will involve exercises to strengthen the weakened muscles within the rectum. The exercises are usually combined with scheduled toilet visits to create a routine, which may help stop leakage.

As with urinary incontinence, surgery will be the last treatment option. This is only an option for the most severe of cases. Those which are showing no response to the other treatments.

Please don't suffer in silence

There you go, we really hope this has helped to put some of your minds at rest. Or at least pointed you in the right direction to find treatment or the cure that you need.

Please share this blog (with friends, family, online, or however you can) as our aim is to get this message out there. Incontinence sufferers are not alone, it is a very common issue that with help can be solved - the individuals just need pointing in the right direction.