Urinary & Faecal Incontinence

Things you should know about Urinary Incontinence

Incontinence   can   be   treated!   –  Incontinence   is   not   an   automatic   part   of   aging. Incontinence is not a disease.  It is maybe a symptom of other problems such as weakened pelvic muscles, neurological disease, injury, impaired mobility, constipation and dehydration.

Incontinence can also occur as a side effect of surgery and medication. Incontinence may result from some of the diseases and impairments that come with increasing age.

Temporary causes of incontinence (DIAPPERS)

• Delirium, in this case incontinence is caused by a confusional state
• Infection, of the bladder, which is easily treated.
• Atrophic urethritis or vaganitis due to a shortage of a hormone called oestrogen
• Pharmacological, many medications can cause or aggravate incontinence
• Psychological, especially depression can contribute to incontinence
• Endocrine, a high calcium or blood sugar(Diabetes) can cause incontinence
• Restricted mobility can cause a patient not to reach the toilet in time
• Stool impaction can cause an over active bladder or overflow incontinence
  

  

Other causes of incontinence

• Over active bladder
• Changes in the body after childbirth
• Surgery
• Pelvic trauma in any type of accident
• Weakened pelvic floor muscles
• Obesity
• Nerve damage to the bladder
• Side effects of medication

These conditions are all treatable.

Speak to your doctor about your condition and the possibility of prescribing other medication to treat other conditions

Symptoms of Urinary Incontinence

The main symptom of urinary incontinence is leakage of urine. This leakage can be frequent and heavy, or it can be small and rather rare. Some other common symptoms include:

• A strong desire to urinate, whether or not the bladder is full, often occurring together with pelvic discomfort or pressure
• Urinating more than once in a two-hour period or more than seven times a day
• The need to get up and urinate at least twice during sleep
• Painful urination
• Bed-wetting or urinating while sleeping
• Leaking when coughing, sneezing or laughing

Types of Urinary Incontinence

Stress incontinence

This is when a person leaks urine with coughing, laughing, sneezing, lifting and exercise or any body movement which puts pressure on the bladder.    This is due to weakness of the support structures of the bladder and weakness of the pelvic floor muscles. In other words, we are unable to use our muscles correctly or sufficiently. This is often caused by pelvic fractures, radical prostatectomy, or bladder neck surgery that can also damage the sphincter muscle and cause stress incontinence. A problem that commonly affects women, stress incontinence may occur after childbirth or menopause.

Urge incontinence now referred to as over active bladder

With urge incontinence, involuntary bladder contractions cause leakage before the toilet can be reached.  People complain of an urgent desire to void frequently, often at night as well. Medication, caffeine intake, constipation, bladder infections, spinal cord injuries, diseases like multiple sclerosis and Parkinson’s disease can cause this condition and often no specific cause is found.

Mixed Incontinence

The presenting complaint is a mixture of stress and urge symptoms, both symptoms should be treated individually. Symptoms of one type of incontinence may be more severe than the other. Treatment may be a combination of the treatments listed for either urge or stress incontinence and will depend on which symptoms are more bothersome to the patient.

Overflow incontinence

In this condition the bladder overfills and does not empty properly, causing symptoms of continuous leaking, frequent infections, burning sensation when emptying the bladder, dribbling, urgency and the need to empty the bladder at night.  An enlarged prostate, narrowing of the urethra, spinal cord injuries and other nervous system disorders, cause this condition.

Neurogenic bladder

This is often caused by birth defects, spinal cord injuries, and other neurological diseases. There is often continuous leakage of urine.

Post – micturition dribble

Men suffer from a slight loss of urine on walking away from the toilet. This is caused by accumulation of urine in the bulb of the urethra and is easily treated.

Enuresis (Bedwetting)

The presenting complaint is urine loss when asleep. The person needs to be evaluated and treated according to the underlying cause.

Chronic Retention of Urine

This type of incontinence refers to leakage that occurs when the quantity of urine produced exceeds the bladder’s holding capacity. It can result from diabetes, pelvic trauma, extensive pelvic surgery, pelvic organ prolapse in women, enlarged prostate in men, injuries to the spinalcord, shingles, MS, or polio.  If you would like additional information about the conditions that may cause chronic retention of urine, please review our detailed sections on prolapse, enlarged prostate, and neurological disorders.

Incontinence due to Surgery

Incontinence due to surgery is a transient condition that follows such operations as hysterectomies, caesarean sections, prostatectomies, lower intestinal surgery, or rectal surgery. This is not considered a diagnostic category.

Giggle incontinence

The muscles of the pelvic floor (including those controlling the anus and urinary sphincters) can become weakened due to:

• Stretching during delivery
• Pelvic trauma

Other Factors

Incontinence can also occur due to other reversible factors, often outside of the urinary tract, such as restricted mobility. Mobility aids can help remove barriers to self-toileting on a timely basis. Other factors such as arthritis, may interfere with managing zippers, buttons, and articles of clothing – or moving quickly enough to reach the toilet.

Treatment

Treatment is individualized for each patient depending on diagnosis:

• Pharmacotherapy
• Urotherapy
  • BioFeedback – sEMG Studies
  • Neurofeedback
  • Nerve/muscle stimulation (NMS)
  • Behaviour therapy
    • Pelvic floor posture synergy
    • Pelvic floor rehabilitation
    • Biofeedback
    • Bladder therapy
    • Diet modifications
    • Fluid management
    • Heart rate variability (HRV)

Faecal Incontinence

Faecal incontinence is the impaired ability to control gas or stool, thus loss of bowel motion. Severe faecal incontinence occurs when the patient is incontinent to solid or liquid stool at least once a week.

Causes of Faecal Incontinence

There are 4 major categories:

• Altered stool consistency – diarrheal states e.g.  Irritable bowel syndrome, Inflammatory bowel disease, Infectious diarrhoea
• Inadequate reservoir capacity or compliance e.g.  Absent rectal reservoir,  Rectal ischemia,   Collagen vascular disease
• Inadequate rectal sensation eg Neurological conditions, Cerebral vascular accidents (stroke), Multiple sclerosis, Spinal cord injuries
• Abnormal sphincter mechanism e.g. Trauma from obstetric injury, Complications of anorectal surgery, Pelvic floor denervation, Chronic straining at stool.

Important Facts about Faecal Incontinence

The most important fact in the management of incontinence is to make the correct diagnosis. With the correct diagnosis the proper treatment can be implemented and the patient can be completely cured or his/her problem can be managed effectively. Incontinence is not part of ageing. It is a symptom of an underlying disease and should be treated accordingly.

Treatment of Faecal Incontinence

Treatment is individualized for each patient depending on diagnosis:

• Pharmacotherapy
• Urotherapy
  • BioFeedback (evaluation) sEMG
  • Neurofeedback
  • Nerve/muscle stimulation (NMS)
  • Behaviour therapy
    • Biofeedback rehabilitation
    • Pelvic floor posture synergy
    • Pelvic floor rehabilitation
    • Bladder therapy
    • Diet modifications
    • Fluid management
    • Heart rate variability (HRV)