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Incontinence: Types, Causes, Management and More

by: Claire Nulla
September 29, 2023

Incontinence, also known as bladder or bowel leakage, is a condition affecting millions of individuals of all ages, genders, and backgrounds worldwide.

In this article, we’ll talk about the following:

  • Forms of incontinence
  • Causes of incontinence
  • Managing incontinence

What is incontinence?

Incontinence refers to the inability to control the passing of urine or feces, or both.

According to recent research studies, it’s experienced by 50% of people who:

  • Are over the age of 65
  • Have neurological conditions
  • Have given birth vaginally

Despite its high prevalence, incontinence remains an underdiagnosed and undertreated condition. It has a profound impact on a person’s well-being, affecting their social life, mental health, physical comfort, self-esteem, and relationships.

The burden of incontinence can lead to:

  • Isolation
  • Depression
  • Feelings of helplessness
  • Disruption of daily activities
  • Limited work opportunities
  • Strained finances

Aside from disrupting a person’s sense of independence and dignity, this condition also places a strain on caregivers and family members. It’s crucial for caregivers and healthcare professionals to provide comprehensive support and resources to address the physical and emotional challenges associated with incontinence.

Types of incontinence

Stress incontinence

Stress incontinence occurs as a result of weakened pelvic floor muscles, which support the bladder, urethra, uterus and rectum. It happens when there’s involuntary leakage of urine during physical activities that put pressure on the bladder, such as:

  • Coughing
  • Sneezing
  • Laughing
  • Exercising

Urge incontinence

This happens when there’s an overwhelming and sudden urge to urinate, resulting in involuntary urine leakage.

Also known as overactive bladder, urge incontinence is caused by involuntary bladder contractions that push urine out of the bladder. It can become more common with age, and can worsen with conditions such as Parkinson’s disease, multiple sclerosis and diabetes.

Overflow incontinence

This type of incontinence occurs when the bladder doesn’t completely drain during urination, fills up again soon after, then leaks.

Symptoms of overflow incontinence include:

  • Dribbling urine
  • Feeling like the bladder isn’t emptying completely
  • Frequent urinary tract infections (UTI)

Mixed incontinence

True to its name, mixed incontinence is characterized by a combination of symptoms from both stress and urge incontinence.

Experiencing mixed incontinence may look like this:

  • Involuntarily peeing when you cough, sneeze, laugh, or engage in physical activity
  • Having a sudden urge to pee that leads to involuntary urine leakage

Functional incontinence

Functional incontinence happens when a physical or cognitive barrier hinders you from reaching the bathroom on time. This type of incontinence is particularly common among elderly individuals and those with disabilities.

Causes of Incontinence

Here are the most common reasons that lead to the development of incontinence:

  • Weak urinary muscle due to aging or childbirth
  • Urinary tract infections (UTI)
  • Constipation
  • Neurological disorders
  • Diabetes
  • Obstructions to the bladder neck, urethra, or prostate in men
  • Pelvic organ prolapse in women
  • Mobility or dexterity issues
  • Cognitive impairments
  • Medication side effects
  • Age-related health conditions: Parkinson’s disease, dementia and stroke

Incontinence care

Assessing incontinence is the first step in developing a care plan for people experiencing this condition.

The process goes like this:

  1. Evaluate the type, severity and underlying causes of the incontinence.
  2. Identify possible contributing factors, such as medications and medical conditions, by going through the patient’s medical history.
  3. Conduct a physical and neurological examination.
  4. Conduct laboratory tests to identify urinary tract infections or other underlying medical conditions.

An accurate and comprehensive assessment helps to identify areas to focus on and develop a management plan that is tailored to the patient’s needs.

Management of incontinence

Managing incontinence requires is a multi-faceted approach for personalized care, which may include the following:

  • Behavioral therapy: This improves bladder control through increased awareness of the bladder’s signaling and strengthening the pelvic floor muscles. Examples include pelvic floor muscle exercises, bladder training and biofeedback.
  • Medication: Antimuscarinics inhibit bladder contractions, beta-3 agonists relax the bladder muscle and alpha-adrenergic agonists increase the bladder sphincter’s tone.
  • Surgery: This is reserved for severe cases and is used to create a sling around the urethra to support the bladder neck and reduce urine leakage.
  • Preventive skin care: Keep the skin as dry as possible, frequently change incontinence underwear or pads, and ensure that the skin is clean and dry after each toileting.
  • Skin care for treatment: Use skin barrier creams and ointments to protect the skin and promote healing, along with regular cleaning and moisturizing.
  • Toileting assistance:
    • Use assistive devices such as bedside commodes, raised toilet seats and grab bars.
    • Create a toileting schedule and practice prompted voiding.
    • Catheterization may be necessary for patients with certain medical conditions that impede normal urination.

Related questions

What is incontinence care?

Incontinence care refers to the care required to manage people who suffer from involuntary loss of bladder or bowel control. It encompasses a range of interventions to manage the condition and minimize its effects.

What causes incontinence?

Several factors can cause incontinence, such as urinary tract infections, prostate gland problems, weak pelvic floor muscles, nerve damage and certain medications. Age, gender, and underlying medical conditions can also play a role.

What are some strategies for managing incontinence?

Several strategies can help manage incontinence, such as bladder retraining, pelvic floor strengthening exercises, scheduled toileting and medication.

Lifestyle modifications, such as reducing fluid intake, quitting smoking and losing weight, can also help.

What is toileting assistance?

Toileting assistance involves helping those with mobility limitations or cognitive impairments carry out toileting activities. This type of assistance can include help with getting to the toilet, transferring on and off the toilet and wiping.

Who needs toileting assistance?

People who have mobility limitations, cognitive impairments or chronic conditions that affect bladder or bowel function may require toileting assistance. This can include seniors, individuals with disabilities and people recovering from surgeries or illnesses.

What are some devices that can assist with toileting?

Several devices can assist with toileting, such as toilet frames, raised toilet seats, bedpans, commodes, and urinary collection devices. These devices can make it easier for individuals with mobility limitations to perform toileting activities safely and comfortably.

The bottom line

Learning how to manage incontinence and toileting assistance is extremely helpful for people with disabilities and older adults, as incontinence can have significant physical, psychological and social impacts.

Currently, you can use various interventions for incontinence care, including routine toileting, medication management, pelvic floor exercises and behavioral therapy. These strategies aim to manage, alleviate or prevent incontinence, while addressing the challenges associated with the condition.