Incontinence in Adults – A Comprehensive Guide
To lay it down very simply and efficiently for your incontinence is a lack of voluntary control over the excreting functions of your body. Incontinence is a word means a lack of self-restraint. So, incontinence in adults is your inability to control the urination or the bowel movements of your body. When you find that you are rushing to the toilet more and more often or are uncomfortable while peeling or passing motion then you could be having incontinence. Unfortunately, most of the cases of incontinence are not discussed by the patients. The society has accepted incontinence as a part of growing old an embarrassing part that needs to be silently dealt with. Indeed, there is nothing more awkward than losing control over your bodily functions but then again it is a medical condition and you should not feel any less of a person for having to go through it.
The Different Types of Incontinence Explained
Your body creates two types of waste, either liquid or solid. The liquid waste is expelled through the urethra as urine and the solid waste is expelled through the anal passage and referred to as stool or motion. The act of passing urine is called urination or peeing in more general terms and the act of excreting stool is simply called passing motion. Incontinence can be of two generic types:
Temporary: In the provisional situation incontinence affects your body due to certain temporary circumstances like urine incontinence that is commonly suffered by women during pregnancy. This type is short-lived and generally resolves by itself when the affecting circumstances change.
Permanent: It can also be a more serious lasting condition brought on due to some underlying medical problems like nerve damage or weakening of the pelvic floor muscles. The permanent type of incontinence in adults can only be resolved or managed effectively under medical supervision. You might have to undergo medical treatment to cure your incontinence or make certain lifestyle changes as advised by your medical practitioner.
Apart from the duration incontinence in adults is broadly classified into two types by the medical community:
Urinary Incontinence: This is a lack of control over the bladder function of the body. It can range from a few drops of urine leaking from a sneeze or laughter to an absolute lack of ability over urination causing you to completely wet yourself.
Bowel Incontinence: Lack of control over your bowel movements including both feces and wind is called bowel incontinence. Once again the intensity of incontinence can vary from just a smidgeon to completely soiling yourself. To put it simply you might pass stool at the wrong time or the wrong place.
Out of this urinary incontinence is more prevalent, widespread and talked about. To the extent that when you talk about incontinence in adults you automatically think of urinary incontinence. Bowel incontinence is less common and only 1 in every 20 reported cases of incontinence is bowel incontinence. Out of this urinary incontinence is further divided into several types based on the causes and symptoms. These are listed below:
Stress Incontinence: Contrary to its name stress incontinence has nothing to do with emotions except that the condition itself is emotionally distressing. Here the word stress refers to any physical strain that is exerted to the body which causes leakage in the body. If normal routine exertions like laughing, coughing, sneezing, and bending over that put pressure on your abdominal muscles cause involuntary urine leakage then its stress incontinence.
This happens because the pressure on the abdominal muscles automatically puts pressure on the bladder. When the pelvic floor muscles or the urethral lining are weak or damages this pressure causes the body to leak. Generally, the leakage is limited to a few drops but in extreme circumstances, if the bladder is too full capacity then it can be more. It is further subdivided into:
Intrinsic sphincter deficiency
Chronic cough and other lung conditions, pregnancy and age are the major contributing factors to stress incontinence.
Urge Incontinence: It is a form of overactive bladder or to be specific one of the results of overactive bladder (OAB). To define OAB is a set of symptoms experienced by a person. Most commonly these include:
A sudden strong involuntary urgency to urinate which you cannot suppress
Leakage of urine because of this urgency
Increased urine frequency
Nighttime waking to urinate
Of these the symptom where your urge to pee is so great that you cannot hold it even till the toilet and have leakage episode is called urge incontinence. This urgency is caused because the detrusor or the bladder muscles contract signaling the body with the urge to pee even though the bladder is not full yet. Because of this urge incontinence is also called “detrusor overactivity”. This is common to both men and women. Often the cause can be physical like nerve or spine damage or it could be medical like menopause, diabetes, urinary infections or Parkinson’s disease to name a few.
Mixed incontinence: An incontinence which is a combination of both overactive bladder and stress incontinence is called mixed incontinence. It will cause you to leak urine with or without an urge. Sometimes when there is physical exertion that puts pressure on the abdominal muscles and sometimes even without this exertion.
Overflow incontinence: When there is a blockage that hampers the body’s ability to fully empty the bladder it causes urine leakage even when you don’t feel the need to pee. This is called overflow incontinence. This happens because your bladder never fully empties which over time causes the bladder to become distended leaving an opening in the urethra from where the urine leaks.
It can affect both men and women but men are more prone to this type of incontinence because of prostate conditions. Other possible causes are nerve damage, bladder stones, scar tissues or a uterus prolapse in the case of women.
Functional incontinence: This is both a very general practical and specific type of incontinence in adults. It covers all the factors that prevent you from urinating when there is nothing physically wrong with the urinary tract or when the urinary tract by itself is functioning properly. The main types can be classified broadly under this:
Reflex incontinence: When the bladder muscles contract causing the urine to leak generally in large amounts it’s known as reflex incontinence. This leakage happens without warning or any urge to pee.
When your ability to recognize the need to pee gets hampered. In other words, you become unaware or maybe even unconcerned that you should go to the toilet and pee. The causes can be dementia, medications or mental illnesses.
When you want to go to the toilet but are physically restricted from doing so or find it physically difficult to get to a toilet on time or at all. The causes for this can be physical restrain, arthritis or being hospitalized.
Lastly, there can be a situation when you simply do not have access to a toilet maybe because it’s unavailable or too far from you.
Common to both men and women, reflex incontinence is caused because of serious neurological disorders like spinal cord damage, multiple sclerosis or never damage due to treatment or radiation.
The Causes of Incontinence in Adults
Incontinence both urine and bowel incontinence differ across the spectrum of age and sex. Your muscle control is defined by the age and sex group you fall into. As you carry on in years the body’s natural ability withers. The general changes that occur in the body through the years and become the causes of incontinence in adults are:
Overactive Bladder: Mayo Clinic describes this as a medical condition where you feel the urge or need to urinate or pee frequently. This sudden urge to pee often dominates your mind and starts to negatively affect your daily life. Over time this condition may lead to a loss of control over bladder movements and therefore incontinence.
Bladder Capacity Declines: As you grow older the bladder capacity of your body also reduces. The normal functions of a bladder include:
Bladder Contractility is Impaired: This can be both a physical and a neurological condition where:
Expulsion of urine at regular intervals
When the bladder capacity is compromised both these functions are also automatically compromised.
Detrusor muscles contract involuntarily
This form is also known as underactive bladder or the other bladder syndrome. In this, the body is unable to fully empty the bladder or takes a longer time than usual to empty it.
Residual volume: It becomes increasingly difficult to empty the bladder fully. This causes a post-void built up. The reasons for this are:
Psychological or neurological
Pelvic floor muscle inefficiency
Apart from these, there are other very general lifestyle factors as well which facilitate incontinence in adults.
Other general factors are listed below:
Chronic Cough: This causes a weakening of pelvic floor muscles and hence urine leakage over time.
Constipation: Constipation makes you exert undue pressure on the pelvic tissues leading to laxity over time. It is the prominent cause of bowel incontinence.
Obesity: Puts pressure on the muscles right over your bladder causing decreased bladder capacity.
Sphincter Strength Weakening: The sphincter muscles are the circular muscles that are responsible for maintaining the body pressure balance through the body passage to the orifice. This plays a major role in urinating properly.
Nerve Damage: Since all the muscles in your body are technically controlled by your central nervous system. Any damage to the nerves will compromise your ability to control the specific muscles involved in peeing.
Medical Conditions: Certain medical conditions come hand in hand with incontinence in adults like:
Some surprising lifestyle factors that also play their part in triggering incontinence are:
Drinking: Alcoholic beverages including wines and cocktails are a diuretic bladder stimulant. They cause both:
Increased urine production
The need or urge to go more often
Drinking to the point of losing consciousness can also result in bladder control loss.
Smoking: If you did not need yet another reason to quit smoking, here’s a new one for you. Smoking is a very prominent factor contributing to stress-related incontinence. The two ways in which smoking affects your ability to continence are:
It causes chronic cough which exerts tremendous pressure on the pelvic muscles over time causing incontinence.
It is a bladder irritant. The chemicals that you inhale while smoking cause the pelvic lining tissues to wither thereby aggravating the overactive bladder symptom.
Sedentary Lifestyle: The two ways in which your sedentary lifestyle might be increasing your risk of incontinence are:
Pelvic muscles: Exercising tones your muscles. Not just the obvious ones but also your pelvic muscles. Just sitting around the entire day will not only make your muscles lax but also reduce your ability to control them over time especially pelvic muscles and tissues paving the way for incontinence. So lace up and do those Kegels.
Obesity: Not exercising or not exercising enough will eventually lead to obesity. This, in turn, will cause a host of problems as explained above.
Gender-Specific Urinary Incontinence Factors
Apart from the general factors common to all adult populations, there are some gender-specific age changes and medical conditions that affect the body’s urination capabilities by making it more prone to certain disorders. Some of these factors about incontinence in adults are:
Pregnancy and Childbirth: The strain of giving birth naturally causes the pelvic ligaments, muscles, and tissues to weaken bringing on incontinence.
Apart from giving birth while carrying the baby itself that is during pregnancy many women suffer from incontinence because the enlarged belly presses onto their bladder undermining its capacity to hold urine. Also, pregnancy exerts a lot of pressure on the pelvic muscles which cause leakages due to involuntary contractions especially while bending over, laughing and sneezing.
Hysterectomy: It is defined as a surgery that removes a woman’s uterus. The surgery can damage the underlying tissues and muscles resulting in incontinence. Studies have revealed that women with hysterectomy were twice as likely to have incontinence as women who did not undergo this surgery. The main reasons for this are:
Pelvic floor muscle damage
Overactive bladder because of the surgery
A fistula that might have been created during the surgery
Menopause: Menopause brings with it a host of problems. One of them in the never-ending list is the problem of incontinence. The two major underlying medical conditions that women suffer from which facilitate the incontinence issue are:
Atrophic Urethritis: Postmenopause women suffer from decreased estrogen levels. This causes a thinning of the tissues that line the vaginal walls medically known as atrophic urethritis or urethral atrophy. This leads to dysuria causing both upper and lower urinary tract infections and which is recognized as a major cause of urge incontinence. The two major causes of incontinence that are caused by atrophic urethritis as per U.S.Pharmacist are:
Detrusor Cramping: Atrophic urethritis causes the “detrusor” muscles to cramp involuntarily. These muscles lie just below the bladder and have to remain relaxed for the bladder to hold urine. Any contractions in these muscles will lead to urine leakage or incontinence.
Stress Incontinence: This is again due to the detrusor muscle activity. Simple activities like laughing, sneezing or coughing put pressure on the abdomen and hence on the detrusor muscle causing urine leakage.
Genitourinary Syndrome (GSM): As per Mayo Clinic GSM is also a post-menopausal syndrome caused due to lower estrogen levels. Even though it is defined as postmenopausal this syndrome can also occur during the years that lead up to menopause when the estrogen levels of your body start to decline. Some basic factors that can cause a drop in the estrogen levels are:
Because of this drop in the estrogen level, the vaginal walls become thin causing laxity and hence urinary problems. Another complication is a vaginal infection which in turn increases your risk of UTI and urinary incontinence.
Pelvic Floor Dysfunction: When the muscles or tissues surrounding the pelvic organs become weak or lose it leads to an inability to adequately control, either relax or tighten these muscles, it is referred to as pelvic floor dysfunction. The muscles that lie at the base of the pelvic area are called the pelvic floor muscles. The organs included in the pelvic floor of women are:
Pelvic floor dysfunction leads you to contract rather than relax these muscles. This contraction causes incomplete urination and leakage.
Pelvic Organ Prolapse (POP): POP is one of the pelvic floor disorders. When you lose the ability to control the muscles surrounding your pelvic region it might cause the pelvic organs to press upon or even peak out of the vagina. This is called POP.
Studies have found a direct positive correlation between pelvic organ prolapse and incontinence for women. Almost 60% of women diagnosed with POP are also found to have urinary incontinence and almost 40% of women with incontinence also suffer from POP
There are certain incontinence factors or causes that are specific to men as well. These include:
Benign Prostatic Hyperplasia: With age, the prostate size of men also increases. The National Institute of Diabetes and Digestive and Kidney Diseases the condition where the prostate gland enlarges but is non-cancerous is called “Benign Prostatic Hyperplasia” or BPH. Other names for this are:
Benign Prostatic Hypertrophy
Benign Prostatic Obstruction
Some of the symptoms associated with BPH as listed by Mayo Clinic are:
Inability to empty bladder fully
Dribbling at end of urination
Needless to say, all these above factors are also symptomatic with incontinence. Bear in mind that BPH does not cause incontinence by itself but facilitates it.
Prostate Cancer: The most common side effect reported by men after prostate cancer treatment as per the Prostate Cancer Foundation is urinary problems. The reason behind this is that the treatment involved compromises the muscles and nerves involved with the ability to pass urine comfortably. The main problems or types of incontinence encountered after the cancer treatment are:
Pelvic Floor Dysfunction: This is common to both men and women. Only the pelvic floor organs involved are different. In addition to bladder, urethra, and rectum, men also have a prostate. Apart from this, the logic of not being able to hold the urine or urinate properly because the pelvic floor muscles are weak remains the same across gender.
Difficulty in urinating or peeing
Causes of Bowel Incontinence
Bowel incontinence in adults is losing control of the bowel movements. One in every 20 cases of incontinence is bowel incontinence cases. It is a common problem but not a serious problem even though it can impact and affect your lifestyle tremendously. Some of the causes for this are:
Vaginal Childbirth: While giving birth vaginally there can a lot of muscle tear and nerve damage to the women’s vagina and anal sphincters. This causes them to lose control over their bowel movements. This is also why women are more prone to bowel incontinence than men.
Anal Surgery: This can also cause damage to the nerves leading to anal sphincters thereby compromising your bowel continence.
Diarrhea: This is categorized by loose watery stools that are harder to hold in than solid stools. This is the most common cause of bowel incontinence in adults. Diarrhea is generally caused due to:
Constipation: Constipation leads to hard stools that are both difficult and painful to pass. It also makes you exert more pressure on the rectum muscles to pass the motion. This undue pressure over time causes the muscles to lax resulting in incontinence.
Physical Injury: When the rectum muscles are injured or weakened, they become lax and are unable to keep the rectum closed. This leads to the stool leaking from the rectum. Some of the causes for this injury are:
Inflammatory Bowel Disease (IBD): Also known as Crohn’s disease. IBD causes intestinal inflammation and irritation.
Irritable Bowel Syndrome (IBS): IBS causes abdominal pain especially while passing stool. It also changes the bowel movements.
Proctitis: This refers to the inflammation of the rectum lining caused because of irritable bowel syndrome or radiation therapy. This inflammation makes it uncomfortable to pass stool and leads to an increased urge to go to the toilet for the same.
Trauma to the anus or rectum
For anal or rectum cancer
Nerve Damage: Your muscles are controlled by the nerves. Any nerve damage will compromise your muscle control ability. The causes of nerve damage are:
Long term straining in passing motion
Rectal prolapse: The condition where your rectum drops to the anus is rectal prolapse. This causes the stool and mucous to pass involuntarily and in an uncontrolled fashion.
Physical inactivity: When you spend a greater part of your day just sitting around and not get the adequate exercise you tend to retain a lot of stool in your rectum. This causes the liquid stool to pool around the harder stool and leak out.
Loss of rectum stretch: Due to radiation therapy or scarring your rectum may get damaged and inflamed. In this situation, it cannot stretch adequately to pass the stool comfortably or even hold stool properly causing it to leak.
Rectocele: This refers to the condition wherein your rectum bulges out of your vagina. This happens when the vaginal lining and the muscles keeping your vagina and rectum separate becomes weak. This makes it harder for your body to push the stool out.
Are You Suffering from Incontinence?
After learning about all the various types and causes of incontinence in adults you might be wondering how to tell if you have incontinence? About one-third of the adult population suffers from incontinence. Getting an accurate statistic is hard because a lot of incontinence issue is not reported making incontinence in adults one of the most under-reported medical conditions in the world. The reasons for this are simple and enumerated below:
Embarrassment: This is the most common reason. Many people simply feel embarrassed when faced with this problem and don’t seek medical help.
Unawareness: Another reason is a lack of awareness regarding incontinence. Several people especially the uneducated class simply do not know that incontinence is a medical condition that can be treated.
Preconceived notions: A lot of people feel that incontinence is just part of growing old like the aches and pains that they feel in their bones. And hence do not even think of getting any medical help just laughing it off or suffering in silence.
If you are one of the many who feel that incontinence is not a medical condition or is just something you will have to bear with as best as you can then think again. There is medical aid for this, and you can overcome it just like any other medical state.
Self-Diagnosis of Incontinence
The question that now arises is how to tell if you have incontinence? Below is a convenient questionnaire that lists the symptoms and can help you self diagnose and figure out if you need to talk to a medical practitioner:
Are you rushing to the toilet often?
Do you feel often that you have not completely emptied your bladder?
Are you feeling anxious and nervous about peeing?
Are you waking up more than twice at night to pee?
Do you sometimes find that you have leaked a bit during laughing, sneezing or coughing?
Do you find that you are not able to hold your urine till you reach the toilet?
Do you have to strain to pass motion?
Do you often find your underwear soiled or wet?
Do you often look around you to find the nearest toilet when outside?
If you have answered affirmatively to even a couple or more than a couple of the above questions, then there are some pretty good chances that you may be suffering from incontinence. You should talk to your doctor about this and seek medical advice. After self-diagnosis and understanding that you might have incontinence, your doctor might prescribe certain tests to be conducted which will analyze your specific problem and chart out a treatment plan. These diagnostic tests which are conducted are:
Urine Analysis and Culture: This is done to ascertain if you have urinary infections like UTI or blood sugar in your urine.
Bladder Stress Test: This mimics the bladder’s response when the body is stressed with exertions like laughing or sneezing. Women might have to undergo a “Bonney” test which is similar to the stress test just that the vagina is first lifted with the fingers and then the stress test is applied.
Pad Test: This test is conducted to gauge the amount of urine leakage. You will be provided with a weighted pad to wear until you experience urine leakage. Then the pad is weighed again and the amount of urine leakage is judged.
Ultrasound and X-Ray: To judge the bladder and urethra’s position while coughing and urinating.
Urodynamic test: These are done when surgery is being considered when other treatment plans have failed to give appropriate satisfactory results. These tests include:
Electromyogram (EMG): The electric activity of the muscles is recorded with the help of machines to gauge muscle responsiveness and laxity.
Post-void residual volume
Don’t panic thinking that you will have to take all these tests. The doctor will guide you and tell you which ones to take to effectively diagnose your type and level of incontinence. Apart from these medical diagnostics, your age and lifestyle pattern will also be considered.
How Is Incontinence Treated?
After diagnosis the next step is treatment. Your physician will take into account the following factors when deciding on the most effective treatment plan for you:
After carefully analyzing these factors the physician might recommend one treatment or even a combination of treatments. Broadly treatment is classified as:
To begin with, if the incontinence is not absolute non – surgical treatments are stressed and the preferred method of overcoming incontinence in adults. Mayo Clinic lists them as:
Non – Surgical Treatments for Incontinence in Adults
Behavioral Techniques: These are changes in your behavior pattern to better accommodate your bladder and bowel movements. Some techniques involved are:
Bladder Training: You can train your bladder to delay peeing. It is recommended to try holding off for 10 minutes and working your way up. The goal is 2.5 to 3 hrs. delay.
Toilet Schedule: In this, you can plan your toilet trips and go every 2 to 3 hours without waiting for your body’s signal thereby training your body for time intervals.
Double Void: It means waiting a few minutes after urinating and trying again to fully empty your bladder.
Diet and Fluid Management: You should try to avoid diuretics like alcohol, coffee, and tea to reduce your urge and need to pee. Reducing overall liquid consumption and having a rich fibrous diet will help you in avoiding and overcoming incontinence.
Pelvic Floor Exercise: Very commonly known as Kegels exercises. These are done to strengthen the pelvic floor muscles which are responsible for urinating. The quickest and most efficient way of exercising pelvic floor muscles is by imagining that you are stopping your urine flow. A step by step guide to help you through Kegels is listed below:
Contract the muscles you would use for stopping the urine flow for 5 seconds and relax for 5 seconds. You can start with 2 to 3 minutes and work your way up
A good rule of thumb is working up to 10 seconds
Make sure you do a three-set of 10 contractions each
Electric Stimulation: Electric waves are given to your vagina and rectum through electrodes to strengthen your muscles. This is very effective for urge and stress incontinence.
Medication: Medications are also used for the treatment of incontinence. These include:
Medical Devices: Certain devices can also be inserted inside your vagina or rectum to help you control the bladder and bowel movements. They are also called external incontinence devices. These are:
Fecal incontinence devices
Interventional Therapy: There are certain interventional therapies also that can help with incontinence in adults. They are mentioned below:
Botulinum Toxin Type A (Botox): Botox can be injected to help with overactive bladder.
Bulking Material Injections: A synthetic material is injected to keep the urethra closed and to reduce urine leakage. It is less effective but also less invasive.
Nerve Stimulators: A pacemaker-like device is implanted on the skin to deliver electric impulses to the nerves involved in the bladder control.
Surgical Interventions for Incontinence in Adults
Surgical interventions are the last resort when all other forms of possible treatments have been exhausted and proven ineffective. The different types of surgeries associated with incontinence in adults are:
Sling procedures: Pelvic sling is created to keep the urethra closed using your body’s tissues.
Bladder neck suspension: It involves making a small abdominal incision to provide support to the bladder neck and urethra.
Prolapse surgery: Surgery to improve the pelvic floor prolapse.
Artificial urinary sphincter: A small ring is implanted around the bladder neck to keep the urinary sphincter shut until you want to urinate.
Incontinence can be a debilitating condition. It can lead to social anxiety and at times even depression. Just remember that incontinence is a perfectly normal medical condition that can be treated and managed very effectively with or without medical intervention depending on the severity of the condition. It is nothing to be ashamed of.
Some simple lifestyle changes that you can make if you do not want to go the medical route are:
Try using a bedside commode in your bedroom
Keep a night light on so that navigating to the toilet becomes easier
Keep the path to the toilet clutter-free so that you don’t risk tripping over any rugs or furniture in the haste of reaching the toilet
Wear easy to remove clothing
Try wearing a pad for urge incontinence or stress incontinence
Clean your intimate area properly to avoid further infections
Carry extra clothes with you while going out
Some Answers on Incontinence in Adults
What Does Incontinence Signify?
Incontinence signifies an inability to control. It is often caused by an underlying condition. This can be a minor condition caused by a temporary infection like urinary tract infection (UTI) or it could be because of something major like a neurological condition or diabetes.
What Are the Major Types of Incontinence?
Incontinence is primarily of two types, urinary, and bowel. Urinary is further classified primarily into four types:
What Are Its Causes in Elderly People?
The elderly population is more prone to incontinence. This is because with age you are more prone to diseases and underlying medical problems. Apart from neurological and medical factors age also naturally makes your muscles lax causing problems with basic body functions. Your pelvic floor muscles and bladder muscles naturally weaken causing incontinence.
What Are the Conditions That Can Lead to Incontinence?
Certain medical conditions are known to cause incontinence. These include:
Apart from these, there are neurological disorders, muscle laxity, and kidney problems also that are a big causal factor.
Incontinence can have a major impact not only on your daily lifestyle but also on your social and mental wellbeing. Remember incontinence in adults is treatable and can be effectively managed with both medical intervention and simple lifestyle changes. In a lot of cases, it can also be cured. You don’t have to needlessly suffer through it.
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