THE WORD INCONTINENCE OFTEN MEANS DIFFERENT THINGS TO DIFFERENT PEOPLE. AS WITH ALL HEALTHCARE PROBLEMS IT IS IMPORTANT WE ARE ALL CLEAR ABOUT WHAT WE MEAN WHEN WE SAY SOMEONE IS INCONTINENT.
Medical definitions focus primarily on the fact that the person with the problem is experiencing an involuntary loss of urine or faeces. In other words, they are unable to control the leakage. However, it is important to understand that incontinence can occur for a variety of reasons. There are a number of physical problems which directly affect the bladder and how it functions.
There are also issues which affect how we access and use toilet facilities. A toilet we cannot get into is a toilet we cannot use!
The most common types of incontinence are:
- Stress Incontinence
- Urge Incontinence
- Overflow Incontinence
- Mixed Incontinence
- Functional Incontinence
- Faecal Incontinence
Present figures suggest that 1 in every 3 people will suffer from urinary incontinence at some time in their lives.
Faecal incontinence affects 500,000 adults or approximately 1% of the adult population (Le Lievre, 2002).
Leaking small amounts of urine when you cough, sneeze or laugh can occur if there is a weakness in the pelvic floor muscles. This type of leakage is called stress incontinence. It is more common in women as pelvic floor muscles can be weakened by pregnancy, childbirth and the menopause.
Men may experience this type of leakage following surgery for prostate problems.
Many people with bladder problems find the desire to pass urine can come on so quickly it does not give them time to get to the toilet. If you have urge incontinence you can find you leak on the way to the toilet or soon after you have experienced the urge to empty your bladder. Some people find hearing running water or putting the key in the front door may trigger episodes of urge incontinence (Thomas, 2001).
If the bladder is unable to empty effectively, overflow incontinence may occur.
Conditions such as constipation, urethral stricture or prostate enlargement can cause obstructions which prevent the bladder from emptying completely (Getliffe et al, 2003). This means there is very little space for new urine to be stored and frequent visits to the toilet to pass small amounts of urine often result.
Some patients with incomplete bladder emptying experience a constant dribble of urine which they are unable to control, this is called overflow incontinence. People with this type of problem may feel that their bladder is never completely empty.
It is possible to experience more than one type of incontinence (Abrams et al, 2002). Some patients find they leak urine when they cough and sneeze but also have to dash to the toilet, often leaking urine before they are able to get there. This is called Mixed Incontinence.
An inability to access appropriate toileting facilities will result in incontinence. The individual may have a bladder in perfect working order but incontinence occurs because toileting facilities do not meet the individual’s needs.
For many people, faecal incontinence occurs because of a number of factors which have all happened at the same time.
Diarrhea caused by infections and stomach upsets may cause fecal incontinence in some people, this usually resolves once the diarrhea settles.
Patients with neurological conditions such as MS or stroke may experience faecal incontinence due to impaired nerve impulses. A number of medications can also cause bowel problems such as constipation which can develop into faecal impaction if not treated effectively.