What is incontinence – Bladder or Bowel Problem?

What is incontinence?
Incontinence is a term that describes any accidental or involuntary loss of urine from the bladder (urinary incontinence) or bowel motion, faeces or wind from the bowel (faecal or bowel incontinence).

Incontinence is a wide
spread condition that ranges in severity from ‘just a small leak’ to complete loss of bladder or bowel control. Millions of people across the globe have bladder or bowel control problems for a variety of reasons. Incontinence can be treated and managed.  In many cases it can also be cured.

    Urinary incontinence 

Urinary incontinence is leaking of urine that you can’t control. Many men and women suffer from urinary incontinence but do not tell anyone about their symptoms.. Urinary incontinence (or poor bladder control) is a common
condition, that is commonly associated with pregnancy, childbirth, menopause or a range of chronic conditions such as asthma, diabetes or arthritis. 
Urinary incontinence is not only a medical problem. It can affect emotional, psychological and social life. Poor bladder control can range from the occasional leak when you laugh, cough or exercise to the complete inability to control your bladder, which may cause you to completely wet yourself. Other symptoms you may experience include the constant need to urgently or frequently visit the toilet, associated with ‘accidents’.Many people think urinary incontinence is just part of getting older. But it’s not. And it can be managed or treated. .

Types of urinary incontinence?

Urinary incontinence is not a disease. It is a symptom of many conditions. Causes may differ for men and women. But it is not hereditary. And it is not just a normal part of aging. These are the four types of urinary incontinence

Stress Urinary Incontinence (SUI)

 Stress incontinence is the leaking of small amounts of urine during activities that increase pressure inside the abdomen and push down on the bladder. With SUI, weak pelvic muscles allow urine escape. SUI is one of the most common types of
urinary incontinence and it is common in older women and less common in men.

SUI happens when the pelvic floor muscles have stretched. Physical activity puts pressure on the bladder. Then the bladder leaks. It may be a few drops of urine to a tablespoon or more. SUI can be mild, moderate, or severe Leaking may occur with exercise, walking, bending, lifting, or even sneezing and coughing.

Stress incontinence is most common with activities such as coughing, sneezing, laughing, walking, lifting, or playing sport. Other factors contributing to stress incontinence include diabetes, chronic cough (linked with asthma, smoking, or bronchitis), constipation and obesity

Stress incontinence in women
Stress incontinence in women is often caused by pregnancy, childbirth and menopause. Pregnancy and childbirth can stretch and weaken the pelvic floor muscles that support the urethra causing stress incontinence during activities that push down on the bladder.
During menopause, oestrogen (a female hormone) is produced in lower quantities. Oestrogen helps to maintain the thickness of the urethra lining to keep the urethra sealed after passing urine (much like a washer seals water from leaking in a tap). As a result of this loss of oestrogen, some women experience stress incontinence during menopause.

Stress incontinence in men

Many men develop stress incontinence after prostate surgery. This can take 6 to 12 months to resolve and it is recommended that men seek help from a health professional to address the issue.

                                     Urge incontinence (overactive bladder)

Urge incontinence or overactive bladder, or detrusor instability.is a sudden and strong need to urinate.

How functional bladder works
In a well functional bladder, the bladder muscle (detrusor) remains relaxed as the bladder gradually fills up. As the bladder stretches gradually, when the bladder is about half full, you will get a feeling of wanting to pass urine. Most people can hold on after this initial feeling until a convenient time to go to the toilet arises.
How Overactive bladder works
However, if you are experiencing an overactive bladder and urge incontinence, the bladder contracts too early when it is not very full. The bladder may feel fuller than it actually is and this can make you increase your urge to use the toilet or suffer leakage of urine.  
The condition where you often experience urge incontinence and you will also have the need to frequently pass urine and may wakeup several times a night to pass urine may be referred to as Nocturia.
Causes of urge incontinence
The cause of urge incontinence is not completely understood, however it appears to be common with ageing and caused by:
§  Age,stress, caffeine in tea, coffee and fizzy drinks or by alcohol.
Constipation (inability or difficulty to empty the bowel)
§  Enlarged prostate long gland
§  Accumulated or history of poor bladder habits

§  Health conditions which interfere with the brain’s ability to send messages to the bladder via the spinal cord  can affect a person’s ability to hold and store urine leading to urge incontinence. Conditions include stroke, Parkinson’s disease, multiple sclerosis etc. However, in some cases, the cause of an over-active bladder is unknown.  

Incontinence linked with chronic retention

When the bladder is unable to empty properly and frequent leakage of small amounts of urine occurs, it is a case of incontinence associated with chronic retention.  
How do you know when your bladder does not empty completely?
Signs that your bladder is not completely emptying include:
§  feeling that you need to strain to pass urine
§  a weak or slow urine stream
§  feeling as if your bladder is not empty even after use of the toilet
§  little or no warning signs when you need to pass urine
§  passing urine while asleep
§  frequent urinary tract infections or cystitis,
§  ‘dribbling’ more urine after visiting the toilet.
       Causes of incontinence associated with chronic retention 
§  Urethra blockage: A full bladder can put pressure on the urethra and make it difficult to pass urine.Urethra blockage may be caused by a full bladder.
§  Some medications can interfere with bladder function, which includes over the counter medications and herbal products.
§  Health conditions such as diabetes, multiple sclerosis, stroke or Parkinson’s disease may interfere interfere with the sensation of a full bladder and with bladder emptying),
§  An enlargement of the prostate in men
§  A Prolapse of pelvic organs can block the urethra

§  A damage to the nerves that control the bladder, urethral sphincter or pelvic floor muscles
Functional incontinence

   In functional incontinence, a person may not see the need to go to the toilet or does recognize the toilet as a result they may pass urine in inappropriate places or not get to the toilet in time.
    What causes functional incontinence?
    Several problems may be responsible for functional incontinence:
§  Dementia
§  Poor eyesight
§  poor mobility
§  Lack of fine motor skills can cause difficulty in removing clothing(poor skill)
§  Reluctance to go the toilet which may be due to depression, anxiety or anger.

§  Environmental challenges or ergonomic factors such as poor lighting, low chairs that are difficult to get out of, and toilets that are difficult to access.

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