A Guide to Incontinence
March 1, 2022
Part 1: The Basics
Welcome to the Incontinence Guide, presented by Tranquility® Products. Incontinence, also known as loss of bladder or bowel control, is a highly prevalent condition in the U.S. and across the world. We are excited to provide you with a blog series that takes a comprehensive look at incontinence and answers the top questions people have about this condition.
Incontinence Guide – Part 1: The Basics will answer the following questions:
Incontinence Guide – Part 2 covers treatments for incontinence, followed by Part 3 on living with incontinence and Part 4 on caregiving and incontinence.
What is Incontinence?
The most common question regarding incontinence is almost always, what is incontinence?
Incontinence is the involuntary loss of urine or stool. More generally, it is the accidental leakage of urine or bowel from the body. Other common phrases for incontinence are loss of bladder control, bladder leaks, overactive bladder, bedwetting and others. Incontinence can be experienced temporarily or can be lifelong.
Incontinence can be urinary (pee), fecal (poop) or both. Urinary incontinence is the term used for people with only bladder leakage; fecal incontinence is used for people experiencing bowel leakage. Urinary incontinence is the most common type of the two. Urinary incontinence can be light, which is described as light drips and dribbles when you laugh, sneeze or don’t fully empty the bladder. Urinary incontinence can also be heavy, described as full urinary voids or full bladder release of urine.
Both adults and children can experience incontinence. Incontinence is more common in older people because incontinence is caused by medical conditions and diseases that are more commonly experienced in old age.
If you experience incontinence, you are not alone!
How Common is Incontinence?
Incontinence is a common condition in the U.S. A recent study shows that over 46 million Americans experience some type of incontinence. That’s one in six U.S. adults! In fact, one in three people will experience a loss of bladder control at some point in their lives.
As we age, our risk of incontinence increases. Incontinence is not caused by age, but as we get older, we are at risk of other diseases and conditions that may cause incontinence. More than half of adults over the age of 65 experience urinary or fecal incontinence. Although not everyone will experience incontinence, chances are as you grow older, you or someone you know will develop incontinence. Therefore, it is important to understand what causes incontinence and what to do if you or someone you know has incontinence.
What Causes Incontinence?
Incontinence is not a normal part of aging. Urinary incontinence, as well as fecal incontinence, is a condition that is a result of another disease, condition, disorder or age-related body change. Urinary incontinence can be caused by the following:
- Weakened pelvic floor muscles
- Nerve damage that effects the bladder
- Enlarged prostate and prostate cancer
- Surgery (such as hysterectomy, cystectomy or prostatectomy)
- People with diseases like diabetes, Parkinson’s, Alzheimer’s and others, may experience incontinence as a result of the disease
- People with neurological disorders like spinal cord injuries, a stroke, multiple sclerosis, a brain tumor and more can experience incontinence
- Children born with disorders like autism, Down syndrome, cerebral palsy and Angelman syndrome may experience incontinence as they develop through adolescence
There are alternative causes of temporary incontinence, such as urinary tract infection (UTI), constipation, certain medications, alcohol, caffeine and other food and drink that irritate the bladder or bowels.
What are the Types of Incontinence?
There are two types of incontinence, urinary incontinence and fecal incontinence. Urinary incontinence is broken down into six types (stress, urge, overflow, reflex, functional and mixed).
Types of Urinary Incontinence
Urinary incontinence is more common than fecal incontinence, with about 44% of adults over 65 experiencing only urinary incontinence and approximately 17% experiencing only bowel incontinence.
Stress incontinence is when there is a sudden pressure or stress on the bladder that causes urine to unexpectedly leak. Sudden pressure or muscle contractions on the bladder are caused by coughing, sneezing, exercising, heavy lifting or laughing. Stress incontinence is more common in women, as it can be a result of weakened pelvic floor muscles due to childbirth and menopause.
Urge incontinence is a sudden urge to urinate that is so strong it cannot be held long enough to reach the bathroom. Urge incontinence is also known as overactive bladder (OAB). Urge incontinence or OAB can be the result of nerve damage, bladder spasms, stroke and other conditions.
Mixed incontinence is the combination of urge incontinence and stress incontinence. Mixed incontinence shares the symptoms and causes of both stress and urge incontinence. Therefore, people with mixed incontinence experience both sudden stress on the bladder and a sudden urge to urinate, causing urine to leak before they can use the bathroom. It is common in women following childbirth and menopause, as well as with nerve damage, multiple sclerosis (MS), diabetes, stroke and others.
Overflow incontinence occurs when the bladder is unable to contain urine under pressure. The bladder fills up and eventually overflows, causing urine to leak. People with overflow incontinence may also feel like they cannot completely empty the bladder. Overflow incontinence is common for men with an enlarged prostate and in adults with a UTI.
Reflex incontinence is caused by bladder muscle contractions that cause urine to leak out without warning. Reflex incontinence is similar to urge incontinence; however, the difference with reflex incontinence is the absence of the warning or urge to go. Reflex incontinence is common in people with neurological impairments, such as spina bifida, MS and spinal cord injury. It can also be the side effect of surgery or radiation treatment.
Functional incontinence is when a person cannot get to a bathroom fast enough or cannot recognize the need to go to the bathroom. It is often due to physical or mental impairments. People with physical disabilities that keep them from being able to get to the bathroom experience functional incontinence. Alzheimer’s and other dementias cause changes in the brain that can make adults unable to recognize the body’s signal of the need to use the bathroom. Additionally, people with Alzheimer’s or other dementias may experience confusion trying to find the bathroom and urinate before they make it to the toilet. Functional incontinence is often urinary and fecal.
Fecal incontinence is the involuntary loss of stool/feces and ranges from occasional leaks to complete loss of control. Fecal incontinence can be temporary or recurring. People can experience temporary incontinence with diarrhea, hemorrhoids or constipation, whereas fecal incontinence caused by muscle damage, surgery or dementia is often recurring.
Fecal incontinence can be experienced with or without urinary incontinence. Fecal incontinence is less common than urinary incontinence, but still affects over 17% of adults over 65 in the U.S.
So, You Have Incontinence. Now What?
Now that we have established some of the fundamentals of incontinence, we can start to address questions like:
What are the treatments for incontinence?
Are there solutions for incontinence?
Should I talk to my doctor about my incontinence?
Part 2: Treatments for Incontinence
Incontinence Guide – Part 2: Treatments for Incontinence will answer the following questions:
Incontinence Guide – Part 3 will cover living with incontinence. The last part of the series, Incontinence Guide – Part 4, will discuss caregiving and incontinence. The Incontinence Guide – Part 1 covered what incontinence is, the types, causes and more.
What are the treatments for incontinence?
There are several treatments for incontinence, and the treatments vary based on the cause and severity of the incontinence experienced. Common treatments for incontinence include pelvic floor muscle exercises (Kegels), medication, surgeries and procedures, catheters and absorbent products.
Pelvic Floor Muscle Exercises
Pelvic floor exercises help strengthen the pelvic floor and bladder muscles, allowing for improved bladder control. Pelvic floor exercises are particularly helpful for people experiencing stress incontinence and urge incontinence. The most common exercise to strengthen the pelvic floor muscles for both men and women are Kegel exercises.
As we age, we slowly lose some of our muscle mass and strength. It is a natural aspect of aging and is not necessarily associated with a disease or condition (although it certainly could be). Loss of bladder control is not a normal part of aging and is always a result of an underlying disease or condition. However, the condition may be as simple as the weakening of the bladder or pelvic floor muscles. Weakening bladder or pelvic floor muscles in older adults is often due to lack of physical activity or general physical changes that make holding in urine more difficult.
Multiple medications are also known treatments for incontinence. Anticholinergics and Mirabegron are used to treat urge incontinence by relaxing the bladder muscles. Alpha blockers are another medication that is used for men to relax the muscles in the prostate. Women may have the option to use topical estrogen to improve incontinence.
Surgeries and Procedures
Surgery is one of the most common treatments of the underlying condition that causes incontinence. Common surgeries that can help improve incontinence include sling surgery, urethra bulking agents, artificial urinary sphincter surgery and colposuspension.
Various surgical procedures like nerve stimulators, Botox and electrical stimulation may be used as treatments for incontinence. Medical devices like urethral inserts and pessaries are sometimes used to treat women with urinary incontinence.
While surgeries can be done to improve incontinence, incontinence can also be a side effect following surgery. In some surgeries, like removal of the prostate, bladder or kidneys, incontinence may be an unintended outcome of the surgery. In many cases, the incontinence experienced after a surgery is temporary and will improve with time.
One way to manage incontinence is through the use of a catheter. A catheter is a tube that is inserted through the urethra and into your bladder, allowing urine to drain. There are three types of catheters: indwelling, external and intermittent catheters. Indwelling catheters, sometimes referred to as a Foley catheter, are inserted by a healthcare professional into the bladder and are used for a longer period of time. The tube is connected to a collection bag that stores the urine. An external catheter, also known as a condom catheter, is worn outside the body, secured around a man’s penis. An intermittent catheter is inserted into the bladder for a short period by the user to drain the bladder and is then promptly removed. This is often referred to as a self-catheter and is used by those who feel comfortable
toinserting and removing the catheter to drain the bladder themselves. Each type of catheter has a different use based on the incontinence experienced and why it is needed.
While catheters work extremely well for many people, they also come with a risk of side effects. The most common side effects are infections, specifically urinary tract infections, difficulty urinating, patient pain and challenges with sexual function.
One of the most common ways to manage incontinence is the use of disposable absorbent products. There are many styles, sizes, shapes and functions of absorbent products to meet the needs of all different body shapes and severity of bladder loss. Some individuals with incontinence, particularly stress urinary incontinence, only leak small amounts of urine (sometimes called drips and dribbles). And while this isn’t as severe as heavy incontinence, absorbent products are often still used to minimize embarrassment and allow for everyday activities. For people with drips and dribbles, pads, liners and guards are the preferred solution. These are worn inside traditional underwear, secured using an adhesive strip, and provide great protection for those drips and dribbles when they occur.
Alternatively, there are products for those with heavier incontinence. Heavy incontinence is often described as full loss of urine control, or events where large amounts of urine come out involuntarily. For children and adults with heavy incontinence, the absorbent products of choice are tab-style disposable briefs and pull-on style absorbent underwear. Tab-style disposable briefs are what most parents have been exposed to with baby diapers. They feature tape-tabs on the sides that secure in the front for application. Pull-on style underwear are worn like traditional underwear, and are preferred by those who are independent and want to wear a product that is more like their typical underwear.
Absorbent products are available in a variety of places. From the grocery store to your local pharmacy to countless online retailers, absorbent products are widely used by many with loss of bladder control.
Are there solutions for incontinence?
There are many solutions for solving or reversing incontinence. As mentioned above, there are surgeries and procedures that treat the underlying cause of incontinence. When completed successfully, many of these procedures can result in temporarily or permanently regaining bladder control. For instance, men with an enlarged prostate may experience frequent urination, sudden urges to go, inability to empty the bladder completely, and/or trouble urinating or initiating flow even when the bladder feels full. For women, loss of bladder control may be experienced after childbirth due to nerve damage or pressure on the urethra. In both instances, a doctor may recommend surgery to treat these conditions. That is why it is important to speak with your doctor about incontinence-related issues.
Should I talk to my doctor about my incontinence?
Yes. Talking to your doctor can be an incredibly important step in improving your incontinence experience. According to the Urology Care Foundation, men and women wait an average of four years before speaking with a healthcare professional about their bladder issues. The best first step is to bring up the topic of bladder loss with your primary care physician. Based on the conversation with your primary care physician and their evaluation, you may be referred to see a urologist. A urologist is a doctor who specializes in the treatment of the urinary system. When visiting a urologist, you may consider these Top 6 Questions to Ask Your Urologist.
Another helpful resource for before or after you discuss your urinary challenges with a physician is a bladder diary. Click here for a three-day bladder diary that you can print and use to track your fluids, trips to the bathroom, leakage and activities.
Up Next – Part 3: Living with Incontinence
Now that we have covered treatments, solutions and talking with your doctors, it’s time to cover living with incontinence. In the Incontinence Guide – Part 3, we will cover products and services that help you manage living with incontinence. We’ll share a few stories from real users – young and old – and how they discovered solutions that gave them back their freedom and confidence.
Tranquility Products are a leading brand of high-quality, high-absorbency incontinence products. Our products are carefully designed and tested to give you premium absorbent protection that holds up to the true demands of everyday living, so you can focus on the things that matter most. If you are ready to try Tranquility products, we offer free 2-pack samples! Use our Product Finder to find the right product for you or contact our Care Center to speak with a representative who can help answer your product or incontinence-related questions.
Disclaimer: This blog provides general information about incontinence, health and related subjects. The content provided in this blog, and any linked resources, are not intended to be taken as medical advice. If you or the person in your care has a medical concern, please consult a licensed physician.
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