Facts

Dignity4You - Facts in incontinence

Incontinence is a problem of the urinary system. Normally, the bladder stores the urine that is continually produced by the kidneys until it is convenient to urinate, but when any part of the urinary system malfunctions, incontinence will result.

The urinary system consists of two kidneys, two ureters, a bladder, and a urethra. The kidneys remove waste products from the blood and continuously produce urine. The well-developed, tube-like ureters transport urine from the kidneys to the bladder, where it is stored until it flows out of the body through the tube-like urethra. There is a sphincter muscle which is a circular muscle, that controls the activity of the urethra. It is not specifically a part of the urinary system but can play a role in incontinence.

Different types of incontinence

  1. Stress incontinence
    • Due to damaged pelvic muscles
    • Causing leakage during activities such as: exercise, coughing, sneezing, laughing, or any body movement which puts pressure on the bladder.
  2. Urge incontinence
    • Urgent need to pass urine
    • Inability to get to a toilet in time
    • Due to damage to the nerve passages along the pathway from the bladder to the brain
    • Causing an involuntary bladder contraction
    • Major symptom of Over Active Bladder.
  3. Mixed incontinence
    • Occurs as a combination of both stress and urge types of incontinence
  4. Overflow incontinence
    • Leakage due to bladders inability to hold the quantity of urine produced.
  5. Reflex incontinence
    • Leakage or loss of urine when you are unaware of the need to urinate
    • Caused by
      • An abnormal opening between the bladder and another structure
      • A leak in the urinary system or urethra
  6. Incontinence from surgery
    • Due to operations like
      • Prostatectomies
      • Lower intestinal surgery
      • Rectal surgery.
      • Caesarean sections
      • Hysterectomies
  7. Health conditions that cause incontinence
    • Menopause
    • Prostate cancer
    • Pregnancy- hormonal changes, fetus weight and stress may lead to incontinence
    • Childbirth- Vaginal birth can weaken muscles and damage bladder nerves or even prolapsed/dropped pelvic floor causing vaginal protrusions which lead to incontinence
    • Enlarged prostate- Benign prostatic hyperplasia
    • Obstruction- Tumors along the urinary tract can block the flow of urine leading to overflow, also urine stones from bladder can cause leakages.
    • Neurological disorders (interfere with the nerve signals involved in bladder control)
      • Multiple sclerosis
      • Parkinson's disease
      • Stroke
      • Brain tumor
      • Spinal injury
    • Bladder infections and constipation (these cause temporary incontinence)

Majority of people living with incontinence do not tell anyone about it, often not even their doctor(s) and especially not their friends. Family members are often the ones to bring up the subject as they are directly exposed to smell or furniture that is soiled. It is a very sensitive issue to bring up in conversation and but know that you are not alone. Both young and old men and women including athletic, pregnant, disabled and abled people can suffer from incontinence.

 

The largest percentage of people affected by incontinence however are elderly woman. Research has found that almost 50% of sufferers are elderly people living at home or in long-term care facilitates. People living with incontinence may experience both emotional and physical discomfort. Most people affected by loss of bladder or bowel control separate themselves for fear of humiliation and loss of self-control. Young and older adults who suffer from incontinence often find employment impossible.

 

Here are some emotions associated with incontinence:

  1. Embarrassment
    • This usually occurs when we were not going to be able to get to the bathroom on time, or would leak when we sneezed, coughed, or laughed
  2. More Emotions
    • Impatience
    • Frustration
    • Annoyance
    • Anger
    • Fear and/or disgust.
    • Can feel dehumanizing, as if the condition has robbed you of your dignity.
    • Loss of control
    • Loss of privacy
    • Loss of dignity
    • Loss of independence.
  3. Anxiety and Isolation
    • Do colder weather conditions make you more nervous to confidently leave home? 
    • When you go out, do you think about how long you will be gone and where the bathrooms are?
    • Are you afraid to travel or make plans with friends for fear there won’t be a bathroom when you need one?
    • Incontinence often leads to restrictive activities, declining social invitations, and avoiding travel. 
    • Always thinking about this issue is not only extremely taxing but can keep you from enjoying activities and friendship.
  4. Denial
    • It’s not easy to be odor free when you have incontinence. Most often you will not realize the odor as your sense of smell will adapt to it. Our sense of smell decreases with both age and many chronic illnesses including Alzheimer’s disease, Parkinson’s disease, and stroke. It is often embarrassing if someone else brings up the topic of odor and this can cause a great deal of emotional stress and embarrassment.   
  • Medical history and a thorough physical examination:
    • Being overweight.
      • Excess weight increases pressure on your bladder and surrounding muscles, which weakens them and allows urine to leak out when you cough or sneeze.
    • Family history.
      • If a close family member has urinary incontinence, especially urge incontinence, your risk of developing the condition is higher.
    • Gender
      • Women are more likely to have stress incontinence. (Pregnancy, childbirth, menopause and normal female anatomy account for this difference.)
      • Men with prostate gland problems are at increased risk of urge and overflow incontinence.
    • Age
      • Changes with age reduce how much your bladder can hold and increase the chances of involuntary urine release.
      • Tobacco use may increase your risk of urinary incontinence.
    • Other diseases.
      • Neurological disease or diabetes may increase your risk of incontinence.
    • Medical tests:
      • Cystoscopic examinations
      • Blood chemistries
      • Urine analysis
      • X-rays
      • Special tests to determine
        • Time taken for urine to expel from the bladder after a bladder movement
        • Bladder capacity
        • Urethral pressure
        • Sphincter condition

Signs and symptoms

Learning to identify the signs and symptoms of incontinence is the first step to dealing with it. There are many different signs and symptoms for incontinence most recognizable is emotional and sensory signs amongst others: (Often these are linked to the awareness of the issue by the person)

Emotional Signs:

  • Desire for Attention
  • Decline in Social Activity
  • Anger

Sensory Signs:

  • Leakages when engaged in physical activity, laughing or sneezing
  • Urine or fecal odor in the room
  • Discomfort and irritability of perineal area
  • Soiling of bedding and underwear