Bladder (and bowel) incontinence - sshhh!
An astonishing one in 10 UK people suffer from bowel problems - mostly constipation. But equally surprisingly, one in 50 adults, and up to one in 12 older folk, suffer from bowel incontinence. At least one in five women over 40 have bladder incontinence. Tragically, shame and embarrassment prevent many from accessing the effective treatments that are available, and they end up prisoners in their own home. But there is help out there - you just have to make sure you get it.
Urinary incontinence - passing water when you don't want to - has two main causes with different treatments. That means it's important to work out which kind you have - although confusingly you can get both at the same time.
What are the symptoms?
Stress incontinence - the most common kind - leads you to leak urine when you cough, sneeze, run, jump or laugh. You'll often lose only fairly small amounts. Urge incontinence (overactive bladder) is the second most common kind, accounting for about 1/3 of cases of incontinence. It's thought to be due to over-sensitivity of the muscles that control passing water. You'll usually get a sudden feeling that you need to go to the loo urgently, followed by losing control. You may also feel the need to pass water more often, including at night. Some unfortunate women suffer from mixed incontinence, with both stress and urge symptoms.
What's the cause?
Stress incontinence is mostly down to weakness of your pelvic floor . Childbirth takes its toll, and it gets more common after the menopause as your supportive structures get less springy because of low oestrogen levels. Being overweight or constipated both increase the pressure inside your stomach, making stress incontinence more likely and the symptoms more severe. Urge incontinence can be down to problems with the nervous system, like multiple sclerosis or stroke, but it can simply be due to the brain getting the wrong messages from your bladder muscles. Urine infections and undiagnosed diabetes can also be to blame.
What's the treatment?
Strengthening your pelvic floor will often help both stress and urge incontinence, although you need to exercise several times a day for some weeks to get the benefit. These exercises can help or solve up to 60% of cases of stress incontinence. Avoiding constipation and losing weight, if you need to, will reduce the strain on your muscles. Try cutting down on caffeine (in tea, coffee and colas) if you have urge incontinence. Medicines like tolterodine, oxybutynin or solifenacin can help with overactive bladder.
Bowel incontinence - what's the cause?
Every case is different. Damage to the outlet of the bowel in childbirth can result in incontinence, often years later. Some medical conditions such as inflammatory bowel disease (Crohn's disease and ulcerative colitis) cause inflammation in the bowel which can lead to diarrhoea, bleeding and pain. Conditions affecting the nervous system, like multiple sclerosis and spinal injury are often associated with incontinence. Up to one person in three with Parkinson's disease also suffers. Sometimes, bizarrely, bowel incontinence is caused by severe constipation. Hard stools can't come out but pressure builds up behind them and liquid stools from further up the large bowel leak past.
What's the solution?
Options for treatment depend a lot on the cause and include:
- At least 1.5 litres of fluid a day if constipation is an issue
- Getting into the habit of trying to go to the toilet regularly after meals
- Pelvic floor exercises may help with bowel as well as bladder incontinence
- Private, comfortable toilet facilities where you can sit or squat to avoid straining
- Easy access to toilet or commode, and clothing that's easy to remove
- An assessment for incontinence pads if you're largely confined to bed or chair
- A food and drink diary, looking to change one food at a time to see its impact on your bowel habit
- An assessment from a district nurse (or ideally a specialist bowel nurse)
- Antidiarrhoeal medication such as loperamide or codeine may help, once constipation has been ruled out as a cause.
When all else fails
Most people with significant bowel incontinence have other medical conditions such as multiple sclerosis, spinal injury or inflammatory bowel disease. You're likely to have a specialist nurse as part of your medical team, who will be all too familiar with the issue. Of course, they won't be able to help if they don't understand the extent of your problems, so it's vital to be honest regardless of how embarrassing it is. If toileting habits and/or medication don't solve the problem, stimulation of the nerves involved in bowel control or surgery may be options. Anal plugs are better tolerated than you might imagine. For some people, especially with nerve damage causing their problems, an irrigation system called Peristeen® can give them their lives back.
With thanks to 'My Weekly' magazine where this article was originally published.