Incontinence, the involuntary loss of bladder or bowel control, is a condition that affects 1 in 4 adult Australians [1]. While it is more common in older adults, it can also occur in younger individuals due to various factors like pregnancy/childbirth, surgery, muscular issues or underlying medical conditions. Though it can be an embarrassing and often misunderstood issue, incontinence is manageable and treatable in some cases with the proper management strategies.
What Is Incontinence?
Incontinence is broadly categorised into two types:
- Urinary Incontinence: This refers to the inability to control urination. It can manifest as occasional leaks or more severe, persistent leakage. Types of urinary incontinence include:
- Stress Incontinence: Occurs when physical activity puts pressure on the bladder. Some examples include coughing, sneezing, laughing, or lifting heavy objects.
- Urge Incontinence: A sudden, intense urge to urinate that is followed by involuntary leakage.
- Overflow Incontinence: The bladder fails to empty, leading to frequent dribbling of urine.
- Functional Incontinence: Physical or mental impairments prevent timely access to the bathroom.
- Fecal Incontinence: This involves the inability to control bowel movements, which may result in unintended leakage of stool or gas. It can be caused by nerve damage, muscle weakness, or other medical conditions.
Prevention of Incontinence
While some causes of incontinence, such as age or underlying medical conditions, may not be preventable, many lifestyle changes and proactive strategies can help reduce the risk or delay the onset of incontinence.
- Maintaining a Healthy Weight
Excess weight, especially around the abdomen, can increase pressure on the bladder and pelvic floor muscles, making incontinence more likely. Maintaining a healthy weight through proper diet and exercise can reduce this risk and assist with improved bladder control.
- Pelvic Floor Strengthening
One of the most effective ways to prevent urinary incontinence, especially stress incontinence, is pelvic floor exercises, known as Kegel exercises. These exercises help strengthen the muscles that control urine flow.
- Avoiding Bladder Irritants
Certain foods and drinks can irritate the bladder and increase the likelihood of incontinence. Caffeine, alcohol, carbonated beverages, and spicy foods can trigger urgency or frequency in people with bladder sensitivity. Identifying and avoiding these irritants may significantly reduce symptoms.
- Quitting Smoking
Smoking is linked to an increased risk of incontinence, particularly because it leads to chronic coughing, which can strain the bladder and pelvic floor muscles. Smoking also contributes to weakened tissue and muscle damage. Quitting smoking reduces these risks and improves overall health.
- Staying Hydrated
Although it may sound counterintuitive, drinking adequate water is essential for maintaining bladder health. Dehydration can irritate the bladder, while staying hydrated ensures the body’s waste removal system functions appropriately.
- Bladder Training
For those who experience urinary urgency or frequency, bladder training can be an effective prevention strategy. This involves gradually increasing the time between bathroom visits to help retrain the bladder to hold more urine.
- Managing Constipation
Chronic constipation can put pressure on the bladder and pelvic floor, contributing to incontinence. Eating a fibre-rich diet, drinking plenty of water, and exercising regularly can help prevent constipation and reduce its impact on bladder control.
Management of Incontinence
For those who are already experiencing incontinence, various management strategies and treatments are available to help manage the condition effectively. These may include lifestyle changes, medical treatments, and surgical options, depending on the severity of the condition.
- Behavioural Therapy
Behavioural therapies such as bladder training and timed voiding are common methods for managing urinary incontinence. These involve setting specific intervals to use the bathroom, gradually increasing the time between trips, and training the bladder to hold more urine.
- Pelvic Floor Exercises (Kegels)
As mentioned earlier, Kegel exercises strengthen the pelvic floor muscles, which are crucial in bladder and bowel control. Regular practice can improve bladder control and prevent leakage, especially in cases of stress incontinence.
- Medications
For some types of incontinence, particularly urge incontinence, medications may be prescribed to relax the bladder muscles or reduce the overactivity of the bladder.
- Absorbent Products
Using absorbent pads or adult pants can help manage leaks and ensure comfort for individuals with moderate to severe incontinence. These products are designed to be discreet and keep individuals dry throughout the day.
- Electrical Stimulation
Electrical stimulation may strengthen the pelvic floor muscles or improve nerve function. This therapy involves using a small device that sends electrical impulses to the pelvic muscles.
- Surgical Options
For severe cases of incontinence that do not respond to other treatments, surgery may be considered.
- Slings or Pessaries: These devices help support the bladder and reduce leakage in people with stress incontinence.
- Bladder Neck Suspension: A procedure to reposition the bladder to prevent leaks.
- Sacral Nerve Stimulation: A procedure that involves implanting a device to stimulate nerves responsible for bladder control.
Psychological Support and Lifestyle Adjustments
Incontinence can be emotionally and socially challenging. People with this condition may experience embarrassment, anxiety, or depression, which can further affect their quality of life. Psychological support, such as therapy or support groups, can help individuals cope with these feelings.
Additionally, making small adjustments to daily routines—such as avoiding long trips without bathroom access, practising good hygiene, and wearing loose, comfortable clothing—can help make incontinence more manageable.
When to See a Doctor
If you experience any form of incontinence, it is beneficial to consult a healthcare provider. They can determine the underlying cause and recommend appropriate treatments. If incontinence is sudden or associated with other symptoms like pain or blood in the urine, immediate medical attention is necessary.