Incontinence

Incontinence explained

When you can't control your bladder or bowel, you may unintentionally leak urine from your bladder (called urinary incontinence) or faeces from your intestine (bowel incontinence).

What causes incontinence?

Causes of urinary incontinence may include:

• weak pelvic floor muscles
• changes in the nerves controlling the bladder or pelvic floor
• overactive bladder
• enlarged prostate (for men).

Causes of bowel incontinence may include:

• weak bowel muscles
• changes in the nerves controlling the bowel
• diarrhoea.

What incontinence signs and symptoms are there?

Each has a different set of symptoms. While some people only experience the occasional leak, others may experience total loss of control over their bladder or bowels.

Urinary incontinence signs:

• leaking urine when coughing, sneezing, laughing or exercising
• leaking urine before getting to the toilet
• passing urine frequently
• urgent need to pass urine
• difficulty starting to pass urine
• wetting the bed when asleep
• a feeling that the bladder doesn’t empty completely.
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Symptoms of bowel incontinence

• leaking from the bowel
• urgent need to open bowels
• being unable to control wind
• straining or difficulty emptying bowels.

How is incontinence determined to exist?

Talking to a medical expert is the first action you can take to help yourself if you have a bladder or bowel issue.

A doctor can evaluate your symptoms, determine the underlying issue, and talk to you about any treatments or exercises that might be able to solve your issues.

Your doctor might request or order these tests to assist diagnose the issue:

• a diary of your bladder habits
• a physical examination to assess your bladder, pelvic floor muscles (women) or prostate (men)
• a sample of your urine for testing
• a blood test to check the health of your kidneys
• an ultrasound scan of your bladder.

Some tests may help your doctor find the cause of your incontinence or a temporary problem, such as a urine infection, that can be treated quickly.

How is incontinence treated?

Managing a weak bladder or bowel is an individual thing and sometimes more than one treatment is needed. Treatments include:

• exercises to help you strengthen the muscles surrounding the bladder (pelvic floor exercises) or bowel
• bladder or bowel training
• medications
• surgery may be an option if other treatments haven’t worked.

How can incontinence products help me?

The right incontinence products will also help you manage the problem and carry on with normal life. Products include:

• washable products such as re-usable pads, which often come as part of a pair of pants
• disposable pads which are held in place by close-fitting pants
• disposable pants, or all-in-one pads with a plastic backing and adhesive patches to seal the sides
• bed or chair protectors in the form of disposable or washable pads
• for men, there are a range of products that fit over the penis and collect urine into a bag strapped to the leg.

You can buy most of these in pharmacies and supermarkets, but seek professional advice before using them permanently.

To qualify for free incontinence products provided by the NHS, you’ll need to meet criteria set out by your local NHS.

Contact your local NHS continence service or clinic for a location in your area and check if you need to be referred by your doctor.

A specialist nurse may need to assess if you are eligible and will then arrange your supply of products.

Tips for living well with incontinence

Be prepared

Try thinking of practical solutions to problems that might arise while you’re out. You could take some spare pads and pants with you. Scented bags for soiled pads or pants could be useful if you’re worried about smell.

You may find a toilet card helpful. The ‘Just Can’t Wait’ card states clearly that you have a medical condition and that you need to use a toilet urgently. Showing this card can help you avoid the queue for a public toilet.

Take care of your skin

Washing regularly and drying carefully with a soft towel will help to keep your skin healthy. Change pads regularly, using a disposable wipe to remove any residue. If your skin becomes broken, speak with your doctor or a nurse immediately as it can lead to a skin infection.

Change pads frequently to avoid smell

Fresh urine should not smell offensive. If it does, there may be an infection. Good quality pads help to absorb some smell, but always change wet clothes as soon as possible.

Smell from bowel incontinence is more difficult to hide. Change soiled pads as soon as possible and put them in an airtight container or sealed bag.

Stay hydrated

Drink normally, unless your GP or nurse has told you otherwise. You should aim to drink 6-8 cups of liquid each day. Tea, coffee or other caffeinated drinks make your symptoms worse. Drinking too many fizzy drinks, alcoholic drinks, or drinks with artificial sweeteners in them can also irritate the bladder.

Prevent constipation

Constipation (irregular bowel motions) can put pressure on your bladder or bowel and worsen incontinence. Eat plenty of fibre-rich foods (e.g. fruit, vegetables) and drink plenty of liquid. Keep active and exercise regularly.

Dress for ease

Try choosing clothing with elasticated waists, or fastenings with Velcro instead of zips and buttons.

Plan before you travel

If you’re going on a long journey with family or friends, and you know you’ll need to use the toilet frequently, let them know beforehand. That way you can identify potential stopping points and can feel more in control.

Consider home adaptations

If equipment or home adaptations, such as handrails in the bathroom or a commode, might help with your incontinence, speak to social services. You’re eligible for a needs assessment, conducted by your local authority, to find out what help and support you need at home.