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We learn how to go to the toilet at a young age. It is drilled into us. The idea that losing control of our bowels, or bladder, in public, is a shameful thing. It is no surprise then that people who are unable to control their bladder, or bowels, due to an underlying medical condition, can find it very difficult to deal with. It can lead to issues with socialising, or going out. If you have to travel, will you be able to make it to the nearest toilet in time? Will there be an area where you can clean yourself, or your loved one, if you do have an accident?
The stigma associated with incontinence can put people off seeking help. Coupled with a decreasing social circle, it can also lead to isolation.
It is important to understand that incontinence can be caused by several medical conditions, and some of them are treatable. For those that are not, the condition can be managed in ways to decrease the impact on a person’s life.
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This is where you are unable to control your bladder. It can be an acute issue, which has happened suddenly, or a chronic one. It could mean that you are wetting yourself a little bit occasionally, or that you have completely lost control of your bladder.
Lots of different things can cause urinary incontinence, some treatable, and some chronic conditions with no available treatments.
Urinary Tract Infection (UTI)
One of the most typical causes of acute urinary incontinence (new incontinence in someone who has previously had good control of their bladder) is a urine infection. A urinary tract infection is an infection of the urethra. This is the tube which you use to urinate and carries urine from your bladder to outside of your body.
It is more common for women than men to get UTIs. This is because the urethra in women is shorter than that of men. Therefore, it is easier for bacteria to travel up.
Symptoms of a urinary tract infection are:
- Passing urine little and often
- Pain when you pass urine
- Blood in your urine, or when you wipe
- Urinary incontinence
If left untreated, simple UTIs can travel up through your bladder and into your kidneys. This causes a condition called pyelonephritis. This is an unpleasant condition which causes back pain, vomiting and high fevers. In severe cases, it can damage your kidneys. If you have any of these symptoms, you should go to A&E, where if you are found to have pyelonephritis, you will get antibiotics through a drip and may be admitted to hospital.
Most of the time, a UTI can be treated with simple oral antibiotics and needs no further investigation. If you have a more complex urinary tract infection (this could be a recurrent infection, or severe bleeding with an infection), then you may be referred for further investigations to check that there is not something more serious underlying them.
In some cases, a urinary tract infection can cause your bladder to stop emptying properly. This would mean that urine continues to collect in your bladder, but isn’t emptying. This causes your bladder to keep getting bigger and bigger and is known as urinary retention. Urinary retention can cause incontinence, as your bladder can’t hold anymore and urine keeps leaking out of you.
Urinary retention can be very painful. You can’t just decide to go to the toilet, because the bladder has stretched so much that it isn’t capable of contracting and pushing out the urine inside of it. If this is the case, the only treatment is to insert a catheter into the bladder, which drains the urine.
Suppose there was over one litre of urine in your bladder when this is done. In that case, you will be admitted to hospital to monitor how well you are producing urine. You may need several blood tests to check your kidney function. This is because, after you have had severe urinary retention, your body can start to over-react and produce too much urine. This means you can lose some of the salts out of your blood, and it is important to monitor your urine output to make sure that this doesn’t happen.
If you had less than a litre in your bladder, then you may be discharged home with the catheter either removed, or still in place. If you go into retention again, you will have to go into hospital. If you are discharged with the catheter in place, then you will be brought back to a clinic to have it removed in a few days, to see if you can pass urine as usual. This gives your bladder time to rest and heal.
There are other things which can cause urinary retention. Some of these are:
- In men, having an enlarged prostate which blocks the flow of urine out of your body. This could be due to prostatic cancer, or just be due to general ageing.
- Certain medications, including some used for depression, antihistamines and muscle relaxants.
- Problems with the nerves which signal from the brain to the bladder to pass urine. This can be caused by problems with the back, multiple sclerosis, diabetes, or stroke.
This is a type of urinary incontinence where the muscles surrounding your bladder and urethra become weak. When you do things like cough, which increases the pressure inside your abdomen and around your bladder, this can cause a little bit of urine to leak out.
This type of incontinence is far more common in women. This is because their urethras are shorter, and therefore the distance the urine has to travel to escape is shorter. Also, a common cause of this type of incontinence is childbirth.
When you give birth vaginally, the muscles and tissues in your pelvis, including those around your bladder, become stretched and weak. This is what can lead to stress incontinence. Pregnancy itself is also a risk factor, even if you have had a caesarean section. This is because the weight of holding the baby for nine months presses down on the muscles in your pelvis, causing them to stretch, having the same effect as childbirth. The more pregnancies you have, the more likely you are to suffer from incontinence.
To start with, treatment for this kind of incontinence could be to lose weight, or take up pelvic floor exercises. Losing weight decreases the pressure on the bladder, and pelvic floor exercises strengthen the muscles surrounding it. This may be all that is needed to treat this type of incontinence.
In some cases, surgery may be considered. If you are a woman with a prolapse, which is where part of your vagina is collapsing down into itself, then correcting this may help with your incontinence. This type of surgery would be done by a gynaecologist. If you are considering surgery to help manage an issue with incontinence, talk to your GP for advice which is tailored to you and your circumstances. Surgery may, or may not be, successful and could have complications. Other treatments for prolapse may be considered first, such as hormone creams, or shelves which are inserted inside the vagina to hold it up.
This is where someone suddenly feels the urge to pass urine, but is unable to make it to the toilet in time. The urge can come on very quickly, making it impossible to hold on until you get to the toilet.
Lifestyle changes can also help with this type of incontinence, for example, limiting fizzy drinks and caffeine. Losing weight may also help, along with pelvic floor exercises. If you see your GP, you will likely be offered bladder training. This is where you are given techniques to help to lengthen the amount of time between when you feel you need to urinate and when you pass urine. Bladder training takes a while to work, around 6 weeks.
Urge incontinence can be helped at home, in part, by a Male Urinal or Female Urinal, which provides you with an instant solution for the urge, especially if your toilet is not right next to you.
There are medications which in severe cases can be used to help with urge incontinence. A common drug prescribed would be oxybutynin. The medications used for this type of incontinence can have some unpleasant side effects. As a result, other forms of treatment are usually tried before this, like bladder training.
Some side effects are:
- Dry mouth
- Dry eyes
- Blurred vision
- Rarely, it can lead to a condition called glaucoma. This is where pressure builds inside the eye and can be sight-threatening and painful. This condition needs to be seen and treated urgently by a doctor.
When Should I Be Worried About Losing Control of My Bladder?
If you have had incontinence for a while, and are otherwise well, you should see your GP. If you have previously had good bladder control, and suddenly have severe recurrent incontinence, then you should attend A&E.
Most conditions which cause incontinence aren’t emergencies. There are a few, however, which need investigation and treatment straight away. Some other symptoms to look out for if you have new incontinence are:
- Back pain – if you are suffering from back pain and new incontinence of your bladder, or bowels, you could be suffering from a condition known as cauda equina. This is where something is pressing on the spinal cord in the bottom of your back. It could be something as simple as a bulging disc, which are fluid-filled cushions which sit between the bones in your spine. If one of these discs presses on the spine enough to stop the nerves working properly, this can cause you to lose control of your bladder. This condition may need urgent surgery. If you have back pain and new incontinence, you should attend A&E straight away.
- Weakness in any part of your body – this could be a sign that something in your brain is affected. This can sometimes happen in a stroke. If you are experiencing new weakness in any part of your body, you should always seek help urgently, and call 999, with, or without, incontinence.
- Confusion – when someone has new confusion and incontinence of urine, there could be a number of causes. It may be due to an infection, or even a side effect of medication. If someone is suffering from new-onset confusion, this is another reason to be assessed urgently.
- Fever, back pain and vomiting – this could be a sign of a severe urinary infection which has spread up to the kidneys.
- Abdominal pain – pain in your abdomen, along with new incontinence, could mean that you are in retention. Urinary retention needs to be treated so that you can pass urine normally, otherwise, it can cause damage to your kidneys. If you have these symptoms, then you should attend A&E.
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There are many different treatments available for all types of incontinence, and many are very effective. Some people, however, will have chronic urinary incontinence despite treatment. For those just starting treatment, it may take a while for it to work.
There are plenty of products available which can help to make managing urinary incontinence easier. They range from aids to protect bedding, or different types of continence pads or briefs.
An example of these are our 1 Way Female Briefs and our 1 Way Male Briefs.
You shouldn’t use sanitary towels for urinary incontinence, because they simply aren’t designed for holding urine. Using sanitary towels can make your skin around your groin painful, and can even cause sores. It is also far more likely to lead to leaking.
One essential mobility aid for living with incontinence is a waterproof mattress protector. If a mattress becomes wet, a lot of problems can occur. It is important to protect a mattress from getting wet, whether resulting from minor spills, or incontinence. If moisture is let into a mattress for too long, fungal mould can form and the mattress becomes a haven for bacteria growth.
Why Can’t I Just Have a Catheter?
If you suffer from long term incontinence, or are caring for someone who does, you might wonder why a long term catheter is not generally used as a solution. A catheter is a plastic tube which is inserted through the urethra into the bladder where it continuously drains urine.
Because it goes from outside of your body into your bladder, a catheter can cause infection. Bacteria can travel along this tube into your bladder and cause severe infection.
There are also other things to consider. For example, if you are caring for someone with dementia who has long-term incontinence, they may become agitated and pull out the catheter. This can cause trauma and bleeding to the urethra.
If they have had the catheter for a while, the bladder may not merely be able to start working normally again, and this can lead to urinary retention. This can lead to frequent, unpleasant reinsertion of the catheter. In most cases, it is better to use incontinence products.
If the catheter was inserted for urinary retention, and there is an underlying condition causing this, there may be no other option. People with these types of conditions will need long-term catheters, as this is the only way for urine to be drained from the bladder.
Rather like urinary incontinence, this is where someone loses control of their bowels. It is less common than urinary incontinence, and if you are suffering from this type of incontinence, you should always seek a medical opinion.
There are a few reasons why someone may have incontinence of their bowels. These include:
- Irritable bowel syndrome (IBS), or food intolerances – conditions like this which can cause chronic diarrhoea may lead people to occasionally lose control of their bowels.
- Inflammatory bowel disease – these are either ulcerative colitis, or Crohn’s disease, and are where your bowels become inflamed. They are auto-immune conditions, and similar to IBS, cause chronic diarrhoea.
- Issues with the nerves around your rectum – if you have a neurological condition (a condition caused by an issue with your nerves), then this may cause you to have issues with emptying your bowels. Some examples of conditions like this are multiple sclerosis, stroke, and cauda equina.
- Severe haemorrhoids (piles) – these can affect the way that your back passage (anus) closes. This can lead to leaking, or smearing.
Treatment for bowel incontinence will depend on the underlying condition. Some of the treatments overlap with urinary incontinence and could start with losing weight, or pelvic floor exercises. The use of incontinence products can also help, and these are similar to those used for people with urinary incontinence.
Someone with bowel incontinence, Antibacterial Incontinence Wipes are an essential mobility aid for keeping clean and replacing the need for excessive washcloths, bowls of water, separate moisturisers and barrier cream
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Bladder and Bowel UK are a charity dedicated to helping people with incontinence. They operate a helpline, Monday to Friday, from 9am to 4:30pm. They have information and resources for both adults and children suffering from incontinence, and advice on which incontinence products to use.
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Medical terms are often baffling and difficult to fully understand. To help, we have listed some frequently used terms below.
Acute – a condition which has happened suddenly, or is being treated in the short-term
Catheter – a device which is inserted where you pass urine (the urethra) into the bladder. This drains urine from your bladder into a bag outside of your body, eliminating the need to go to the toilet
Chronic – a condition which has been present for weeks, or months.
Glaucoma – a medical condition affecting the eye. Fluid from inside the eye becomes blocked and unable to drain, this leads to increased pressures, pain, and blurred vision. It can be a sight-threatening condition and requires urgent treatment.
Incontinence – unintentionally losing control of your bladder, or bowels
Pyelonephritis – an infection which affects the kidneys