Shame, embarrassment, anxiety, isolation—these are just a few of the emotional consequences of incontinence.  For some, incontinence is a simple daily inconvenience.  For others, its impact can be devastating, affecting personal intimacy and sexual activity, social relationships, and the ability to function normally at work or in public settings.   

Who suffers from incontinence?

You’re Not Alone

While most people associate incontinence with aging, men, women, teens, and children also struggle with the inability to effectively control bladder and bowel function for a number of different reasons.[2]

Incontinence, The Facts

• Approximately 20 million Americans suffer from urinary incontinence. Many of these individuals have difficulty with bowel control as well.[5]
• Women experience urinary incontinence twice as often as men.[9]
• About 1 in 3 women experience bladder control issues if they have ever given birth.

• 1 in 20 adults have both bladder and bowel incontinence.

• 1 out of every 100 adults never manages to gain complete bladder control at night.

• Approximately 1 in 5 children have experienced bed wetting at some point in their lives.

• Contrary to popular belief, incontinence is not an inevitable part of aging.[2]

What is incontinence?

The inability to control passing urine or feces is a major concern for many individuals.  This involuntary loss of control affects people on a daily basis.[5]

When does urinary incontinence occur?

Urinary incontinence involves the leaking of urine before an individual can get to a bathroom.  While millions of women and men have difficulty with UI, the impact it has on their lives varies.  While some individuals may only pass a small amount of urine when they cough, sneeze, or laugh, others may completely empty the bladder involuntarily at night, or when they cannot reach a bathroom quickly.  Urine may be passed while running or during sexual activity.  High emotional stress can bring about incontinence as well.[8][9]

What types of incontinence exist?

Both Urinary Incontinence (UI) and Fecal Incontinence occur in males and females.[8]

Several types of urinary incontinence exist based on the root cause of each.

These include:

Stress Incontinence (SI) is due to physical stress on the body including sneezing, laughing, coughing, and exercise.  Over 15 million Americans suffer from stress incontinence.  The majority of these individuals are women, aged 30-59.  Pregnancy, childbirth, and menopause may create SI.

Urge Incontinence refers to the sudden urge to urinate that cannot be stopped or controlled.  This often happens at night and is associated with urinary frequency. The condition is also known as an “overactive bladder”.  Individuals with urge incontinence often have anxiety if traveling to new locations or places that are unfamiliar.  The need to know where bathrooms are located, should the urge strike causes stress for those with urge incontinence.  This can also occur in response to the sound or touch of running water, or after drinking water.

Mixed Incontinence involves the combination of two or more types of incontinence such as, stress incontinence and urge incontinence.  This may require the use of pads for protection throughout the day.   

Overflow Incontinence refers to the inability to empty the bladder completely because of obstruction to the flow of urine.  This results in urine build-up throughout the day, causing leakage to occur.  Men with an enlarged prostate or individuals with a weakened bladder muscle may suffer with overflow incontinence.[5]  

Functional Incontinence refers to the inability to reach a toilet in time because of difficulties with mobility, or planning.  Alzheimer’s patients or wheel chair-dependent individuals may struggle with functional incontinence. 

Transient Incontinence refers to incontinence that is only temporary due to an illness such as, a bladder infection, or may be due to pregnancy. This type of incontinence will resolve naturally when the root cause is no longer present.[5]

What is Fecal Incontinence/Anal Incontinence?

Fecal incontinence involves the inability to control liquid or solid stool before reaching the toilet for elimination.  Anal incontinence includes the inability to control the expulsion of gas or mucus.[1]

How do I know if I’m incontinent?

Symptoms of urinary incontinence include the following:

• Leaking urine when coughing, sneezing or exercising
• Leaking urine directly before making it to the toilet
• Frequent urination
• Rushing urgently to the toilet
• Awaking 2 or more times each night to urinate
• Bedwetting while asleep
• Feelings that the bladder has not fully emptied
• Poor/inadequate urine flow
• Straining to empty the bladder
• Frequent urinary tract infections

Fecal Incontinence Symptoms

Symptoms of fecal incontinence are as follows:

• Premature leaking from the bowels as the urge to empty the bowel occurs
• Urgent rushing to the toilet accompanied by the feeling that bowels must be emptied immediately  
• Leaking from the bowels without feeling the need to empty
• Leaking from the bowels when passing gas
• Straining when attempting to empty the bowels[2]

Why did I become incontinent?

Risk Factors for Incontinence

Many factors can increase the risk of developing either urinary or fecal incontinence.  These include:

• Age 
• Gender   
• Smoking  
• Weight  
• Diseases  
• Nerve damage 
• Dementia  
• Physical disability[5] 

There are several reasons women become incontinent.  These include:

• Pregnancy—During pregnancy the unborn baby puts pressure on the bladder, urethra and pelvic floor muscles.  The pelvic floor support may become weak as a result, causing leaking urine or trouble passing urine.
• Childbirth—after giving birth, many women may be incontinent.  Labor and vaginal birth can weaken the pelvic floor support and damage nerves.  This may resolve after the body heals post partum.  
• Menopause—Once women enter menopause, the ovaries stop making the hormone, estrogen.  This may cause weakening of urethral tissue causing incontinence.
• Pelvic Organ Prolapse occurs when the pelvic organs, which include the uterus, bladder, and rectum move out of place and enter the vagina.

Both women and men may suffer from incontinence due to:

• Constipation—Chronic constipation may cause bladder control problems in individuals.
• Medicines—Certain medications such as diuretics may cause incontinence.  Hormone replacement therapy can worsen urinary incontinence.
• Caffeine and alcohol—Drinking too much coffee or soda with caffeine may cause the bladder to fill very quickly causing urine to sometimes leak.
• Infection —Urinary tract infections or bladder infections can cause incontinence.  This usually resolves once the infection is treated.
• Nerve damage —Once nerves are damaged, either through trauma or disease, such as diabetes or multiple sclerosis, mixed signals may be sent to the bladder at the wrong time, which may cause incontinence. Sometimes this occurs as a result of childbirth.
• Excess weight—Overweight individuals may experience worsening incontinence as weight puts pressure on the bladder.

Men often become incontinent for the following reasons:

• Prostate removal—Men may become incontinent due to the surgical removal of the prostate gland.  This can produce stress incontinence.
• Enlarged prostate—This sometimes blocks the urethra causing a strong urge to urinate.  This can result in overflow incontinence.[8]

Will I always be incontinent?

That depends on the reason for the incontinence.  Many medical interventions and procedures are meant to treat incontinence long term.

How is incontinence diagnosed?

Urinary Incontinence

Urinary incontinence may be diagnosed by a general practice physician or urologist through careful physical examination, patient health history, urine and blood tests, or tests to measure how well urine empties from the bladder.[8]

Diagnosing Fecal Incontinence

A physician may conduct a digital rectal exam and/or a pelvic exam to determine if reproductive organs are of normal size.  They may also perform blood tests, stool tests, urine tests, bowel function tests, an endoscopy or other imaging tests.[3]

Can my doctor treat incontinence?

Effective treatment for both urinary and fecal incontinence is available.

Treating Urinary Incontinence in Women

Many successful treatments for urinary incontinence are available today.  Treatment depends on the type of urinary incontinence diagnosed, and the primary cause for the condition. 

Medications for Urinary Incontinence in Women

Pharmaceuticals can be prescribed to help individuals void the bladder more completely.  Other medicines can help strengthen affected muscles.  Low dose estrogen may be applied as a vaginal cream to urethral tissue and vaginal walls to prevent urgency.  Injections that help thicken the area around the urethra may also help to close the bladder opening.

Other Treatments for UI in Women

Women may be able to use a disposable urethral insert or pessary (stiff ring) inserted into the vagina if a prolapsed bladder or vagina exists.

Nerve stimulation involving a mild electric current to the bladder may be used to help control urination.  

A mid-urethral sling, or a tension-free sling procedure may be successful for stress incontinence.

Bladder augmentation surgery for urge incontinence is effective.

Botox injections may be used to relax the bladder in some individuals.

Managing Urinary Incontinence

While ongoing treatment is always an option, sometimes urinary incontinence cannot be cured completely.  In this case UI must be effectively managed.

Products and supplies to help with urinary leakage include adult diapers, urine deodorizers, furniture pads and skin cleansers.

To minimize toileting accidents individuals may refrain from drinking too many caffeinated drinks, ensure the bathroom is well lit with clear access, wear undergarments that are easy to get on and off, and schedule regular bathroom breaks.

Male Treatment for Urinary Incontinence

For males, no medication has been approved as of yet for the treatment of stress incontinence.

Lifestyle Changes for Incontinence

To minimize leakage, men should avoid or limit the following:

• Tobacco products
• Alcohol
• Caffeine (coffee, tea, soda, chocolate)
• Spicy foods 
• Foods containing high concentrations of citric acid   
• Tomato-based foods 

Devices for Male Incontinence

These include condom catheters or clamps that squeeze the penis.

Placed inside the bladder, internal catheters may be used, but have a high rate of infection.

Bulking Materials

These are products, such as collagen that are injected directly into the urethra to block a quantity of urine flow.

Surgery

Surgical procedures for SUI may include either a pelvic sling or an artificial sphincter implant.  Surgeries may be necessary following prostate removal surgery.[6]  

What can I do to naturally treat incontinence?

There are a number of natural treatment options for women including:

• Bladder training
• Kegel exercises to strengthen muscles
• Fluid restriction/modification
• Caffeine reduction in drinks and chocolate
• Alcohol reduction
• Tobacco elimination
• Weight loss
• Acupuncture
• Hypnotherapy
• Vitamin D supplementation
• Magnesium supplementation[7]
• Group yoga therapy for incontinence in women[4]

Natural Treatment for Men

• Bladder control training
• Men can practice strengthening muscles that control urine flow.
• Losing excess weight
• Biofeedback strengthens the brain body connection to help individuals aware of signals from the body

• Timed voiding can be used to help train the body to urinate on a set schedule. 

• Lifestyle changes that help the body include eliminating foods that may cause constipation, refraining from heavy lifting, and drinking water instead of coffee or soda. 

Causes of Fecal/Anal Incontinence

Injury or weakness of the sphincter muscles necessary for fecal control may be due to:

• Childbirth
• Rectal surgery
• Weakness due to age

• As the smooth sphincter muscle loses some of its elasticity over time, the ability to hold stool becomes weaker causing feces to leak out.
• Constipation or loose stool may cause fecal incontinence.
• Rectal scarring from diseases such as ulcerative colitis or Crohn’s disease, or surgical removal of the rectum itself can cause stool to leak.
• Rectoceles or prolapses can cause fecal incontinence.
• Myopathies cause muscle weakness and lack of control of fecal material.
• Nerve damage to pudendal nerves that affect the sphincter muscles can be caused by a prolonged baby delivery, aging, trauma, or disease such as diabetes.   The inability of the sphincter to close, or for the nerves to communicate with the muscles, makes fecal incontinence a reality for some.[1]

Multiple causes may be apparent for individuals with fecal/anal incontinence.

Treating Fecal/Anal Incontinence

A urogynecologist, gastroenterologist, or a colon/rectal surgeon can diagnose incontinence.

Treatment may include:

• Physical therapy to strengthen muscles
• Surgery to repair torn sphincter muscles
• Medications to resolve diarrhea or constipation
• Surgery for Rectoceles (bulge through the rectum to the vagina in women) or Prolapses
• Nerve stimulation through electric impulses
• Medication to thicken the anal canal wall to help prevent leaking of a small amount of stool or mucus after a bowel movement.[6]

While millions of individuals suffer from urine or fecal incontinence, this may be of little consequence when it’s you. Learning more about the inability to fully control bladder and bowel function, as well as finding a caring healthcare practitioner who specializes in incontinent conditions is critical for optimal health and wellness.