By Dr David Delvin

Incontinence! This is a word that makes many people shudder! A lot of my patients have said to me “well doctor, once you’re incontinent, you’ve lost all your dignity, haven’t you? So life is scarcely worth going on with ……”.

Today, I hope to show you that those views are wrong. Being incontinent isn’t the end of the world. And this symptom can often be successfully treated!

But first of all, let’s get clear about what incontinence actually is.

What is incontinence?

Incontinence means ‘accidental leakage of urine – or bowel motions’.

In fact, leakage of urine is far, far more common, and affects literally millions of people in this country. So today I shall mainly be concentrating on urinary incontinence (‘wetting oneself’). But at the end of this article, there’s a short section on bowel incontinence.

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Who is affected?

Now who are these millions of people who are affected by urinary incontinence? They can be of any age, but in fact this symptom is commonest in:

• Older People
• Women
• More specifically, women who have had children

Why are women affected so much more often than men? For two reasons:

1. The female bladder is much nearer to the surface than the male bladder is;
2. The majority of women have had children at some time in their lives, and childbirth often weakens the ‘supports’ around the bladder.

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Your Waterworks

Now in order to understand incontinence, you need to have an idea of how your urinary system actually works. It’s like this.

The human body has to produce urine, or die. The urine is actually made by your kidneys, which are located just under your lowest ribs, at the back. From the kidneys, it flows down to your bladder, which is a kind of ‘storage bag’ or reservoir. The bladder is situated just behind your pubic triangle. If it gets very full, it’s possible to feel the top of it, in the part of your tummy which lies below your navel.

From the bladder, the urine gets to the ‘outside world’ through a narrow pipe called the urethra. (Say it ‘yew-wreath-ra’). In men, this pipe is quite long. It runs through the prostate gland, and downwards to the tip of the penis.

However, in women this little pipe is very short indeed, just about the length of a matchstick, in fact.

A few useful facts about urination

* Basically, it’s your brain that controls your bladder. When you decide that it’s time to go to the loo, your brain sends a message to your bladder saying ‘It’s OK to empty yourself’.
* Until that message is received, then in theory your bladder shouldn’t empty. Unfortunately, in cases of incontinence, that’s not what happens!
* A normal person passes urine about five or six times a day – that is, roughly every four hours. But you go less often in warm weather, and more often when it’s cold.
* Your bladder can easily hold about three quarters of a pint (400 ml) of urine.
* But when it contains much more than that, the bladder starts sending messages to your brain saying ‘Oy! I demand to be emptied soon….’.

Why not? Because of the fact that muscles located round the ‘outflow’ of the bladder are usually in a state of contraction, which keeps this ‘way out’ closed. They shouldn’t relax and open up the ‘exit’ until your brain gives the say-so.

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So why does incontinence occur?

Well, incontinence happens when something goes wrong with the mechanisms that stop urine from leaving the bladder. There are various types of incontinence, and among the commonest are:

• Stress incontinence;
• Urge incontinence;
• Overflow incontinence.

We’ll now look at each of these in turn.

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1. Stress Incontinence

This is the type which is so common in women. Accidental loss of urine occurs when you laugh, sneeze, or cough.

Incidentally, stress incontinence has nothing to do with emotional stress, as people often think! It means the ‘stress’ (or pressure) on the bladder caused by a laugh, a sneeze, or a cough.

Stress incontinence is usually caused by weakness in the muscles and other ‘supports’ around the outflow of the bladder. As I’ve already indicated, that weakness is frequently caused by childbirth – particularly repeated childbirth.

This type of stress incontinence is usually treated with ‘Pelvic Floor Exercises’ to begin with (see Question and Answer section). If those fail, then a gynaecologist can do a ‘tightening up’ operation, or possibly a hysterectomy.

Some older women prefer, instead of having surgery, to use a device called a ‘pessary’. This is a specially designed object with a gynaecologist can place in the vagina. It provides much needed support to the area where the urinary pipe leaves the bladder.

The menopause.  Another factor in causing stress incontinence can be the menopause. The fall in female hormones which occurs at ‘the change’ may lead to weakening of the supports’. Where this is the case, Hormone Replacement Therapy (HRT) may sometimes help, including HRT cream applied to the area round the urinary opening.

Stress incontinence in men.  This can happen after a prostate operation – because the structures around the bladder outflow have been damaged by the surgery. Pelvic Floor Exercises (see Q & A section) may help.

Also, many men aged over 50 find that they ‘leak’ a little, soon after they’ve been to the toilet to pass water. Again, pelvic exercises may be of some use.

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2.  Urge Incontinence

This means a common type of incontinence in which you get a sudden ‘urge’ to pass water and can’t get to the loo in time. It is quite common in older men and women, particularly those who have recently had a serious illness, such as a stroke.

The basic problem here is that the bladder has somehow become ‘over-active’. As a result, it gives you less warning that you really do need to head for the loo – fast.

Once your GP or urologist, or gynaecologist has diagnosed Urge Incontinence, then they’ll almost certainly suggest that you have a course of ‘Bladder Re-training’ (see Q & A Section).

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3.  Overflow Incontinence

This is a problem which mainly occurs in the over-60s (both male and female). It is caused by not emptying the bladder completely.

As a result of the failure to empty the bladder, what happens is that the volume of urine inside it keeps building up. Eventually the bladder becomes permanently full, and urine tends to be dribbling out of it.

Possible causes of overflow incontinence include:

• Prostate trouble;
• Diabetes;
• Strokes;
• Parkinson’s disease;
• Multiple Sclerosis (MS);
• Dementia – such as Alzheimer’s disease.

Overflow Incontinence can be difficult to treat. But with help from an urologist or a gynaecologist, the problem can often be eased.

Urinary Incontinence – Summing Up

So, urinary incontinence is not something to be ashamed of.  If it happens, it’s not your fault!  Best thing is to talk to your doctor, and let him/her work out what the underlying cause is.  After that, you may need a specialist advice – for instance from a urological surgeon (Urologist), or, if you’re a woman, a gynaecologist. 

Also in all parts of the country there are now specially trained ‘Incontinence Advisors’. These are people who know all about the various devices and articles of waterproof clothing which can often be used in cases of sever incontinence.

You’ll find more information in the Question and Answer section – see below.

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Bowel Incontinence

Incontinence of faeces is much rarer than incontinence of urine. For many people, it is much more embarrassing.

Among the possible causes are:

• Bowel operations – if they damage the muscles round the bottom;
• Constipation;
• Diarrhoea – for instance, caused by infection;
• Muscle damage caused by childbirth.

The most important thing is to see the doctor, so that he/se can sort out the cause and then help you decide on the best course of action. As is the case with urinary incontinence, bowel incontinence can usually be helped.

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Q. My doctor has recommended that I do ‘Pelvic Floor Exercises’. But what are they?

A. Pelvic Floor Exercises are good for both men and women, but particularly for women who have had children. They help to keep incontinence at bay!

A midwife or a physio can give you full and detailed instruction in ‘PF’ exercises. But for starters, what you do is this:

1. Each day, set aside two short sessions for your exercises. You can carry them out anywhere, because other people won’t know you’re doing ‘em! Lots of folk do them on buses…….
2. Tighten up the muscles round your urinary opening by pretending that you are trying hard to stop the flow of urine.
3. Hold that contraction for 10 seconds.
4. Release the contraction for 10 seconds.
5. Do it again – 10 times.
6. Continue with these twice-daily sessions for at least six months!

Q. I have been told that you can buy special devices to put into the vagina and to ‘squeeze’ on – in order to help incontinence. Is this a good idea?

A. Well, there are such devices. But I would take a physio’s, or midwife’s advice before you decide to spend money on one.

Q. A nurse told me that if it did the Pelvic Floor Exercises for incontinence, this would improve my sex life. Is that true, doctor?

A. The exercises do tend to help a lot of women’s love-lives, because they tighten up the muscles round the vagina. Good luck!

Q. What are ‘Bladder Re-training Exercises?’

A. Bladder Re-training Exercises are used in the treatment of ‘Urge Incontinence’ (please see above).

To do them properly, you need personal guidance by an expert, such as a doctor or Incontinence Advisor. But basically, what you need to do is this:

1. Get a little notebook, and carefully record in it every time you go to the loo (or are incontinent).
2. Under the guidance of your Advisor, gradually lengthen the interval between visits to the loo.
3. When you feel the urge to go, try to ‘hang on’ for a minute longer – even if you’re already near the toilet.
4. Use the ‘Pelvic Floor Exercises’ (outlined above) to enable yourself to hang on a little longer.

Bladder re-training is not easy. With the help of your health doctor, or Incontinence Advisor, you can do it!

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Q. I’m a man of 60, and I have suddenly become a little anaemic. Any ideas why?

A. The likeliest cause at your age is bleeding piles (haemorrhoids). But it’s very important that your own doctor looks for the cause of this anaemia – just in case it’s anything serious.

Q. I’m a widow, age 56. I’m thinking of getting remarried. But would resuming sexual intercourse at my age be harmful?

A. Not at all, ma’am. But if you want reassurance that your vagina is in good shape, do go along and have an examination at a Family Planning Clinic or a Menopause Clinic.

Q. I’m 53, and I keep getting painful little cracks at the tips of my fingers.

A. These minute cracks are very often in the over-50s at this time of year, and are mainly due to the cold weather. Each night, dab them with Vaseline before you go to bed. And during the day bind up your fingertips with a protective tape called Micropore, which you can buy from any chemist’s.

Q. My doctor gets very cross if I go to him with a cold, or cough, as he says its ‘wasting his time’. Any suggestions?

A. Well, you could change your doctor! Failing that, just go to your local pharmacist for advice. Pharmacists are generally very willing indeed to give you a helpful consultation on these matters.

Q. I have noticed that my motions have suddenly become black. Why?

A. There could be a harmless explanation. Black motions can be caused by taking Iron pills, or by drinking red wine.

However, in general the appearance of dark, ‘tarry’ motions means that you are bleeding somewhere inside you. So you must get your GP to sort this out at once.

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