Incontinence - prevention tips

Incontinence means involuntary leakage of urine (wee) or faeces (poo) or both. Over four million Australians are affected by accidental leakage from the bladder and bowel. Incontinence can occur in men or women of any age, but it is more common in older people.

In many cases, incontinence can be prevented.

Signs of a healthy bladder and bowel

Signs of a healthy bladder and bowel include:

• urinating between four and six times per day, and once (or not at all) during the night
• urine that is usually pale yellow – dark yellow or brown urine may indicate that you are not drinking enough (dehydration)
• producing bowel motions (poo) between three times a day and three times a week
• having bowel motions that are soft and easy to pass
• not having any accidental leaks.

Bladder and bowel symptoms that may indicate a problem

Any of the following symptoms may indicate a problem with your bladder or bowel:

• accidental leakage of urine or faeces
• inability to get to the toilet in time
• passing small amounts of urine many times a day
• needing to get out of bed often, every night, to pass urine
• difficulty with starting to urinate
• urination stream that keeps stopping and starting
• a burning or stinging sensation when you urinate
• the feeling that your bladder isn’t empty after urinating
• sudden onset of bedwetting
• chronic constipation.

If you have any of these symptoms, or if you have any concerns at all about your toilet habits, see your doctor, or talk to a continence professional.

Prevention of incontinence

To prevent urinary and faecal incontinence it is important that you:

• drink plenty of fluids
• eat a high-fibre diet
• are physically active
• practice good toilet habits
• make healthy lifestyle choices.

Drinking fluids helps prevent incontinence

Dehydration can cause constipation or bladder irritation. To prevent dehydration:

• Do not wait until you feel thirsty to have a drink of water.
• Drink up to two litres (six to eight glasses) of fluid (preferably water) each day, unless advised otherwise by your doctor.
• Drink more fluids in hot weather or after heavy exercise.
• Take small sips and spread your drinks evenly throughout the day.

Water is the best fluid for preventing dehydration, but other hydrating fluids may include fruit juice, tea, coffee, milk or soup. Limit your daily intake of carbonated drinks, alcohol, tea and coffee because they can cause bladder irritation.

You can check to see if you are drinking enough fluid by looking at the colour of your urine. If you are well hydrated, your urine should be pale yellow (except for the first urine passed of the day, which is often more concentrated). Urine that is dark yellow in colour may indicate you have not had enough fluid. Remember that some medications, vitamins and foods can affect the colour of urine.

High-fibre diet helps prevent incontinence

It is important to eat well to keep your bowels healthy and regular. Your diet should contain food that is high in fibre. Dietary fibre is not digested, so it adds bulk to the stools (poo), which is important to keep things moving and to avoid constipation. A poor diet can cause chronic constipation, which can lead to faecal incontinence.

Suggestions for adding more fibre to your diet include:

• Eat plenty of wholegrain cereals (such as porridge, brown rice, wholemeal pasta, wholemeal bread or pulses such as lentils and beans) rather than highly processed or refined food.
• Eat fruit (at least two pieces) and vegetables (at least five serves) every day.
• Aim for 25–30 g of fibre every day. As a rough guide, a bowl of muesli contains about 8 g of fibre and an apple (with skin) has just over 3 g.
• Drink up to two litres of fluid per day (dietary fibre needs water in order to plump up the stool).

Physical activity helps prevent incontinence

Physical activity helps prevent constipation by stimulating muscular activity of the bowel (peristalsis).

Exercise also helps to maintain a healthy body weight, which reduces pressure on the pelvic floor – the sling of muscle directly responsible for bladder and bowel control.

Suggestions for physical activity include:

• You don’t have to choose an expensive activity – a brisk 30-minute walk every day is free and great for your general health.
• Pick something that’s fun – you are more likely to stick to a regular exercise routine if you enjoy the activity.
• Keep your pelvic floor muscles in shape – obesity, pregnancy, childbirth, regular heavy lifting, high impact exercise and a chronic cough can weaken the pelvic floor, but you can strengthen these muscles with specific exercises.
• If you haven’t done any physical activity for a while, see your doctor and complete an Adult Pre-Exercise Screening Questionnaire before starting.

Good toilet habits help prevent incontinence

Good toilet habits can help to prevent bladder and bowel problems. Suggestions include:

• Go to the toilet to urinate only when your bladder is full. If you make a habit of trying to urinate ‘just in case’, you’ll teach your bladder to signal the urge to urinate when it isn’t full.
• Take your time on the toilet. Allow urine to flow at its own speed (don’t use your pelvic floor to push out urine).
• Go to the toilet when you feel the urge to pass a bowel motion. Hanging on can lead to constipation.
• Give yourself plenty of time to pass a bowel motion.
• Don’t strain to open your bowels. Regular straining can cause problems including haemorrhoids (swollen veins in the anus), and can weaken your pelvic floor muscles.
• Use correct posture on the toilet (it can help you pass a bowel motion). Put your feet on a footstool, place your elbows on your knees, bulge out your stomach and straighten your back.
• Treat laxatives as a short-term solution and work on treating constipation with diet, exercise and lifestyle changes.

A healthy lifestyle helps prevent incontinence

Healthy food choices, exercising and managing your weight are important to prevent incontinence. Suggestions for a healthy lifestyle include:

• maintain a healthy weight – excess body fat strains the muscles of the pelvic floor. Lose weight slowly and sensibly with improved eating habits and regular exercise. See your doctor for more information
• seek medical advice – beware of self-diagnosis. Constipation is sometimes a symptom of an underlying health problem. Always see your doctor for diagnosis and treatment advice
• don’t smoke – if you smoke, quit. A chronic cough because of smoking weakens the pelvic floor and contributes to the onset of incontinence
• treat urinary tract infections (UTIs) promptly – UTIs irritate the bladder lining. Seek immediate treatment if you have symptoms.

Where to get help

• Your GP (doctor)
• Local continence clinic or service
• A continence or pelvic floor physiotherapist
• National Continence Helpline Tel. 1800 33 00 66