Incontinence and continence problems

Bladder and bowel control problems are common. More than four million Australians regularly experience leakage from the bladder and bowel (incontinence). Many others have bladder and bowel control problems, such as needing to go to the toilet more frequently and an urgency to go without leakage. Together, these problems are often called continence problems.

Although incontinence and continence problems have a considerable impact on a person’s quality of life, many people do not seek help. Embarrassment often prevents people talking about their bladder and bowel problems. Some people restrict going out and have little social contact outside their home.

There is no need to become a recluse. The good news is that for most people, these problems can either be cured or at least better managed. You can lead a normal life without needing to plan your activities around the toilet.

Incontinence and continence problems are common

Incontinence and continence problems affect people of all ages, gender, cultures and backgrounds. Despite popular beliefs, older people are not the only ones affected.

Some incontinence facts include:

• One in three women who have had a baby experience loss of bladder control.
• One in five children wet the bed at some time.
• One in 100 adults never achieve bladder control at night.
• One in 20 adults experience bladder and bowel control problems.

Bladder and bowel control problems are not an inevitable part of ageing. Visit your doctor to discuss treatment and management options.

Continence problems and bladder or bowel issues

Incontinence and continence problems are symptoms of bladder or bowel dysfunction. They tell you that something is not quite right. Pelvic floor muscle weakness is a common cause of these symptoms. Changes to the nerves controlling the bladder, bowel or pelvic floor can also result in loss of control.

Sometimes, other health problems such as diabetes, stroke, Parkinson’s disease or multiple sclerosis can cause bladder or bowel control problems.

Symptoms of bladder continence problems

People with bladder control problems may experience:

• leaking urine with coughs, sneezes or exercise
• leaking urine on the way to the toilet
• passing urine frequently
• rushing to the toilet (urgency)
• getting up twice or more at night to pass urine
• wetting the bed when asleep
• feeling their bladder is not completely empty
• having poor urine flow
• straining to get the bladder to empty
• frequently having urinary tract infections (UTIs).

Symptoms of bowel continence problems

People with bowel control problems may experience:

• leaking from the bowel with the urge to open their bowels
• rushing to the toilet and feeling the need to urgently open their bowels
• leaking from the bowel without the urge to open their bowels
• leaking from the bowel on passing wind
• being unable to control wind
• straining to empty their bowels.

Types of bladder control problems

Urinary incontinence and continence problems may include:

• stress incontinence – leakage of small amounts of urine with exertion. Causes include childbirth, being overweight and prostate surgery
• urge incontinence – leakage following a sudden urge to urinate. Causes include stroke, enlarged prostate gland and Parkinson’s disease, but often the cause is unknown
• overflow incontinence – leakage because the bladder does not empty well and overfills. Causes include multiple sclerosis, an enlarged prostate gland and diabetes
• functional incontinence – leakage of urine because a person was unable to get to or use the toilet due to a physical disability, a barrier in their environment or because of an intellectual or memory problem. Causes include dementia and poor mobility.

Types of bowel control problems

Bowel problems have many causes and may result in:

• diarrhoea – frequently passing loose bowel motions. Causes include infection or bowel conditions such as Crohn’s disease and ulcerative colitis.
• constipation – passing hard, dry bowel motions (with difficulty or straining). Causes include not drinking enough fluid, eating a diet low in fibre and lack of exercise.
• faecal incontinence – an uncontrolled loss of a bowel motion. Causes include diarrhoea and constipation. It can also result from a problem in the lower bowel or anus, making it difficult to hold onto a bowel motion. Causes include childbirth and nerve problems such as diabetes.

Treatment for incontinence and continence problems

If you have incontinence or continence problems, you should seek help. There is a range of management options available. The treatments depend on the type of incontinence you have and what you hope to achieve.

An incontinence management plan will usually include several of:

• adequate fluid intake of up to two litres (6 to 8 glasses) each day (your urine should be pale yellow in colour)
• a diet rich in fibre (such as wholegrain bread, cereals, fruit and vegetables) to prevent constipation
• a pelvic floor muscle exercise program
• a bladder retraining program
• a toileting program
• medication
• incontinence aids such as pads, condom drainage or catheters.

Prevention of incontinence and continence problems

There are things you can do to help keep your bladder and bowel healthy, and avoid incontinence and continence problems.

Suggestions for healthy lifestyle choices include:

• Drink plenty of fluid – up to at least two litres (six to eight glasses) each day, unless your doctor advises you otherwise.
• Eat well to prevent constipation and to maintain a healthy body weight – eat plenty of wholegrain foods (such as porridge, brown rice, wholemeal pasta, wholemeal bread, or pulses – lentils and beans) rather than highly processed or refined food and at least two pieces of fruit and five serves of vegetables every day.
• Exercise regularly (at least 30 minutes every day) to keep fit and to prevent constipation.
• Tone up your pelvic floor with pelvic floor exercises for good bladder and bowel control.
• Practise good toilet habits to prevent bladder and bowel control problems.

Good toilet habits can help to prevent incontinence and continence problems. These include:

• going to the toilet to pass urine only when you have the urge to go – don’t go ‘just in case’
• taking time to completely empty your bladder and bowel
• not delaying going to the toilet when you have the urge to use your bowels
• using the correct posture on the toilet to help you pass a bowel motion (place your elbows on your knees, bulge out your stomach, straighten your spine and put your feet on a footstool (if it is safe to do).

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
• Incontinence In Confidence website for young people