>Continence Information > About Incontinence > What is Incontinence?

Incontinence is the accidental or involuntary loss of urine from the bladder (urinary incontinence) or bowel motion, faeces or wind from the bowel (faecal or bowel incontinence).

Urinary incontinence

Urinary incontinence is a term used to describe losing control of your bladder and wetting yourself. This includes being damp or soaked. Incontinence relates to poor or lack of control, which includes symptoms such as urgency and frequency.

How the bladder works

The bladder is a storage organ that sits in your pelvis. Urine is made by your kidneys and stored in the bladder until you are ready to empty it. When you go to the toilet your bladder outlet muscles (urethral sphincter and pelvic floor) relax and your bladder contracts (squeezes) emptying your bladder of urine. Your brain controls your bladder by sending messages to tell it when to hold on and when to empty.

A normal bladder:

• empties 4-8 times each day (every 3-4 hours);
• can hold up to 400-600ml of urine (the sensation of needing to empty occurs at 200-300 ml);
• may wake you up once at night to pass urine and twice if you are older (i.e. over 65 years of age);
• tells you when it is, full but gives you enough time to find a toilet;
• empties completely each time you pass urine; and
• does not leak urine.

Anatomy of urinary bladder and pelvis with pelvic floor muscles

Male	Female

Types and causes of urinary incontinence

Urinary incontinence or bladder problems can happen for many reasons. There are different types of incontinence with a number of possible causes. The following are the most common.

Stress incontinence

Stress incontinence is the leaking of small amounts of urine associated with activities that increase pressure inside the abdomen and push down on the bladder. Stress incontinence is most common with activities such as coughing, sneezing, laughing, walking, lifting, or playing sport. This occurs mainly in women and sometimes in men (most often as a result of prostate surgery).

Pregnancy, childbirth and menopause are the main contributors to stress incontinence in women. Pregnancy and childbirth can stretch and weaken the pelvic floor muscles that support the urethra causing stress incontinence with activities that push down on the bladder.

During menopause, oestrogen, a female hormone, is produced in less quantity thereby thinning the lining of the urethra. The thickness of the lining keeps the urethra sealed after passing urine (much like a washer seals water from leaking in a tap) and as a result some women experience stress incontinence during menopause.

Many men develop stress incontinence after prostate surgery. This can take 6 to 12 months to resolve and it is recommended that men seek help from a health professional to address the issue.

Other factors contributing to stress incontinence include diabetes, chronic cough (linked with asthma, smoking or bronchitis), constipation and obesity.

Urge incontinence

Urge incontinence is a sudden and strong need to urinate. It is often associated with frequency (the need to frequently pass urine) and nocturia (waking several times at night to pass urine). Some people with urge incontinence get little or no warning and wet themselves before they get to a toilet.

Urge continence is often due to having an over-active or unstable bladder. This can happen at any age but it becomes more common as people get older. Urge incontinence can be linked to stroke, Parkinson's disease, multiple sclerosis and other health conditions which interfere with the brain's ability to send messages to the bladder via the spinal cord. This affects a person's ability to continue to hold and store urine.

Urge incontinence may also occur as a result of constipation (not being able to empty the bowel or having difficulty doing so), an enlarged prostate gland or simply the result of a long history of poor bladder habits. In some cases the cause of an over-active bladder is unknown.

Overflow incontinence

Overflow incontinence occurs when the bladder does not empty properly and leakage occurs as a result. Symptoms of incomplete bladder emptying include:

• straining to pass urine;
• a weak urine stream;
• feeling as if your bladder is not empty just after going to the toilet;
• little or no warning when you need to pass urine;
• passing urine while asleep;
• frequent urinary tract infections or cystitis; and
• 'dribbling' more urine after visiting the toilet.

There are several causes for this:

• a blockage to the urethra by a full bladder (this puts pressure on the urethra, making it difficult to pass urine);
• an enlarged prostate;
• a prolapse of pelvic organs which can block the urethra;
• damage to the nerves that control the bladder, urethra sphincter and pelvic floor muscles;
• diabetes, multiple sclerosis, stroke and Parkinson's disease (these conditions can interfere with the sensation of a full bladder and with bladder emptying); and
• some medications (which can interfere with bladder function) including over the counter medications and herbal products.

Functional incontinence

Functional incontinence occurs when a person does not recognise the need to go to the toilet or does not recognise where the toilet is, which results in them not getting to the toilet in time or passing urine in inappropriate places. The causes of functional incontinence include dementia, poor eyesight, poor mobility, poor dexterity, or unwillingness to go to the toilet because of depression, anxiety or anger. Environmental factors can also contribute to functional incontinence, such as poor lighting, low chairs that are difficult to get out of, and toilets that are difficult to access.

Reflex incontinence

Reflex incontinence occurs when a person loses control of their bladder without warning. This is normally due to neurological impairment.

Faecal incontinence

People with faecal incontinence have difficulty controlling their bowels. As a result they pass faeces or stools at the wrong time or in the wrong place. Staining of underwear or passing of wind without control may also be a problem.

How the bowel works

Digestion of food occurs in the stomach and small bowel. The small bowel takes the nourishment your body needs from what you eat. The remaining waste forms bowel motions (faeces).

Faeces enter the large bowel (large intestines or colon) as liquid. The large bowel absorbs water back in the body and the faeces become more solid. When faeces reach the lower part of the large bowel (rectum), you feel fullness or the urge to pass a bowel motion.

A normal bowel:

• normal frequency for bowl motions varies greatly and can be within the range of three times a day to once every three days;
• bowel motions are soft and sausage shaped;
• you should not have to strain to empty your bowel;
• you should not experience any accidental loss of faeces;
• bowel motions should not take more than a minute to completely evacuate; and
• you should not experience pain when emptying your bowel.

Bristol Stool Chart

The Bristol Stool Chart or Bristol Stool Scale is a medical aid designed to classify faeces into seven groups. It was developed by K. W. Heaton and S. J. Lewis at the University of Bristol and was first published in the Scandinavian Journal of Gastroenterology in 1997.1 The form of the stool depends on the time it spends
in the colon.1

According to the chart, the seven types of stools are:

• Type1: separate hard lumps, like nuts (hard to pass)
• Type2: sausage-shaped but lumpy
• Type3: like a sausage but with cracks on its surface
• Type4: like a sausage or snake, smooth and soft
• Type5: soft blobs with clear-cut edges (easily passed)
• Type6: fluffy pieces with ragged edges, a mushy stool
• Type7: watery, no solid pieces, entirely liquid

Types 1 and 2 indicate constipation.2
Types 3 and 4 are the easiest to pass.
Types 5-6 are more symptomatic of diarrhea.
Type 7 may be a sign of cholera or food poisoning, etc.

For further information on the Bristol Stool Chart, click here.

Types and causes of faecal incontinence

Faecal incontinence can have a number of possible causes. The following are the most common.

Constipation

Severe constipation is by far the most common cause of bowel leakage (faecal incontinence), especially in the elderly population. Hard bowel motions are difficult to pass and may cause a partial blockage high up the bowel, resulting in watery faeces flowing around the constipated stool without warning. This may be mistaken for diarrhoea.

Constipation may be caused by:

• not eating enough or too much fibre (fruit and vegetables, wholemeal bread, high fibre cereals);
• not drinking enough - always drink more when you increase fibre in your diet;
• not exercising enough or reduced activity in general;
• the side effects of some medicines (e.g. pain-killers or iron tablets);
• not being able to go to the toilet because of poor mobility;
• some nerve diseases;
• some bowel diseases - haemorrhoids, irritable bowel syndrome, or diverticulitis;
• anorectal pain caused by haemorrhoids, fissures (tear in the skin of the anus) or birth trauma; and
• a slow transit bowel. This occurs where there is nerve damage such as with stroke, Parkinson's, multiple sclerosis or trauma. It takes longer for the bowel action to travel all the way to the rectum, so more water is removed over time and constipation is much more likely.

Diarrhoea

Diarrhea is the passing of frequent, urgent loose bowel motions. If you cannot find a toilet in time, leakage may result. Diarrhoea has many possible causes including:

• the use of stimulant laxatives, especially if overused or used incorrectly;
• bowel or stomach infection;
• bowel diseases - diverticulitis, Crohn's disease, and ulcerative colitis, or irritable bowel syndrome;
• some medicines (e.g. antibiotics);
• a shortened bowel (following surgery to remove some of the bowel);
• food allergies (e.g. wheat);
• food intolerance (e.g. milk);
• alcohol; and
• radiotherapy.

References

1. (September 1997) "Stool form scale as a useful guide to intestinal transit time". Scandinavian Journal of Gastroenterology 32 (9): 920 - 924. Retrieved on 2007-03-02.

2. "Constipation Management and Nurse Prescribing: The importance of developing a concordant approach" (PDF). Retrieved on 2006-11-06.