How could incontinence affect your client’s mental health? In a story for Continence Foundation members, Dr Lori Shore (Senior Clinical Psychologist at Alfred Health Continence Service) shares how psychological approaches can help manage the impacts of incontinence.

Dr Lori Shore

Dr Lori Shore, Senior Clinical Psychologist, Alfred Health Continence Service
Dr Simon Knowles, Associate Professor of Clinical and Health Psychology, Swinburne University

Do mental health difficulties lead to incontinence or does incontinence lead to mental health difficulties? What we know is both can be equally true: increased stress can lead to incontinence and other physiological responses in the body, and incontinence can have a significant impact on stress, wellbeing and functioning.

The dual role of a health-focused psychologist is to assist clients to not only manage mental health issues such as stress, anxiety, trauma and depression, but also to directly target incontinence, gut and pain issues that often co-exist. This connection is known as the brain-bladder or gut-brain axes: functional disorders related to a “false alarm” of threat due to underlying hypersensitivity of the body’s defence system.

For many people with long-term incontinence, unwarranted feelings of shame and social stigma play a significant role in their mental health – even talking about symptoms to a professional can be challenging. Going out may require significant planning and preparation (often in the form of multiple extended stays on the toilet and identification of toilet opportunities along the journey). There can also be an immense guilt factor with the perceived burden on family members and friends, significant anxiety/rumination about past experiences, self-blame and excessive safety behaviours. And the impact of all of this can be withdrawal from valued social and occupational activities. Quality of life can be significantly compromised, as can compliance with medication regimes. These are all areas for psychological intervention.

Psychological approaches

There are a range of psychological approaches which can provide assistance in understanding and managing the psychosocial impact of incontinence. For example, through Cognitive Behavioural Therapy, which involves behavioural interventions, desensitisation, and thought challenging, clients can be assisted to reduce stress and anxiety and increase mood.

Teaching skills of mindfulness, grounding and relaxation exercises and diaphragmatic breathing can assist with reduction and acceptance of accidents or flare ups that may happen from time to time. The psychologist also has a key role in providing non-judgemental, support, validation and normalisation of concerns that are often present in chronic illness management.

Equally, incontinence is a condition in itself. Psychological intervention for incontinence, gut and pain issues may involve a combination of behavioural modification in the form of timed toileting, exposure work, pacing, and lifestyle changes, as well as psychoeducation, problem solving, stress management strategies and hypnotherapy for reinforcement of strategies, increasing confidence and desensitisation.

Finally, of utmost importance in any health condition is completion of a full clinical assessment to ensure that any structural or biological complications (for example Inflammatory Bowel Disease or urinary tract infections) are not missed. This is an ongoing process and requires paying close attention to reported symptoms and linking in with other practitioners, ensuring an effective multi-disciplinary approach.

Most often this requires specialist involvement (nursing, gynaecology, urology, gastroenterology, physiotherapy, dietetics, pain specialists and other psychologists) who can jointly identify the source of distress signals associated with incontinence and formulate a treatment plan that builds patient’s resilience and improves quality of life.