Incontinence

Updated 10 June 2016

Risk factors for incontinence

There are a number of factors that put you at a greater risk of developing either urinary or faecal incontinence.

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There are a number of factors such as age, gender, previous trauma to the pelvis and childbirth that can place you at an increased risk of incontinence.

In both males and females, the risk of incontinence increases with age. Incontinence in elderly patients is a common condition. Incontinence in women is also common, especially those who have experienced multiple childbirths.

It is important to note that certain risks are unavoidable. 

Risk factors for urinary incontinence

Urinary incontinence affects about 5% of the adult population or 8% of adult females and 3% of males affected respectively. 

It's more common in old age and in debilitated patients. Approximately 50% of all nursing-home residents, as well as 15-30% of women over age 65 in retirement communities suffer from urinary incontinence. 

Despite being more common in old age, incontinence shouldn't be regarded as "normal" at any age. 

Risk factors include: 

• Female sex 

• Multiple childbirth 

• Old age 

• Pelvic radiation 

• Pelvic surgery 

• Pelvic trauma 

• Tuberculosis of the urinary tract 

• Stroke 

Females are more prone to incontinence than males. The female urethra is short and the continence mechanism is less well developed than in the male. The female bladder neck and urethra are also much less well supported than in the male, and are subjected to the rigours of childbirth. 

Multiple childbirths stretch and weaken the support of the bladder and urethra. This can cause hypermobility of the bladder neck and the urethra, leading to stress urinary incontinence. Injury during childbirth or Caesarian section can cause a vesicovaginal fistula to develop. 

Detrusor (bladder muscle) instability is common in old age and can lead to urge incontinence. Menopause causes atrophy of the vagina and urethra, which impairs the occlusive function of the urethra. Elderly men are prone to benign prostatic hyperplasia (enlargement), which can lead to chronic retention and overflow incontinence. 

Tuberculosis of the urinary tract can lead to a small contracted bladder incapable of storing adequate amounts of urine. Trauma, surgery or radiation to the pelvis can either damage the bladder or urethra directly, or can damage the nerves that control bladder function. Almost any neurological disease can affect the control of bladder function. Strokes, dementia and spinal-cord injuries commonly lead to incontinence.

Risk factors for faecal incontinence

Just because people are too embarrassed to talk about faecal incontinence doesn't mean it isn't common.

Almost 18 million US adults (about one in 12) have faecal incontinence. In Australia, this problem affects up to 20% of men and up to 12.9% of women. The problem though, is that people often keep it secret: only about 20% of people in the UK who have some form of bowel incontinence tell their doctors about their symptoms.

There are several risk factors for FI. Advancing age is the most significant because the anal sphincter muscles that control bowel movements weaken over time. FI can affect people of all ages, but it’s more common in older and middle aged adults, affecting an estimated one in 10 women over 40.

Here are other factors that may increase your risk of faecal incontinence:

• Urinary incontinence
• Frequent constipation
• An injury or illness that damaged the nerves controlling defecation (e.g. diabetes or multiple sclerosis)
• Obesity
• Poor overall health
• Physical disability and dementia. People who are physically disabled may find it difficult to reach a toilet in time, and people with dementia and late-stage Alzheimer’s disease also often suffer from FI.

Read more:

What is incontinence?

Causes of incontinence

Preventing incontinence

Image: Childbirth from Shutterstock

 

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Incontinence Expert

Prenevin Govender completed his MBChB at the University of Cape Town in 2001. He obtained his Fellowship of the College of Urologists in 2009 and graduated with distinction for a Masters in Medicine from the University of Cape Town in 2010. His special interests include laparoscopic, pelvic organ prolapse and urinary incontinence surgery. He consults full-time at Life Kingsbury Hospital in Claremont.

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