Incontinence

Updated 10 June 2016

What is incontinence?

There are two main categories of incontinence, urinary incontinence and faecal incontinence.

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Urinary incontinence is the involuntary loss of urine whilst faecal incontinence involves faeces that are expelled involuntarily.

Urinary Incontinence

Urinary incontinence isn't a disease in itself, but a symptom of many different disease processes.

The only two functions of the bladder are to store urine and to expel urine in a coordinated fashion under appropriate circumstances. The bladder needs to be of adequate capacity and compliance in order to store urine. The tone within the bladder neck and sphincter (valve) prevents urine from leaking from the bladder. During voiding, the bladder muscle contracts while the sphincter relaxes in a coordinated fashion.

Incontinence can be classified according to the mechanism causing the leakage of urine or according to the type of symptoms.

The main types of urinary incontinence are:

1. Stress incontinence

Stress incontinence is the leakage of urine associated with episodes of increased intra-abdominal pressure such as coughing or sneezing. It's caused by loss of bladder-neck and urethral support or inherent sphincter (valve) deficiency.

2. Urge incontinence

Urge incontinence is the leakage of urine associated with a great desire to urinate that cannot be suppressed. It's invariably associated with symptoms of urgency and frequency. The bladder is incapable of storing adequate amounts of urine, because it's either too small or unstable. There are many different causes of urge incontinence.

3. Overflow incontinence

Overflow incontinence is associated with chronic retention of urine. The bladder is permanently full and distended with urine. The kidneys continue to produce urine and the excess spills out of the urethra, much like a dam that's overflowing. Overflow incontinence is associated with a poor stream and difficulty passing urine. Chronic retention is either due to bladder-outlet obstruction or bladder-muscle dysfunction. Bladder-outlet obstruction is relatively common in elderly males and rare in females.

4. Total incontinence

Total incontinence is the continuous leakage of all the urine. It's most often due to a vesicovaginal fistula, which is an abnormal communication between the bladder and the vagina.

Urinary incontinence affects about 8% of females and 3% of males. It's more common in the elderly, but shouldn't be regarded as normal at any age. There's no single treatment for urinary incontinence. The treatment options will depend on the type and severity of the incontinence.

Most people with urinary incontinence can be cured or improved.

Faecal Incontinence

Faecal incontinence (FI) as the inability to control bowel movements, causing stool (faeces) to leak unexpectedly from the rectum.

Also called bowel incontinence, faecal incontinence ranges from an occasional involuntary leakage of stool while passing wind, to a total loss of bowel control. Some people feel the urge to have bowel movements but are unable to reach a bathroom in time. Others don't experience the sensation of a pending bowel movement and completely lose bowel control.   

It's important to know that faecal incontinence isn't a condition or illness in itself, but rather a sign or symptom of a condition.

Even though it’s generally not life-threatening, it can have a negative impact on self-esteem, emotional health and quality of life. The upside though, is that it's not a normal part of ageing and is usually treatable.

Read more:

Causes of incontinence

Diagnosing incontinence

Preventing incontinence

Image: Human female organs 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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