Incontinence

Updated 04 August 2016

How incontinence can mess with your mental health

As many as one in three people over the age of 60 is affected by urinary incontinence (UI), a condition that can leave psychological scars.

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Wetting yourself in public is experienced by people as extremely embarrassing, and incontinence is regarded to have potentially serious psychological consequences.

Quick facts on urinary incontinence

As many as one in three people over the age of 60 is affected by urinary incontinence (UI). UI is the involuntary loss of urine, and is a symptom of many conditions, but is not a disease in itself.

The causes can be increased abdominal pressure, such as when you sneeze or cough; leakage of urine because the bladder cannot store big amounts of urine; or it is never emptied properly; or there is a continuous leakage for physical reasons. Some people experience UI after surgery or childbirth.

Incontinence can be treated in a variety of ways, of which pelvic floor exercises and lifestyle changes such as weight loss and stopping smoking are the most common.

Read: How physiotherapy can reduce urinary incontinence

There are also medical and surgical treatments available if non-surgical treatments are ineffective.

Twice as many older women as men suffer from urinary incontinence. This is often related to several factors, including childbirth, menopause and surgery. Many men suffer from urinary incontinence for several weeks after undergoing prostate surgery.

It is thought that as many as 50 percent of people with urinary incontinence do not seek medical help, as they feel embarrassed, are not sure whether they can be helped, or simply hope that the problem will go away by itself.

The psychological effects of suffering from UI

But physical discomfort and embarrassment are not the only possible consequences of suffering from UI. The psychological effects can be huge too.

"Patients who experience incontinence might experience a significant effect on their self-confidence and dignity,” according to Dr Ulla Botha psychiatrist and senior lecturer at the Department of Psychiatry at the University of Stellenbosch. “Depending on the level of incontinence, their general functioning might also be affected, as patients often start to isolate themselves and may avoid social interaction to prevent possible embarrassment. This can even lead to depression.” 

If someone withdraws socially as a result of urinary incontinence, it can have a huge impact on their quality of life and their psycho-social well-being. They could become increasingly isolated, not be interested in starting a new relationships and friendships, and develop both anxiety and depression.

Read: 'I thought incontinence only affected old ladies until I got it!'

Normal activities they used to enjoy could become difficult and they could start avoiding club outings, parties and other social get-togethers, as many people fear the embarrassment of having an "accident" in public. Public toilets are not always conveniently situated.

What the research says

Scientists are not sure whether suffering from urinary incontinence as such is a contributing factor to depression and anxiety, or whether the depression and anxiety could play a contributory role in the development of urinary incontinence, according to Barbara Broome, wiring for the National Institutes of Health.

Many people who suffer from depression stop taking part in activities they formerly enjoyed – and the same is true of people who suffer from urinary incontinence.

A negative event, such as having an "accident" in public can lead to an alteration of mood and cause anything from sadness to dissatisfaction, lowered self-esteem and self-depreciation.

Read: Weight-loss surgery may help curb urinary incontinence

The greater the degree of urinary incontinence, the greater the degree of social isolation and depression, according to an article published in the American Journal of Managed Care in 2005.

It reported on a study that found that people with urinary incontinence were twice as likely to suffer from depression as those in a control group.

Interestingly enough, those with UI, also rated their state of health more negatively than those without UI.

All the more reason why it is essential to seek medical help for UI before the damage it can do to you goes far beyond an "accident" in public.

Read more:

What is incontinence?

Causes of incontinence

Risk factors for incontinence

References:

The National Institutes of Health: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC194226/

 

Ask the Expert

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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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