Incontinence: regaining control
29 May 2014
70 per cent of the 4.8 million Australians who experience incontinence avoid seeking help. Here’s what it is and how to treat it.
While 37 per cent of women and 13 per cent of men will be effected by urinary incontinence, with a further 20 per cent of men and 12.9 per cent of women experience faecal incontinence, it should not simply be accepted as a normal part of ageing.
“Incontinence is not normal. It’s definitely not a normal part of ageing, but it’s a very common condition as we age,” reveals Steve Marburg, a continence nurse who is the Continence Foundation of Australia’s (CFA) National Continence Helpline Coordinator.
“It is important to remember that you aren’t abnormal for having incontinence – there is nothing wrong with you and there is nothing to be ashamed of. But it’s a problem and it needs treating,” explains Marburg.
“People tend to think it is normal because, as we age, most other things tend to droop and drop,” says physiotherapist Jane Le Fevre. “But your pelvic floor should not drop. It is a hammock of muscles running from your pubic bone to your tailbone that helps support your body, and muscles can be exercised and strengthened.”
Marburg agrees, “If you don’t hitch things up, things will fall down.”
What is incontinence?
Incontinence is when urine or faeces is passed by accident or involuntarily. It can be mild through to severe. There are four types of urinary incontinence; stress, urge, overflow and functional.
Stress incontinence happens when pressure is put onto the pelvic floor, such as while exercising, picking up grandkids or even sneezing or laughing. This is generally due to a weakening of the pelvic floor muscles. The hormone ‘Relaxin’ produced during pregnancy relaxes the ligaments in the pelvic area to accommodate the growing foetus. For men, stress incontinence can occur as a result of prostate surgery.
Urge incontinence is the frequent and sudden urge to wee. It happens more often as people age and can increase in times of stress or after consumption of tea, coffee, fizzy drinks and alcohol. It’s also linked to stroke, Parkinson’s disease and multiple sclerosis where nerve damage disrupts the communication between the brain and the bladder and can sometimes occur during peri and post-menopause.
Overflow incontinence occurs when the bladder isn’t emptied properly, so it slowly leaks. It can be caused by a urethra blockage, enlarged prostate, prolapse, nerve damage and some medications.
Functional incontinence is when you don’t realise you need to go to the loo, or don’t know or remember where the loo is. This is linked with dementia, reduced mobility, poor eyesight or lack of bathroom access.
Faecal incontinence tends to be a result of poor bowel control, often because of straining on the toilet, weak pelvic floor muscles, medications or even diabetes.
What causes incontinence?
“Many health factors increase the risk of incontinence,” says Marburg. “The problem is that many people look at incontinence as an issue in itself, rather than considering what else may be going on.”
For example if you are overweight or obese, the added pressure of the weight on your pelvic floor can weaken it. If you have arthritis and have limited mobility, often you can’t get to the bathroom in time.
Experiencing frequent urinary tract infections or the medications used for heart disease can cause incontinence, too. Nerve damage experienced by some people with diabetes can be linked to incontinence.
Effects of incontinence
You may think the physical effects of incontinence are obvious – leaking. But there is so much more to it than that. “Men might have an enlarged prostate, women might have a prolapse, both might have discomfort in their groin or stomach as well as skin rashes and problems in their pubic area,” says Marburg.
Le Fevre says the physical effects can go even further and masquerade as other ailments. “A weak pelvic floor can create lower back pain, weak legs, sore knees, hips and joints and even a flabby tummy because you are not supported by your pelvic floor muscles.”
The psychological and emotional effects are clear. “People experience embarrassment and shame,” says Marburg.
How to prevent and treat incontinence
Incontinence may be prevented by eating a fibre-rich, balanced diet, drinking 1½-2L of fluid a day that is mainly water, exercising, doing pelvic-floor exercises correctly and maintaining good toilet habits. These five things are also used to help treat incontinence, taking into account your individual medical needs.
“The methods for treating incontinence depend on your personal circumstances,” says Marburg. Almost always it starts with strengthening the pelvic floor. Then medication or surgery may be considered.
The initial step in getting treatment is seeing your doctor,who can help devise a treatment plan for you. The continence nurses like Marburg on the CFA Helpline can also offer advice and point you in the right direction. Products such as pads, pants or a urodome can be used too.
“It’s also worth knowing that a range of product subsidies are available for some people with incontinence, but you must be assessed by your doctor first to find out if you are eligible,” advises Marburg.
If you have a friend or loved one who you suspect is experiencing incontinence, Marburg says the CFA can send out some brochures to help, or initiate a conversation about it.
“It’s a sensitive thing, but you and the person you care for need to realise that if you do nothing, it will only get worse.”
Case study: just talk about it
Former Victorian Health Services Commissioner Beth Wilson AM is the patron of the CFA, and she has no qualms these days about talking about incontinence, or what she light-heartedly calls “piddling your pants”.
Beth first encountered her stress incontinence more than 20 years ago. “At first I thought it was just an accident and hoped that it would go away,” she says. It didn’t. It got worse.
“I put up with it unnecessarily, holding onto my guilty secret and putting off getting help.”
It got to the stage where Beth had had enough and mentioned it to her doctor, who gave her a referral to a specialist.
“I kept the referral in my bag for weeks, afraid of making the call,” remembers Beth. Her executive assistant finally made the appointment for her. The specialist established quickly that Beth was a candidate for surgery. “It might have had something to do with the cough test that he had me do, which resulted in me leaking all over his fashionable linen jacket!”
Beth’s surgery was a success and, combined with vigilantly exercising her pelvic floor, the improvement made Beth realise just how bad it had been.
“It wasn’t until I got it fixed that I realised how much being incontinent had impacted on my life. I had stopped exercising, I wasn’t walking and I avoided social occasions.”
Beth implores everyone with incontinence to get help. “You don’t have to put up with it. There is so much help available and you are entitled to it, so go and get it. And remember – it is not your fault! Don’t be ashamed about it; have a good laugh about it with your friends and family as this will slowly help reduce the stigma of it.”
When Beth’s incontinence came back three years after her original surgery, she was armed with the knowledge of how to deal with it, so she visited another specialist and had another round of surgery.
“Sometimes it takes a couple of attempts,” Beth explains. It’s been about four years since then and Beth is doing well. It seems as though she is living her motto: “It is my ambition to fart without pissin’!”
®