Incontinence: An Overview for Caregivers

Caring for someone with bladder or bowel control challenges can be overwhelming.

If you're a caregiver, it can be helpful to learn about incontinence so you can better care for your loved one.

What is incontinence?

Incontinence means the loss of control over bladder or bowel function. It can cause bothersome and embarrassing issues, such as involuntary leaking and not making it to the bathroom in time. Urinary incontinence is the term for loss of control over bladder function. Fecal incontinence and bowel incontinence are the terms for not being able to control bowel function.

Incontinence affects both men and women but the causes may be different. While it's also more common among older adults, incontinence should not be regarded as a normal part of aging. In many cases, it can be cured or controlled with appropriate treatment.

Types of incontinence

There are several types of urinary incontinence:

• Stress incontinence. This common form of incontinence causes one to leak urine when jumping, sneezing, coughing, laughing or doing some other type of movement. Physical stress increases pressure on the bladder which causes leakage. Most of the time, only small amounts of urine come out.
  Stress incontinence occurs when the pelvic floor muscles (muscles that support the bladder) and/ or urethral sphincter (muscles that control urine release) weaken. This often happens due to pregnancy and childbirth in women, and surgery for prostate disease or a pelvic fracture in men. Frequent coughing due to emphysema, cystic fibrosis and other serious lung conditions may also lead to stress incontinence.
• Urgency incontinence. Urge incontinence happens when someone has a strong need to urinate even when their bladder isn't full. At times, the urge may be difficult to control, which can cause urine to involuntarily leak. This condition happens when the detrusor (bladder muscle) contracts and signals a need to urinate before the bladder is full. Urge incontinence can stem from nerve damage from an accident, neurological issues or diabetes. It can also be caused by an infection.
  This type of incontinence is common in postmenopausal women, and may develop as the result of age-related bladder lining and muscle changes. Note that some people refer to urge incontinence as overactive bladder, though that is a slightly different condition. People with overactive bladder feel an urge to urinate, but don't necessarily leak urine.
• Mixed incontinence. Some people have mixed incontinence, where they experience symptoms of both stress and urge incontinence. This condition appears more often in women, frail seniors and men who have had surgery for an enlarged prostate or prostate removal.
• Overflow incontinence. This type of incontinence occurs when the bladder doesn't fully empty. Someone may have urine leakage without feeling the need to go. This can be caused by something physically blocking urine from coming out of the bladder, such as an enlarged prostate. Or it may be caused by underactive bladder muscles, which can keep the person from feeling the urge to go. This can happen due to diabetes, heart disease or nerve damage (from childbirth, injury or surgery, for instance). Medications can also contribute to overflow incontinence.
• Functional incontinence. In this condition, the urinary tract works properly, but other challenges may keep one from reaching the toilet in time. This can happen due to disabilities, mental illness, dementia or even medications.

Urinary incontinence treatment

The treatment your loved one needs depends on the type of urinary incontinence they have, how serious it is, and what's causing their symptoms. Encourage them to work closely with their healthcare provider and follow their care plan as directed. Some urinary incontinence treatment options include:

• Behavioral treatments. These may include doing Kegel exercises (pelvic floor strengthening exercises to help reduce leaking), bladder training (using the bathroom at set times), losing weight, reducing fluid intake, quitting smoking or cutting back on certain foods and drinks that make symptoms worse. Spicy foods, caffeine-containing beverages and alcohol can irritate the bladder.
• Medications. Depending on the type of incontinence, medications may be prescribed to relax the bladder muscles and prevent bladder spasms. Examples include:
  • For urge incontinence, anticholinergic medicines reduce involuntary bladder contractions. Examples include oxybutynin (Ditropan XL), tolterodine (Detrol), darifenacin (Enablex), fesoterodine (Toviaz), solifenacin (Vesicare) and trospium (Sanctura) may be used. Healthcare providers also prescribe beta-3 agonists, such as mirabegron (Myrbetriq), for this type of incontinence. An injection of botulinum toxin type A (Botox) into the bladder may be given to those who have not responded to other treatments.
  • For women with stress incontinence, duloxetine (Cymbalta) may be prescribed. For women with stress or urge incontinence who have gone through menopause, topical estrogen (estrogen cream, gel or a vaginally inserted tablet) may help tone and rejuvenate tissues in the urethra and vaginal areas.
  • For men with urge or overflow incontinence due to prostate problems, alpha blocker medicines can help relax the smooth muscle of the bladder neck to make it easier to empty the bladder. Examples include tamsulosin (Flomax), alfuzosin (Uroxatral), silodosin (Rapaflo), doxazosin (Cardura) and terazosin.
• Pessary device. Used to treat stress incontinence in women, a pessary is a device that a health care provider inserts into the vagina to help support the bladder.
• Nerve stimulation. Mild electric impulses are used to stimulate the nerves around the bladder and contract the pelvic floor muscles. This may be an option for individuals with urge incontinence who have not responded to behavior treatments or medications.
• Biofeedback. This technique uses sensors to make a person aware of signals from the body to help control bladder function. Biofeedback can train the pelvic floor muscles to contract and relax properly.
• Surgery. There are several procedures that may be used for incontinence. Surgery may be an option when other treatments fail to work.

Incontinence products

There are a wide variety of incontinence supplies available on the market. While these products don't treat incontinence, they may help the person you care for feel more comfortable:

• Pads and liners. Incontinent pads and liners stick to underwear.
• Protective underwear and briefs. Disposable and reusable absorbent underwear offer protection in case of leaks.
• Cloths and wipes. Using cloths and wipes after going to the bathroom can help keep skin clean and dry.
• Cleansers, creams and lotions. When urine or stool is in constant contact with skin, irritation can occur. Using a mild cleanser after using the bathroom can help clean skin. Moisturizers can moisten the skin, while sealants provide a protective barrier over the skin.
• Bedding protection. Disposable and reusable bedding liners, pads and covers can protect beds in case of an accident.
• Bedpans and urinals. These products allow people with limited mobility to use the toilet without traveling to the bathroom. After use, bedpans and urinals can be emptied, cleaned and reused.

Use incontinence products according to the directions on the package. Talk to your loved one's doctor or pharmacist about their symptoms and challenges. Providers can recommend incontinence products based on their specific needs.

Published on June 28th, 2018

Sources:

"Definition and Facts of Fecal Incontinence," National Institute of Diabetes and Digestive and Kidney Diseases. Web. 10 May 2018. https://www.niddk.nih.gov/health-information/digestive-diseases/bowel-control-problems-fecal-incontinence/definition-facts

"Urinary Incontinence," Office on Women's Health. Web. 10 May 2018. https://www.womenshealth.gov/a-z-topics/urinary-incontinence

"Urinary Incontinence," MedlinePlus. Web. 10 May 2018. https://medlineplus.gov/urinaryincontinence.html

"Patient Education: Urinary Incontinence in Women (Beyond the Basics)," UpToDate. Web. 10 May 2018. https://www.uptodate.com/contents/urinary-incontinence-in-women-beyond-the-basics

"Types of Urinary Incontinence," Harvard Medical School. Web. 10 May 2018. https://www.health.harvard.edu/bladder-and-bowel/types-of-urinary-incontinence

"Patient Education: Urinary Incontinence Treatments for Women (Beyond the Basics)," UpToDate. Web. 10 May 2018. https://www.uptodate.com/contents/urinary-incontinence-treatments-for-women-beyond-the-basics

"Skin Care and Incontinence," MedlinePlus. Web. 10 May 2018. https://medlineplus.gov/ency/article/003976.htm

"Urge Incontinence," WebMD. Web. 10 May 2018. https://www.webmd.com/urinary-incontinence-oab/urge#1

"Urinary Incontinence in Older Adults," National Institute on Aging. Web. 10 May 2018. https://www.nia.nih.gov/health/urinary-incontinence-older-adults