Updated: Feb 9
Did you know there are different kinds of incontinence - or different symptoms that make us worry we might leak? The type you have effects what you should do to manage it!
There are several types of urinary incontinence, with different names depending on who is defining them. This does NOT help people understand the issues!
As always there are countless rare issues, which are not the subject of this post. Those less common conditions might include nerve or spinal cord injuries, or obstructions such as scar tissue.
The majority of people, though, will find their bladder problems fit into these groups:
Stress Urinary Incontinence
Urge Urinary Incontinence
Nocturia (needing to get up often at night)
Defining Functional Incontinence
Functional Incontinence is possibly the easiest to explain: a person is incontinent because of a functional problem – they can’t walk to a toilet, or they can’t undo their pants to use the toilet. This can be a problem for the very elderly, and others with mobility difficulties.
A person whose age means they have much less space in their bladder and much less bladder stretchiness available simply doesn’t have as much time to get to the toilet.
If they have to wait for someone to come and help them up, they run out of time. If it takes them ten minutes and a great deal of effort to get out of a chair, get across the room, deal with their clothing, and lower themselves onto the toilet - they run out of time.
This might sometimes look like they have Urge Incontinence, but the real problem might be their reduced ability to respond when they need to get to a toilet.
Sometimes, pelvic floor exercises can work to buy a little extra time.
Help with finding the right aids or appliances can be very useful (Occupational Therapists are handy for that).
Having a schedule for being assisted to the toilet at regular intervals can work wonders - it’s important to choose a schedule that suits the individual’s needs, because toileting too often when they don’t need to can make symptoms worse. Physios and Community Nurses are good sources of information for this situation.
Defining Stress and Urge Incontinence
Stress and Urge Urinary Incontinence are two distinct conditions that can, I’m sorry to say, both occur at the same time in the same person.
Stress Incontinence is sometimes called activity-related incontinence. It’s the leaks that occur on exertions like laughing, or sneezing. Often the amount lost is small, just enough to wet our undies. But it is possible for stress incontinence to involve bigger leaks.
Coughing and jumping are also common causes of stress leakage. Less well-publicised triggers include bending, getting up from sitting, or sexual activity. In one all-too-publicised event, pictures of a gymnast competing in the Olympics hit front pages because the camera caught her "springing a leak" during a backflip. No-one is immune, especially when asking our bodies to perform at their maximum. (Also, no-one should be mocked with stupid puns by ignorant scandal-mongers.)
People sometimes try to keep their bladder empty to avoid it, but they find the leak happens anyway. Please don’t try to keep your bladder empty, it's not a useful treatment and it’s very bad for your bladder.
The most common and usually effective treatment for Stress leakage is pelvic floor muscle training, which features in another blog in this series: The 1, 2, 3 of Pelvic Floor Training.
Other tips for reducing the stress placed on the pelvic floor are described in 3 Ways to Protect Your Pelvic Floor.
There are other strategies which may suit, depending on individual circumstances. I hope to cover some of these in future articles. It seemed best to start with the information that can help the most people!
Urge Urinary Incontinence gets its name from its most obvious symptom: a sudden and pressing need to empty the bladder. Sometimes this is called Overactive Bladder.
The urge might have predictable triggers like the moment you come in the front door of your home. If you always make it to the loo without leaking, it technically isn’t incontinence – but it’s still urgency and the same management strategies will apply. For those who do leak, it may be a small amount or it may be a flood.
People tend to give up social outings for fear of this type of incontinence. It makes basic life activities like grocery shopping extremely stressful. For more information on dealing with urgency, check out the related blog post 8 Ways to Reduce Bladder Urgency.
Getting up a lot at night is often a part of Urge, but it can also happen without daytime urgency. Nocturia means sleep is being disturbed by a need to empty the bladder too often. (Although 'noct' means night, in this age of shiftwork we might not be doing our sleeping at night.)
A healthy bladder in a younger person should allow six to eight hours sleep without a need to empty the bladder.
With age, our bladder function does naturally change. At 70, for example, we might expect to get up once or possibly twice each night. Regardless of your age, if your bladder is disturbing your sleep, it’s worth reading for more information on causes of nocturia, what those age changes are, and tips for managing nocturia and sleeping longer. A separate blog about nocturia is now online, so check out More Sleeping, Less Peeing if you are looking for more info and some tips.
Just a little bit more sleep can make a big difference to how well we feel!
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