Incontinence

Taboo buster time – let’s talk about incontinence.

We may hope it never happens to us, but incontinence happens.  It’s embarrassing and can really stop us doing what we enjoy.  But what is incontinence and how common is it?

For babies, incontinence is normal, but what about adults?  Thankfully, adverts talking about ‘a little wee’ and ‘bulky pee-pads’ have started to reduce the stigma surrounding female urinary incontinence, but incontinence affects men too, it can happen at any age and also includes faecal incontinence.  I believe that being open and talking about things like incontinence can make a difference.  So, for this article, I thought I’d do a bit of research to try and find out more about incontinence, to share the facts and in the hope of starting a conversation.

Contents

• Jargon
• Types of incontinence
• Facts
• Causes
• Effects
• Treatment
• Stalls for All
• Hobbies
• Summary
• References

Jargon

There’s always a lot of code and scientific language around medical things, especially stuff that’s embarrassing, so it can be hard to make sense out of things.  It might be obvious to most people, but I thought I’d try to pick through the language around incontinence and try to translate it into something that maybe is a bit clearer for those that don’t know.  (Oh, and I did Google it all to check/find out!)

Let me know if there are more terms to add.

• Bladder – hollow organ that stores wee.
• Bowel – the final part of the digestive system including the intestines through to the bottom/anus.  Can also be called the lower gastrointestinal tract.  The bowel’s job is to digest food, absorb goodness and get rid of the waste.
• Catheter – flexible tube that directs wee to a bag from the bladder.
• Constipation – going for a poo less often, difficulty fully emptying bowel and/or hard, lumpy poo.
• Faecal incontinence/bowel incontinence – involuntary leaking of poo.
• Gastrointestinal/GI – the gastrointestinal tract is the digestive system, it covers mouth all the way through to exit at the bottom/anus. 
• Hand held urinal – portable wee pot.
• IBS – irritable bowel syndrome, a common condition of the digestive system causing stomach cramps, bloating, diarrhoea and constipation.
• Incontinence – leaking wee or poo unintentionally.
• Mild, light, moderate, severe incontinence – there really seems to be no science to the level of incontinence, but light/mild is probably a dribble though to severe being a full wee/poo.
• Pads/absorbent pads – like sanitary pads for periods, a white, roughly rectangular pad that goes into your knickers/pants to soak up leaks.  For incontinence, there are also knickers/pants with integrated pads.
• Pelvic floor – muscles that sit low down in your pelvis (between your hips) and control things like bladder, bottom, vagina and penis.
• Prostate – small gland in men and trans women that sits around the urethra (pipe taking wee out of the body).  It generates a thick, white fluid that gets mixed with sperm to create semen.
• Runner’s tummy/trots/stomach/belly/gut – endurance sports especially running can cause stomach troubles and faecal incontinence.
• Sanitary waste – usually means the used absorbent products that have mopped up leaks.
• Sheath/condom catheter/external catheter – condom like cover that goes over a penis and directs wee down a pipe to a bag.
• Sphincter – circular muscle that works like a valve to open and close a pipe such as the pipes letting poo or wee out of the body.
• Urethra – exit pipe for wee.
• Urinary incontinence/bladder incontinence – involuntary leaking of wee.
• Urinary tract – the body’s equipment for removing wee, including kidneys, bladder and the pipes that connect it all, though to the exit point (urethra).

For simplicity, I’m going to use the word ‘wee’ for urine, pee, etc., poo for faeces, shite etc., urinary incontinence for unwanted or urgent weeing and faecal incontinence for unwanted or urgent pooing.  Maybe not the best words, but hopefully not offensive to anyone and understood by all.

Types of incontinence

These are the main types of incontinence [1,2,3,4,5].

• Stress incontinence – leakage of wee when sudden abdominal pressure puts the bladder under stress, such as coughing, laughing, sneezing, lifting heavy items and straining.
• Urge incontinence – a sudden need to wee which usually results in leakage.
• Overflow incontinence – leakage of wee happens when the bladder can’t fully empty and so the excess dribbles out later.
• Total or continuous incontinence – when the bladder can’t store wee so it leaks constantly or frequently.
• Functional incontinence – physical or mental health makes it impossible to get to the toilet in time.
• Post-micturition dribble – leakage from urethra a few minutes after having a wee.
• Giggle incontinence – tends to only occur in young girls and they grow out of it.
• Faecal or bowel incontinence – for some reason this isn’t divided into types, but can include a sudden urge to poo that you can’t control, accidentally pooing without knowing and leaking poo when passing wind/farting.  Faecal incontinence can be associated with other problems such as constipation, diarrhoea, bloating and excess wind.  Accidents can occur during with diarrhoea, but these aren’t generally classified as faecal incontinence. 
• One additional type of faecal incontinence I’d like to add to the list is runner’s tummy (or any other name).  For some reason it doesn’t seem to get included in information about incontinence, but it is common and it is a type of faecal incontinence [6,7,8,9,10,11].

Women are more likely to suffer stress incontinence, whereas men are more likely to suffer overflow incontinence than women due to enlarged prostate [22]. The NHS recommends you see a GP for any type of incontinence because it’s common and they may be able to help [4,5].

Facts

Incontinence is under-reported so it’s hard to get accurate facts.  In fact, one study found that men are more likely to see their GP about sexual impotence than incontinence [3].  Many people view is an inevitable part of aging (it isn’t, [2,3,4,12]) and so don’t see their GP, or maybe they don’t want to bother already too busy GPs.  Also, most people find it embarrassing, which is probably the main cause of under-reporting.  The main thing is – incontinence is common.

This data is for the UK, unless it says otherwise.

• 14 million people suffer from bladder problems [12,13].
• 6.5 million people suffer from bowel problems [12,13].
• Incontinence can affect anyone, any age, and any gender [14].
• Bladder problems are more common than asthma, diabetes or epilepsy [3].
• One main problem with data from research is that the studies use different populations, definitions and measurements, which has resulted in studies suggesting incontinence affects 5-69% of the population [15].
• 5% of people worldwide suffer from incontinence [3].
• 10% of people experience faecal incontinence at some point [13,16].
• 60-80% of people never seek medical advice for incontinence [2].
• 10% of men are living with bowel or bladder control problems [1,17].
• 34-40% of women are living with urinary incontinence [13,15].
• 25% of men over 40 experience some form of urine leakage [18].
• 33% of women have urinary incontinence in the 1^st year after giving birth and of these, 75% will have urinary incontinence for up to 12 years after giving birth [19].
• 10% of women have faecal incontinence after giving birth [19].
• Women are twice as likely to have urinary incontinence as men [3].
• Stress incontinence is the most common type of urinary incontinence, with stress and urge incontinence combined accounting for 90% of female incontinence [2,3].
• Men are more likely to admit to sexual impotence than incontinence [3].
• 44% of men are too embarrassed to seek medical advice [1,20].
• 54% of men with incontinence are too embarrassed to tell close friend or family [1,20].
• Less than 17% of men have access to workplace sanitary waste disposal and 29% of men with incontinence have had to carry a used absorbent pad with them due to no access to sanitary waste disposal [12,20].
• 61% of men experience lower urinary tract symptoms at some point [13].
• 50% of women get a urinary tract infection at least once in their lifetime [21].
• 3-20% of people suffer from constipation [16,22].
• A non-UK study found that 25% of people with IBS have faecal incontinence [22].
• 3-50% of runners suffer faecal incontinence and it’s not just runners, but other endurance sports too, though runners tend to be more likely [6,9,11].
• Incontinence is a significant reason for care home admissions.  In care homes, 50% of the residents suffer incontinence [3,13].
• People can suffer from both faecal and urinary incontinence, with 10% of women experiencing it at some point and 5-6% of men [3].
• For women, younger women are more likely to suffer slight to moderately urinary incontinence, whereas moderate to severe incontinence predominates for older women [15].

Causes

There are various causes of incontinence [2,4,5]. I’ve listed the common causes.

• Stress incontinence – weakened or damaged muscles that prevent weeing (pelvic floor, sphincter/valve).
• Urge incontinence – overactive bladder control muscles.  The actual cause is often unknown.
• Overflow incontinence – obstruction or blockage in bladder such as urinary infections, bladder stones, bladder cancer, enlarged prostate.
• Total incontinence – problem from birth, spinal injury, fistula etc.
• Bowel incontinence – severe or long lasting constipation or diarrhoea, IBS, inflammatory bowel disease, severe piles, damage to muscles than control bowels, conditions that affect nerves in bottom.
• Environment can also cause incontinence such as inaccessible or unsafe toilets [18].

One reason stress incontinence is more common for women than men is pregnancy.  Pregnancy puts pressure on the bladder and bowel, which can lead to the muscles getting weaker.  Childbirth adds extra pressure.  Also for women, hormonal changes seem to cause additional problems, with an increase in the number of women suffering urinary incontinence post menopause [2,3].

There are other factors that don’t help – obesity (puts extra pressure on the bladder and bowel), connective tissue disorders, neurological diseases (like Parkinson’s and stroke), medications (some cause more wee to be produced), family history, diabetes and dementia can all cause or make incontinence worse [3,4,18].

Effects

Incontinence can really effect quality of life.  Whether it’s the worry of incontinence happening or the loss of dignity if it does happen.  It’s embarrassing and has been linked to loss of self-esteem, depression, anxiety, loss of independence, it affects relationships and it affects employment prospects [5,13,14].  In children, research has shown than incontinence can have a greater negative impact of self-esteem, education and social relationships than almost any other medical condition, so it’s important not to underestimate the effect of incontinence on anyone of any age [13]. 

As men have much lower access to sanitary waste disposal, incontinence in men can cause men to stay at home, miss work and avoid social initiations [12,20].

Treatment

Incontinence is not an inevitable part of aging.  Yes it does get more common with age due to other reasons, but that doesn’t mean it should just be accepted [2,3,4,12].  The NHS suggests speaking to a GP for any incontinence because they can help with checking why it’s happening, understanding the problem and helping with what can be done about it [4,5].

Treatments usually depend on the type of incontinence, but for all it helps to stay a healthy weight, stop smoking, limit alcohol and caffeine and do pelvic floor exercises [2,4].  Pelvic floor exercises have been shown to be more effective than medication [13] and can also help with faecal incontinence [5]. 

• Stress incontinence – treatment may also involve physiotherapy and hormone supplements if it’s due to menopause [2].
• Urge incontinence – treatment may also involve medication and bladder training/behaviour modification [2].
• Faecal incontinence – treatment may involve changes to diet and medication to reduce constipation or diarrhoea [5].
• Runner’s tummy – treatment may involve changes to diet, but also increased hydration, changes to routine and checking that not overtraining [6,7,8,9,10].
• Other forms of incontinence – treatment is usually linked to the cause of the problem [2].

Generally, surgery is the last option [2,4].

For pelvic floor exercises, these are two good starting points –

Women – https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Pelvic%20floor%20XS%20female.pdf [23].

Men – https://prostatecanceruk.org/prostate-information/living-with-prostate-cancer/pelvic-floor-muscle-exercises [24].

For living with incontinence, both for dignity and personal health, absorbent or collecting products can really make a difference [13].  For light incontinence, absorbent pads are good and for heavier incontinence, pants with integrated pads tend to be better [3].  Collecting devices include sheaths/products that fit over a penis to direct urine to a leg bag, hand held urinals and faecal collectors [13,25]. For faecal incontinence, small specific plugs can be used [5].  At home, bed and chair protectors can be useful [25].

Bladder and Bowel UK charity has produced a ‘just can’t wait’ card to get access to loos not normally accessible to the public in shops and public services (visit https://www.bbuk.org.uk/ to find out more) [26].

Stalls for All

November last year I read an article on the Guardian website about male incontinence and a campaign for washroom dignity for all [17].  I guess the article has stewed in the back of my mind since then and prompted me to write this article.  I wanted to try to break a little of the taboo and stigma around incontinence in adults, especially the less well known or talked about forms.  If incontinence effects anyone and is common, shouldn’t everyone be able to talk about it and feel supported?  Perhaps a naïve question, but one step towards that aim is to support the ‘Stalls for All’ campaign.

Stalls for All is a combined campaign by Bladder and Bowel UK charity and Initial Washrooms Hygiene [12,20].  It aims to deliver washroom dignity for everyone, regardless of age, gender or need.  One part of this aim is to provide sanitary waste disposal in all female, male and gender neutral public washrooms.  Currently female public toilets have 1 sanitary disposal waste bin per cubicle, which makes it very easy for women to dispose of used sanitary items in a dignified and private way.  In men’s public toilets, there are fewer cubicles and normally no bin inside the cubicle, in fact often no sanitary waste disposal bin at all [18].  As I mentioned earlier, there is more stigma and less awareness about male incontinence, so to add to that burden, any sufferer will also struggle to dispose of essential items as things stand currently [1, 12, 20].

Things may change slowly.  Female urinary incontinence is now talked about a lot more openly than it was a short while ago and Germany has introduced regulations to ensure at least one hygiene bin per male washroom [18].  But is there anything we can do?  My thought is that a lot of us can make a difference by simply asking our employer or at places we visit to add a sanitary disposal bin to the men’s toilets. 

One disappointing thing I did note when I was doing the research for this article was how the majority of sites focus on female urinary incontinence.

Hobbies

As this is a post is for the Hobby Aids website, what has incontinence got to do with hobbies?  A lot I’d say.  Incontinence is a limitation for most/all hobbies.  For people suffering it may stop them doing the hobby they want to do, influence their choice of hobby, limit them doing or enjoying a hobby or stop them enjoying a hobby with others.

Summary

I’ve learnt a lot researching this article.  Starting from not being aware how common urinary and faecal incontinence is for people of all genders, I feel like this has been a bit learning curve.  So what can we all do to make things better?  I believe part of the answer is to talk openly about incontinence to try to break down the stigma.  Another bit part is to push for sanitary waste disposal units in men’s loos.  And perhaps the final part is to resist the temptation to judge anyone with a tell-tale whiff, because they’re probably far more embarrassed than we can possibly imagine, and it probably isn’t due to poor hygiene as it’s easy to assume.

Ah, so now I must do what I preach and tell my story about incontinence….  Perhaps wrongly I’ve left it to the end, but that was because I wanted to get the facts out there first, before emotion.  I’m lucky to be honest, yes I do get urge incontinence and runner’s tummy, but both are very mild and for both I’ve managed to learn triggers etc. to be able to control them better.  My urge incontinence was triggered by a day outdoors without access to a loo and it flares up occasionally, but so far thankfully has only resulted in small leaks and bit of weird jiggling when I suddenly need to wee and need to distract myself.  Runner’s tummy was a bit shock.  I was training up for a half marathon (my one and only) and the first time it hit, I assumed I’d eaten too much too recently.  The next time ended up as a disaster and resulted in me googling it.  I’m glad I did google it, because otherwise I think I would have quit running there and then.  Now I know a lot of the triggers, though I must admit I do tend to stick to countryside runs just in case!  And if you do see a runner (or other sport) suddenly diving into the bushes, leave them be and don’t be surprised!

Tell us in the comments your experience of incontinence and maybe if you’ve been able to get a sanitary waste disposal bin added to a men’s loo!

References

For my references, I tried to stick to trustworthy sources.

1 Over, P (2022).  Male Incontinence – a Silent Struggle.  Available at: https://www.initial.co.uk/blog/male-incontinence-a-silent-struggle/ (Accessed 17^th April 2023)

2 The British Association of Urological Surgeons.  Patients I Think I Might Have Incontinence of Urine.  Available at: https://www.baus.org.uk/patients/conditions/5/incontinence_of_urine (Accessed 17th April 2023)

3 Incontinence UK.  What Percentage of the Population are Affected by Incontinence.  Available at: https://www.incontinence.co.uk/what-percentage-of-the-population-are-affected-by-incontinence (Accessed 17th April 2023)

4 NHS Overview Urinary Incontinence. Available at: https://www.nhs.uk/conditions/urinary-incontinence/ (Accessed 17^th April 2023)

5 NHS Overview Bowel Incontinence.  Available at: https://www.nhs.uk/conditions/bowel-incontinence/ (Accessed 17^th April 2023)

6 Latter, P (2018).  Why Does My Stomach Hurt During, or After, Running? Available at: https://www.runnersworld.com/uk/health/mental-health/a774629/how-to-avoid-stomach-problems-on-the-run/ (Accessed 17^th April 2023)

7 Cooper, M (2020).  Can’t We Get Rid of the Runner’s Tummy. Available at: https://www.asics.com/gb/en-gb/frontrunner/articles/runners-tummy-do-we-really-need-to-just-live-with-it (Accessed 17th April 2023)

8 Glover, E (2023).  Asking For A Friend: Why do I always need to poo while running? Available at: https://metro.co.uk/2023/04/13/why-do-i-need-to-poo-when-running-heres-how-to-avoid-runners-trot-18575184/?ico=amp_tag-post-strip_item_3_lifestyle (Accessed 17^th Aril 2023)

9 Watson, K (2019) What Causes Runner’s Stomach and How to Treat It. Available at: https://www.healthline.com/health/runners-stomach (Accessed 17th April 2023)

10 Ho, Garry W.K. (2009). Lower Gastrointestinal Distress in Endurance Athletes. Current Sports Medicine Reports 8(2): p 85-91.  Available at: https://journals.lww.com/acsm-csmr/fulltext/2009/03000/Lower_Gastrointestinal_Distress_in_Endurance.13.aspx (Accessed 17th April 2023)

11 de Oliveira, E. P., & Burini, R. C. (2009). The impact of physical exercise on the gastrointestinal tract. Current opinion in clinical nutrition and metabolic care, 12(5), 533–538. Available at:  https://pubmed.ncbi.nlm.nih.gov/19535976/ (Abstract accessed 17^th April 2023)

12 Initial Washroom Hygiene.  Stalls for All.  Available at: https://www.initial.co.uk/stalls-for-all/ (Accessed 17^th April 2023)

13 NHS.  Excellent in Continence Care.  Available at: https://www.england.nhs.uk/wp-content/uploads/2018/07/excellence-in-continence-care.pdf (Accessed 17th April 2023)

14 Bladder and Bowel UK. Adults Bladder and Bowel Health.  Available at: https://www.bbuk.org.uk/adults/ (Accessed 17^th April 2023)

15 National Institute for Health and Care Excellence (2019).  Incontinence – Urinary, in Women: How Common is it?  Available at: https://cks.nice.org.uk/topics/incontinence-urinary-in-women/background-information/prevalence/ (Accessed 17^th April 2023)

16 Bladder and Bowel UK. Bowel Problems in Adults.  Available at: https://www.bbuk.org.uk/adults/adults-bowel/ (Accessed 17^th April 2023)

17 Booth, R (2022).  England Rugby Player Calls for Incontinence Pad Bins in Men’s Loos.  Available at: https://www.theguardian.com/society/2022/nov/09/england-rugby-star-calls-for-incontinence-pad-bins-in-mens-loos (Accessed 17th April 2023)

18 Horne, N (2022).  We Need to Start Talking About Male Incontinence.  Available at: https://www.initial.co.uk/blog/we-need-to-start-talking-about-male-incontinence/ (Accessed 17^th April 2023)

19 NHS (2021) NHS Pelvic Health Clinics to Help Tens of Thousands of Women across the Country. Available at: https://www.england.nhs.uk/2021/06/nhs-pelvic-health-clinics-to-help-tens-of-thousands-women-across-the-country/ (Accessed 17^th April 2023)

20 Bladder and Bowel UK (2022).  New Campaign to Deliver ‘Washroom Dignity’ for Men.  Available at: https://www.bbuk.org.uk/new-campaign-to-deliver-washroom-dignity-for-men/ (Accessed 17^th April 2023)

21 The Urology Foundation.  Bladder-related Statistics.  Available at: https://www.theurologyfoundation.org/professionals/healthcare-resources-and-reports/urology-resources/facts-and-figures/bladder-related-statistics (Accessed 17th April 2023)

22 Allanda. Some Statistics about Urinary and Faecal Incontinence.  Available at: https://www.allaboutincontinence.co.uk/incontinence-statistics (Accessed 17th April 2023)

23 The British Associations of Urological Surgeons.  Pelvic Floor Exercises in Women.  Available at: https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Pelvic%20floor%20XS%20female.pdf (Accessed 17^th April 2023)

24 Prostate Cancer UK, What are Pelvic Floor Muscles?  Available at: https://prostatecanceruk.org/prostate-information/living-with-prostate-cancer/pelvic-floor-muscle-exercises (Accessed 17th April 2023)

25 Age UK. Incontinence.  Available at: https://www.ageuk.org.uk/information-advice/health-wellbeing/conditions-illnesses/incontinence/ (Accessed 17^th April 2023)

26 Bladder and Bowel UK. Welcome to Bladder and Bowel UK.  Available at: https://www.bbuk.org.uk/ (Accessed 17^th April 2023)

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Eleanor Rogerson

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Dr Eleanor Rogerson founded Hobby Aids because she believes hobbies are good for you and limitations shouldn't stop doing what you enjoy. She is based in North Lincolnshire, UK.

Her background is chemistry, but after years in industry she wanted to work for herself and so went self-employed. During this time she mainly worked as a gardener. Recently she has been diagnosed with arthritis in her hands, which has caused her to discover the gap in the market to cater for hobbies for people with limitations.

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