Different Types of Incontinence
Have you ever had a medical condition you couldn't tell anyone about? Incontinence is much like that. It is not a very commonly used word, mainly because of the perceived stigma attached to it. Many people may not even know what it means. But if over 13 million people in the US suffer from this condition, then either you or someone you know has it.
As common as incontinence may seem to be, judging by the number of people that suffer from it, it is not at all easy for affected patients to talk about it with other people, even their doctors. It is seen as a very embarrassing subject. Have you ever sneezed and urinated a bit afterwards? How did that make you feel? Then I guess you'll understand why people do not want to talk about it.
Why is it embarrassing? You may ask. You need to understand what incontinence is in the first place.
What then is Incontinence?
The definition of incontinence is usually summarized to include only one type of incontinence- urinary incontinence. But I will try to give a general explanation and definition of incontinence to accommodate the other type of incontinence that is Fecal.
Incontinence can be defined as a condition where urine, feces or wind is involuntarily or accidentally passed from the bladder or the bowels. These are also commonly called urinary incontinence and fecal or bowel incontinence. There are other types of incontinence that fall under urinary incontinence as subcategories. We will look into all these as we move on. Incontinence is most common in women and older people, but it can happen to anyone and at any age. This post is going to explain and talk about all the details you may be too embarrassed to ask anyone about. And as I said earlier, it's a common condition. You are not alone. All you need is the right information and proper management.
Now let's look into the types of incontinence and the symptoms associated with them.
Types of Incontinence
Urinary Incontinence is also regarded as poor bladder control. It is one of the common types of incontinence. Urinary incontinence is when you have leaking urine. It can range from the occasional urine leaks that occur when you laugh, cough or strain yourself by carrying something heavy or working out to completely wetting yourself due to poor bladder control. Another telltale sign of urinary incontinence is when you frequently or regularly have to visit the bathroom and sometimes you experience leaking urine accidents on your way.
Many things can cause urinary incontinence. But first, let's take a look at the various types and symptoms.
●Types of Urinary Incontinence
The different symptoms of urinary incontinence differ according to the specific type a person has.
-Urge or Bladder Incontinence (Overactive bladder incontinence):
This type of urinary incontinence is also called urgency incontinence. Bladder incontinence is when you feel a sudden urge to go to the bathroom and not being able to control the intense urge to urinate even when your bladder isn't full. Bathroom visits can range from a few seconds to a few minutes. The need to urinate is so urgent that any slight delay may lead to completely wetting yourself, irrespective of where you are.
This type is also called an overactive bladder incontinence. This happens when the detrusor or the bladder muscles begin to contract. This contraction signals that you need to urinate but for urge or bladder incontinence patients, your bladder may not even be half filled with urine before the detrusor starts contracting. This condition can be called overactive bladder or detrusor overactivity. An overactive bladder is usually as a result of physical or neurological conditions which prevents the body from stopping the contractions of the detrusor or bladder muscles.
These conditions can be as a result of brain damage, spinal cord and nerve ending damages caused by accidents, neurological conditions or diabetes. Some infections can eventually lead to substances in the bladder that can lead to detrusor contractions.
According to Harvard Health, there is no known cause for detrusor overactivity or bladder overactivity, but it is most prevalent in aged patients and postmenopause women. This may be because of bladder lining and muscle changes. They also claimed that white women in America suffering from incontinence are more likely to be affected by stress incontinence while African American women are more likely to be suffering from overactive bladder incontinence.
Urge or bladder incontinence is usually caused by;
-Hearing the sound of water
-Sex or orgasm
-Change in position, either from sitting to standing position or vice versa.
While overactive bladder incontinence can be caused by neurological conditions like I mentioned earlier or infections that cause the bladder muscles to contract, there are several other causes. These include bladder stone partial blockage, prostate partial blockage, enlarged prostate, prostate cancer, surgery for prostate removal and treatment for prostate - cryotherapy or freezing treatment and brachytherapy or radiation seed treatment.
Stroke, Parkinson's disease and multiple sclerosis can also lead to urge incontinence.
A common symptom associated with overactive bladder is a syndrome called myofascial pelvic pain. This syndrome is usually accompanied by pelvic aches and pains, burning sensation and heavy feeling.
Stress incontinence is not when you feel stressed. Its name is associated with the pressure that accompanies urine leakage. This occurs when there's a sudden or unexpected pressure or physical exertion on the body. Any physical exertion on the body that can also put pressure on the abdominal region leads to stress incontinence. Stress incontinence usually happens in small drops of urine leakage.
This usually happens even when the bladder muscle is not contracting. With this type, any physical exertion on your body that affects your abdominal region will lead to leaking urine. Laughing for example can cause sudden urine leaks.
This type of incontinence happens when the pelvic floor muscles, the urethral sphincter or both are damaged or weak. Their urine holding capacity in their damaged or weakened state is mostly insufficient and this leads to stress incontinence.
There are two types of stress incontinence;
-Urethral hypermobility: In this case, the urethra and bladder move downwards when abdominal pressure is applied. And since there is no support for the urethra to press against in order to keep it closed, urine drops escape.
-Intrinsic sphincter deficiency: This, on the other hand, has to do with problems occuring in the urinary sphincter region that prevents the urethra from closing fully or open at any slight pressure exerted on the body. Bladder infections are common causes of this.
Other pressures applied to the body that can cause leaking urine are;
5.Lifting heavy objects
Stress incontinence can lead to few drops of urine leaks or complete wetting.
Women who give birth vaginally are at greater risk of developing stress incontinence. This is because vaginal births stretch the pelvic region and can quite possibly damage the pelvic floor nerves and muscles. The odds are more likely to stack high against an older woman giving birth vaginally, a woman giving birth to a larger baby, a woman who has given birth multiple times before or one experiencing long hours of labor.
Men are only at risk of having stress incontinence either from pelvic injury or urinary sphincter damages as a result of prostate surgery. Women, on the other hand, become vulnerable to stress incontinence as they age, usually after menopause. Lung infections that cause racking coughs can also lead to stress incontinence. The infections can be caused by cystic fibrosis or emphysema. This happens to both men and women.
Mixed incontinence is when a patient suffers from both urge incontinence and stress incontinence. If you pass out urine when you cough or laugh and you also feel an intense and uncontrollable urge to visit the bathroom or risk wetting yourself, then you have mixed incontinence.
This condition can be caused by a number of factors;
1.Hearing the sound of water
2.Sex or orgasm
3.Change in sitting or standing position
4.Overactive bladder syndrome
9.Heavy lifting, and
10.Surgery, this could also be prostate removal in men.
Total incontinence is what happens when you constantly pass out large volumes of urine. It can also be when you infrequently pass out large volumes of urine and small urine leaks escape every now and then or inbetween the large volumes. This type of incontinence can also occur at night.
Incontinence is usually referred to as total incontinence if the symptoms are very severe and continuous.
This happens when your bladder is never really emptied of urine. This is why you have urine leakages even if you do not feel the need to use the bathroom. This occurs when something hinders the bladder from completely discharging its entire urine content. An example of this is prostate enlargement. This can occur in both men and women but it is more prevalent in men. It is when the urethra is partially closed due to prostate enlargement. This stops the urine from flowing out completely. Eventually, the muscles around the bladder become inactive or underactive and you don't feel the urge to urinate or visit the bathroom. This causes the bladder to overflow, become engorged and eventually the urethra is forced open or there is bladder spasms and this causes urine leakage.
Other than prostate enlargement, there are other conditions that can cause overflow incontinence. These include;
6.Uterus prolapse; this is only associated with women. It is when the uterus is no longer in its normal position and it interferes with the bladder.
8.Nerve injuries, usually as a result of shingles, multiple sclerosis, surgery, childbirth and certain diseases.
Overflow incontinence can also be caused by medication that doesn't make you aware of having urine urges or weakening of the bladder often associated with old age.
Reflex incontinence only usually occurs in patients with neurological impairments or severely damaged nerves due to injuries, exposure to radiation, multiple sclerosis, spinal cord injuries and surgery.
The nerve endings are responsible for signalling the brain when we feel the urge to urinate and the brain in turn signals us to get up and go to the bathroom. The nerves responsible for all of that communication becomes unresponsive as a result of the conditions I listed above. This is why reflex incontinence patients do not receive any urges or warnings that their bladder needs to be discharged. This often leads to accidental or involuntary urine discharges, usually in large volumes.
This type of incontinence occurs when the urethra and the bladder function well but the patient finds it difficult to visit the bathroom, and when they do, aren't able to undress in time to urinate without spilling urine leaks on themselves. This is usually as a result of an ailment, medication, mental illness or dementia. Some functional incontinence patients do not care if they make it to the bathroom or not but their bladder functions properly.
Sometimes, the bathrooms are located in distant places and they don't make it in time without leaking urine. Arthritis patients may have problems moving to the bathrooms. Mentally ill or disturbed patients that are restrained may also be unable to make it to the bathroom in good time. Medications like diuretic treatments may cause patients to produce abnormally large volumes of urine. This also can lead to functional incontinence.
If these symptoms occur at night, it is referred to as bedwetting or nocturnal incontinence.
2. Fecal Incontinence
Fecal incontinence is also commonly called bowel incontinence or accidental bowel leakage. It is a loss of bowel control which invariably leads to involuntary passage of liquid stool, solid faeces, mucus, and even air or gas. When the passage is air or gas it is regarded as anal incontinence. It is also commonly regarded as flatulence.
Fecal incontinence is mainly caused by damages caused by childbirth, rectal surgeries, ulcerative colitis, Crohn's disease, and receptive anal sex. It may also be accompanied by occasional bouts of diarrhea and constipation but if it is not constant and/or severe then you have nothing to worry about.
Surgeries that may cause this type of incontinence are the types usually involving the anal sphincters and hemorrhoidal vascular cushions.
Fecal incontinence is not as prevalent as urinary incontinence, but it is quite common and worthy of note.
I already listed a few reasons why people may end up with Fecal incontinence but let's delve in a little deeper.
1.Rectocele: This is a condition where the rectum collapses and protrudes from the vagina. As you can guess already, it only occurs in women. This condition causes fecal incontinence.
2.Rectal prolapse: This condition is when the rectum collapses and drops from the anus. This also causes fecal incontinence.
3.Hemorrhoids: This is the swelling of rectal veins. The engorged veins keeps the rectum from closing up completely, thereby causing Fecal incontinence.
4.Surgery: Rectal surgeries can cause injuries or damages that may lead to rectal leaking.
5.Damaged muscles: Anal sphincters are rings of muscles present at the end of the rectum. They are in charge of contracting to hold back faeces or relaxing to pass out faeces. When these sphincters are injured or damaged, it becomes difficult to voluntarily hold back faeces, and this leads to stool leaking out involuntarily. This is especially common during episiotomy or forceps during childbirth.
6.Damaged nerves: Nerve endings that alerts the anal muscles or sphincters on when to contract may get damaged due to constant straining during defaecation, childbirth, multiple sclerosis, stroke, diabetes and spinal cord injuries. This may lead to Fecal incontinence.
7.Severe constipation: Severe constipation can cause a hard and dry ball of impacted faeces to gather in the rectum. Eventually, it becomes too hard and large to pass out. This causes the muscles to stretch out and weaken with time. Watery or softer faeces above the impacted mass of faeces goes around the mass and starts to leak out after a while. This kind of severe constipation can also cause rectal nerve damage that also leads to Fecal incontinence.
●Types of Fecal Incontinence
There are two types of Fecal incontinence.
-Urge Fecal incontinence:
This is when you feel an uncontrollable urge to pass out stool irrespective of where you are at that particular moment. This usually occurs before the patient has the chance to dash to a toilet, thereby ruining their pants or panties.
-Passive Fecal incontinence:
This is a condition where a person is not aware he or she needs to defecate or pass out stool. This is most common in people with damaged nerves or rectal muscles. Fecal incontinence sometimes occurs alongside flatulence, bloating, diarrhea and constipation.
Another noteworthy cause of Fecal incontinence is medication. Treatments like exposure to radiation, surgery and certain drugs are other notable causes. They could stiffen the walls of the rectum or scar them and the muscular walls that are usually supposed to stretch to accommodate faeces will no longer be able to stretch. This will cause Fecal incontinence where unaccommodated faeces pass out involuntarily because the rectum can't contain them.
People at risk of having Fecal incontinence;
-Women; this is especially so because of childbirth complications.
-Damaged nerve endings
-Dementia and Alzheimer's
Please note that not everyone at risk of having Fecal incontinence is listed in the above list. An example is the young demography that may be exposed to receptive anal sex or even Crohn's disease.
Urinary Incontinence Diagnosis
To diagnose the type and cause of your urinary incontinence, a physical examination has to be carried out first. Here, the medical practitioner will ask you a series of questions like how often you leak urine and how much urine. What you drink and how much of it. This stage will be easier for you if you keep track of your bladder and urine leaking quantity and frequency.
The examination could also include a simple test like asking you to laugh or cough. Just to see if you would let out any urine. It is the prerogative of the doctor to tell you if you need more tests or not.
There are tests and procedures that can be done to find out the type and the cause of the urinary incontinence you are suffering from. They are;
1.Urinalysis and urine culture: This is simply used to determine if you have sugar or blood in your urine or if you have UTI also known as urinary tract infection. This test will also determine if you are suffering from prostatisis, especially if you're a man.
2.Pad test: This test is to help know how much urine is leaking through. An absorbent pad is weighed before and after urine leaks onto it from the wearer's bladder.
3.Bladder stress test: This is when pressure is exerted on the body to stimulate urine leakage. This is done by coughing, laughing, sneezing or working out.
The women's version of this test is the Bonney test. It is almost like the bladder stress test but the bladder neck is slightly lifted with a tool inserted through the vagina or with a finger and the bladder stress test is carried out.
4.Ultrasounds and x-rays: This is used to view and record the changes happening to your urethra and bladder while you carry out some bladder stress exercises like laughing or coughing.
5.Electromyogram: This is also popularly called EMG. It is used to record the electrical activities of muscles.
6.Cystoscopic exam: This test is carried out with a thin and lit tube that allows the doctor to see inside your urinary tract.
7.Cystourethrogram: This is when an x-ray of your urethra and bladder is taken while you are urinating.
8.Urodynamic tests: This test is usually only done when other treatments have not worked and you are contemplating having surgery. This test involves other tests to be carried out.
-Uroflowmetry; rate of urine flow.
-Pressure flow studies; measures pressure changes as urine flow changes.
-Post-void residual volume; measures volume of urine remaining in the bladder after urinating.
-Cystometry; measures pressure of bladder when full at different levels.
Fecal Incontinence Diagnosis
Fecal incontinence diagnosis also begins with a physical examination that involves questioning and some anal probing in most cases.
Diagnosis carried out to know the cause and type of Fecal incontinence includes;
1.Balloon expulsion exam
2.Digital rectal exam
7.Magnetic resonance imaging; defecography.
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