Urinary or fecal incontinence can be embarrassing and impair quality of life, but both can be treated more easily now than ever before. Incontinence – the inability to contain urine or fecal matter – isn't a topic often discussed in social circles.
Your Local Health | Written by BJ Towe
Urinary or fecal incontinence can be embarrassing and impair quality of life, but both can be treated more easily now than ever before. Incontinence – the inability to contain urine or fecal matter – isn't a topic often discussed in social circles. Although advertisements for products such as Depend® and Poise® have helped bring urinary incontinence out of the closet, fecal incontinence remains largely in the dark. Yet both forms of incontinence are more common — and more easily treated — than you might think.
Urinary incontinence can affect anyone, although women experience it twice as often as men. Symptoms range in severity from a little leakage that comes with coughing or laughing to involuntary release of urine that can be socially debilitating.
“The uncontrollable leakage of urine is reported to affect over 30 million Americans, but reluctance to discuss the problem means the real number is probably significantly more,” says Stephanie Powell Morgan, M.D., a fellowship-trained, board-certified Urogynecologist who focuses on disorders of the female pelvic floor (the muscles, ligaments, and tissues that support the uterus, vagina, bladder, and rectum) and reconstructive surgery for pelvic organ prolapse.
Morgan often sees women with incontinence issues stemming from pregnancy and childbirth, which can damage the nerves and muscles that are supposed to help hold and release urine. In addition to anatomical changes caused by childbirth, Morgan says other factors can increase a person's risk of developing urinary incontinence:
- Lifestyle factors such as alcohol, caffeine, smoking, weight, and medications.
- Easily treated medical conditions including constipation and urinary tract infection.
- Chronic medical conditions such as bladder conditions, hysterectomy, urinary tract obstruction, and neurological disorders.
“If you have early symptoms of urinary incontinence, discussing those with your doctor is a very simple way to get started toward treatment and preventing it from becoming socially debilitating. Don't be afraid that surgery is the only option.”
-Dr. Stephanie Morgan, The Iowa Clinic's Urogynecologist
Based on the type of incontinence, extent of the problem, and the underlying cause, current treatment options may include:
- Behavioral changes, such as modifying food and fluid intake, training the bladder to hold urine longer, or scheduling trips to the bathroom throughout the day. Medication may also be indicated.
- Physical Therapy, which may also be used in conjunction with medications. These help strengthen muscles that control release of urine.
- Medical devices, including a vaginal ring insert or pessary. Morgan explains: “A pessary is a small silicone ring that sits in the top of the vagina. Some women who have worn pads 30 to 40 years come in, get fitted with a pessary, and leave the office able to do jumping jacks. It can provide instant treatment gratification with no risk. Many very active women choose this form of management as there is no risk and it is adjustable to her symptoms.”
- Tension free vaginal tape slings have an excellent success rate and a low complication rate for urinary incontinence.
Types Of Urinary Incontinence
- Overflow | Unexpected leakage of small amounts of urine because of a full bladder.
- Stress | Leakage of small amounts of urine during physical movement (coughing, sneezing, exercising).
- Functional | Untimely urination because of physical disability, external obstacles, or problems in thinking or communicating that prevent a person from reaching a toilet.
- Overactive Bladder | Urinary frequency and urgency, with or without urge incontinence.
- Urge | Leakage of large amounts of urine at unexpected times, including during sleep.
- Transient | Leakage that occurs temporarily because of a situation that will pass (infection, taking a new medication, colds with coughing).
- Mixed | Usually the occurrence of stress and urge incontinence together.
Risk Factors Leading to Fecal Incontinence
- Muscle damage or weakness
- Nerve damage
- Loss of elasticity in the rectum
- Difficult childbirth with injuries to the pelvic floor
- Hemorrhoids and rectal prolapse
- Rectocele, a condition causing the rectum to protrude through the vagina
Source: National Institutes of Health