Despite the potentially debilitating impact and embarrassment of living with incontinence, those people who do can at least take heart that they are not alone and that help is available.
Whilst incontinence is a condition that people are understandably uncomfortable talking about, it is in fact incredibly common, with an estimated 400 million people affected around the world.
The International Continence Society (ICS) describes incontinence as the unwanted and involuntary leakage of urine or stool.
These conditions are too often poorly addressed and subsequently inadequately managed, despite the substantial impact on individual health, self-esteem and quality of life.
World Continence Week, an annual event organised by the ICS and running this year from June 22 to June 28, is a way of addressing that.
The two most common types of urinary incontinence are referred to as “stress” or “urge” incontinence. In reality, many patients suffer with a mixed picture of both stress and urge incontinence.
Stress incontinence occurs when the pressure inside the bladder, as it fills with urine, is greater than the strength of the urethra to remain closed. This can lead to urine being released involuntarily when additional pressure is created, for example due to sneezing or laughing.
This can be a result of childbirth, weight issues, surgical damage during hysterectomy or prostate operations, and neurological conditions including multiple sclerosis or Parkinson’s disease.
Pelvic floor exercises are so often overlooked but can have a significant impact on stress incontinence. Maintaining pelvic floor tone in women can also help prevent genital prolapse later in life.
Urge incontinence is a result of the detrusor muscles within the walls of the bladder contracting too often. Causes can include consuming large quantities of alcohol or caffeine, some medications, poor fluid intake, neurological conditions and constipation.
A blockage in the bladder, perhaps due to an enlarged prostate in men, bladder stones and constipation, can also lead to overflow incontinence.
People who experience total incontinence often have a problem from birth or experience symptoms after spinal damage.
Bowel incontinence is normally a symptom of an underlying problem. It can be related to constipation, diarrhoea, inflammatory bowel conditions, haemorrhoids, muscle or nerve damage within the bowel due to stroke, diabetes or multiple sclerosis.
Bowel incontinence can be a sign of more serious medical issues and should never be ignored.
Whilst incontinence is incredibly common, it is not a symptom to be ignored. New or sudden onset of either bladder or bowel incontinence could indicate infection. Whilst sudden loss of bladder/bowel function, particularly in the presence of back pain, is a medical emergency until proven otherwise. It can indicate that the spinal cord has been ‘pinched’.
There are many treatment options that we can consider, and not all involve taking medication. Patients can be referred to specialists, including specialist nurses and physiotherapists who specialise in pelvic floor work. Supervised pelvic floor exercises or bladder and bowel training can improve symptoms and quality of life. Whilst some patients find their symptoms can even be effectively treated with Botox administered to the bladder.
It can be embarrassing to discuss incontinence with your GP. Patients also often worry about the examinations or tests that might be needed. Your GP can guide you through this process. As there are so many treatment options now available, it is absolutely worth discussing with them.
The bottom line is that no-one need suffer in silence.
Dr Alexandra Phelan is a practicing community GP and member of the Pharmacy2u.co.uk Online Doctor Service team.
Running from Monday, June 22 to June 28, World Continence Week 2015 is an International Continence Society initiative aimed at raising awareness of incontinence.
To find the local continence service, telephone the Bladder and Bowel Community on 01926 357220. They can also provide “urgency” cards that can be a less embarrassing way of signaling you need to use facilities if out and about.
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