Continence is the ability to have control over your excretory bodily functions. A person who suffers from continence problems will lack the ability to control their flow of urine or passing of faeces.
It is a common myth that only older people suffer from continence problems. This is not true. Continence problems can affect anyone, irrelevant of age, gender and health status.
It is estimated that 9 million people in the UK suffer from urinary continence problems (Bladder and Bowel Foundation, 2011) and approximately 1% to 10% of adults suffer from an element of faecal incontinence (NICE, 2007).
Whilst having a continence problem is not harmful to the individual, it can have serious implications on a person’s life, for example it may affect self-esteem, personal and sexual relationships, and emotional wellbeing.
Assessment and Management of Patients with Continence Problems
People who are identified as suffering from a continence problem by The Rotherham Foundation Trust staff either in the community or in hospital, and who would like these problems assessing and managing, will undergo a baseline assessment.
This baseline assessment will include:
- a brief past medical history
- details of any current medication
- fluid intake
- bowel management
- observation of the penis or vulva
- assessment of mobility and dexterity
- discussion around toilet facilities
There are many factors that could contribute to continence problems including pregnancies, urinary tract infections, mental or cognitive problems or even the side effects of some medication. By having a baseline assessment the individual is able to be managed appropriately and hopefully see improvements in their continence.
There are a range of things that can be done to improve a person’s continence, from simple exercises to strengthen the pelvic floor to surgical interventions, dependent on the type of continence problem.
Types of Continence Problems:
Stress incontinence is the most common form of urinary incontinence, occurring when the pelvic floor muscles which support the bladder are weakened. It is characterised by symptoms such as leaking urine when laughing, sneezing or exercising.
The main treatment for stress incontinence is pelvic floor exercises to retighten the muscles. For more information on pelvic floor exercises please read the patient information booklet.
Overactive bladder syndrome is when the bladder contracts suddenly without you having control, and when the bladder is not full. It is characterised by needing to pass urine frequently and urgently, sometimes leaking if unable to get to the toilet in time. Caffeine may exacerbate symptoms so it is recommended to reduce your caffeine intake. Pelvic floor exercises can also help alleviate symptoms.
Bladder training is the main treatment. This involves keeping a record of when you pass urine and how much, gradually increasing the time between passing urine. For more information on bladder training please read the patient information booklet.
Voiding difficulties causing discomfort on urination, or retention, are the reflection of an imbalance between bladder contraction and urethral resistance. It is characterised by an intermittent stream of urine, incomplete emptying and straining to void. Management depends on the cause of the voiding difficulties and may require a review of medication, bladder training, or may be caused by constipation which would require a discussion regarding fibre intake and looking after the bowels.
Faecal incontinence is an inability to control bowel movements, which means that stools can leak uncontrollably from the rectum (bottom). Some people may just pass a small piece of stool when passing wind, while others may have a complete loss of bowel control.
Faecal incontinence is not a condition in itself; it is likely to be a symptom of an underlying condition so it is important to see a healthcare professional regarding this.
Treatment options may include lifestyle changes, exercise programmes, medication or surgery.
What do do if you have continence problems
Fluid intake should not be reduced as a way of preventing continence problems. On average, an individual should drink between 1 and 2 litres of water a day.
People often do not seek treatment as they are embarrassed or believe that continence problems are a natural part of ageing. This is not the case. Continence problems should not be accepted as inevitable, as improvements can often be made.
There are services available within The Rotherham Foundation Trust, if you require further assessment or intervention or for information on product and pad usage, which can be accessed via your GP. Find out about the Continence Advisory Service here.