Incontinence

Incontinence is the involuntary loss of urine or faeces. It may cause disruption to social life, may affect one's self-esteem and can result in hygiene problems. Both problems can affect people of all social classes, ethnic groups and ages; however they tend to be more common as you get older.

Urinary incontinence

Urinary incontinence refers to involuntary urine leakage from the bladder. Women are more likely to be affected than men. It is also more common in older people. However it should never be considered as a normal part of the ageing process. It is always a symptom or sign of an underlying problem.

There are different types of urinary incontinence:

• Stress incontinence - leakage of small amounts of urine when sneezing, coughing, laughing, straining or lifting
• Urge incontinence - associated with a sudden strong urge to urinate
• Functional incontinence - resulting from problems such as poor mobility or dexterity, loss of memory or environmental factors

Faecal incontinence

Faecal incontinence refers to the involuntary loss of bowel contents - solid or liquid.

There are several causes of faecal incontinence including, among others:

• Diarrhoea - resulting from medication side-effects, irritable bowel syndrome, radiotherapy, or conditions such as diverticulitis and ulcerative colitis
• Constipation - infrequently hard bowel actions, along with episodes of incontinence or diarrhoea occurring unpredictably. This is a common cause of incontinence among older people and people with disabilities. Contributing factors may include a diet poor in fibre, low fluid intake, poor mobility, some medicines (e.g. painkillers) and various medical conditions.

You aren't alone! Seek help.

Incontinence is very common and help is available. If you suffer involuntary loss of urine or faeces, you will benefit from an assessment by a medical officer, continence nurse adviser or physiotherapist continence advisor.

Incontinence can be treated and often cured, or managed to considerably improve the symptoms of the condition and to allow full participation in a satisfactory lifestyle.

What help is available?

Incontinence can be assessed by a number of people. Your family doctor is a good place to start, particularly if s/he is keeping tabs on your medication. You may then be referred to a specialist - an urologist, urogynaecologist, continence nurse adviser or continence physiotherapist depending on investigations required.

A continence nurse adviser can assist with problems such as bladder leakage, bladder frequency, bladder urgency, frequency overnight, bowel leakage and/or constipation. Individual confidential programs include assessment, pelvic floor muscle exercise programs, bladder and bowel retraining, toileting programs, constipation management, symptom management strategies and practical advice and support, as well as information about useful products available.

A continence physiotherapist adviser will help with specialised intensive pelvic floor muscle rehabilitation, biofeedback and bladder retraining.

How to describe the condition to the doctor or nurse?

Before your appointment, keep a chart of your bladder habits:

• What time do you go to the toilet? How much is passed? (use an old plastic jug to measure the amount of urine)
• Write down episodes of wetness and if you have to change a pad. What activities cause urine leakage?
• How much loss? Day, night or both?
• What do you drink in a 24-hour period? (Amount and type of fluid e.g. tea, coffee, cola, water, alcohol)
• How often do you use your bowels?
• Are the motions constipated or loose?
• Do you strain to go or stain your underwear?

What can be done?

Incontinence has many different causes. The diagnosis will point to the treatment or management that is best for the individual. Some of the possible answers could be: reducing caffeine intake, improving water intake, review of medications taken, constipation management, effective bladder and bowel emptying strategies and good bladder and bowel habits, pelvic floor muscle strengthening exercises, bladder retraining, using containment products. In some cases, only as a last resort, surgery may be needed.

Pelvic floor muscle exercises

Pelvic floor muscle exercise strengthens the muscles inside the pelvis to improve control and function of the bladder and bowel. Through a series of properly taught, regular exercises, incontinence can often be cured or the problem reduced considerably. These exercises can be effective in reducing urine loss when coughing, sneezing, exercising, or on hearing running water, or putting a key in your front door (which creates a sense of urgency). It will however, take several weeks or months of commitment to a regular pelvic floor muscle exercise program to regain continence. To order the appropriate Pelvic Floor Exercise Fact Sheet contact the National Continence Helpline. Discuss with your adviser to ensure that you are using the correct technique.

Useful contacts

National Continence Helpline FREECALL™ 1800 33 00 66 - or email helpline@continence.org.au confidential telephone service available to all Australians, staffed by continence nurse advisors who provide information and advice on bladder and bowel problems. The Helpline also provides other services such as continence fact sheets, information on continence funding schemes and continence services.
The fact sheets may also be ordered from the website of the Continence Foundation of Australia.
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The Bladder & Bowel Website provides information on the various aspects of incontinence including brochures in English and fifteen other languages

The National Public Toilet Map is available on any mobile phone with an Internet browser. Go to m.toiletmap.gov.au on your phone to be automatically directed to the mobile site. It can also be searched on the website.
 
SA Continence Resource Centre (located at the Independent Living Centre of South Australia) - Information and advice on continence management, products and services.
Tel. 8266 5260 or 1300 885 886 (local call cost for SA and NT callers)

 Royal District Nursing Service (RDNS) - Clinic appointments or home visits can be arranged. For comprehensive assessment and management strategies. Tel. 1300 364 264

Australian Physiotherapy Association SA Branch (APA) - List of continence physiotherapists in private practice available on request. Tel. 8362 1355
The association’s website features a 'Find a Physio' facility (under Physiotherapy and You) which allows a search by suburb/locality and treatment area, including incontinence/continence. 

CAPS – The Continence Aids Payment Scheme, (CAPS), enables eligible people who have permanent and severe incontinence to pay for some of the costs of their continence products. An annual payment of up to $506.30 (plus indexation), for 2011-12 is available. For more information on CAPS,           tel. 1800 33 00 66 or go to www.bladderbowel.gov.au