FAQs About Incontinence
- How many people have incontinence?
Currently, over 25 million people in North America experience incontinence. While it is not a symptom of old age, rates of incontinence increase above age 65.
In 2010, 40 million Americans will be age 65 or older. Over the next 40 years, 3.65 million more will celebrate a 65th birthday every year. Many will eventually require long-term care (LTC) or home healthcare (HHC), and the majority of people in LTC are incontinent.
While millions will need help managing incontinence, the most profound impact is the one it has on you or your loved one.
- What is incontinence?
Incontinence is not an illness or a disease, but a symptom of another problem. It can be caused by a variety of conditions and disorders, including birth defects, pelvic injuries or surgeries, damage to the spinal cord, neurological diseases, multiple sclerosis (MS), infections, and changes that are a result of aging. Incontinence can be temporary or permanent, depending on its cause.
Because bladder weakness is a symptom, not an illness, you may want to talk to your doctor. It may simply be a sign of aging, or it may be a sign of something else happening in your body.
- Is choosing the right incontinence product important?
Yes. Selecting the improper product can have serious consequences:
- Skin breakdown can occur due to urine wetness against your skin. Attends products quickly capture voids and lock them in the product core to keep your skin healthier.
- Odors can occur when urine is held against your skin. Attends products feature specially treated fibers to change the chemistry of urine to reduce growth of odor-causing bacteria.
- Leakage and embarrassment can be the result of improper fit. The right fit goes a long way to ensure containment and increase personal self-confidence.
- View a guide to selecting our products.
- Complete your Personal Assessment to receive a customized product recommendation.
- What causes or contributes to incontinence?
There are many factors that may contribute to incontinence. The most common causes are:
- Relaxation of the pelvic muscles; this is often seen in women after they have had children
- Reduced muscle control; this is something that may accompany menopause
- Infections or inflammation of the bladder or the urethra
- Nervous system disorders
- Aggravation to the bladder caused by alcohol, caffeine, or medications
- Are there different types of incontinence?
There are different types of incontinence, and you may experience more than one type at the same time:
- Stress incontinence affects one in every three women, commonly after multiple births or during menopause. Stress incontinence usually causes intermittent leakage of small amounts of urine, which often happens with exercise, coughing, sneezing, or laughing. Other causes include damage to the pelvic region or the sphincter muscle.
- Urge incontinence comes with a sudden, urgent need to urinate and no access to a toilet. Urge incontinence occurs when nerves between bladder and brain are damaged. Stroke, dementia, Alzheimer’s disease, and MS can all cause urge incontinence, but it also can be caused by a simple urinary tract infection.
- Mixed incontinence occurs when you experience symptoms of more than one type of urinary incontinence, such as stress incontinence and urge incontinence. With mixed incontinence, you must determine which symptoms are most bothersome and treat those symptoms. If you treat only the symptoms of stress incontinence, it could make the urge incontinence worse, and vice versa.
- Overflow incontinence happens when there is more urine created than the bladder can hold. Overflow incontinence happens when the bladder fails to contract as it should or to release urine due to an obstruction of the urethra. It can be caused by diabetes, pelvic damage or surgery, spinal cord injuries, MS, and/or other diseases. Constipation, medications, and an enlarged prostate gland can also cause overflow incontinence.
- Fecal incontinence happens when you are unable to control bowel movements or gas and includes liquid and/or solid stool. Fecal incontinence can vary by degree, from only a small amount of liquid waste to entire solid bowel movements. It can be caused by neurological diseases, musculoskeletal disorders, or injuries to the pelvic area.
- Functional incontinence happens when physical or cognitive limits prevent you from reaching a toilet. The limits can be physical barriers, such as being too far from a bathroom when the urge strikes, psychiatric barriers that interfere with knowing when you need a bathroom, or mobility problems such as arthritis.
- Should I talk to my doctor?
Yes. Up to 80% of people with urinary incontinence can be cured or experience improvement. A physical exam can help determine the cause of your incontinence and help you and your doctor decide how to correct or manage it.
There are different ways to manage incontinence: behavioral, pharmacological, surgical, and use of disposable incontinence products. The sooner you talk to your doctor, the sooner you can start to manage your incontinence and get on with your life.
- How do I start a conversation with my doctor about incontinence?
It’s normal to feel uncomfortable talking about losing control of your bladder and urine, but doctors understand that these are normal changes in all of us. The most important thing is to talk plainly and thoroughly about your incontinence:
- Describe your symptoms clearly
- Let your doctor know how incontinence is affecting your life
- Talk about how long you have had incontinence and if it’s getting worse or changing over time
- Discuss other illnesses that may be affecting your health
- Bring a list of medicines you are taking, including herbal supplements, vitamins or minerals
- Talk about any surgeries you have had
- Tell your doctor how many children you have had
- Ask about treatment options, including incontinence products
- A voiding diary will give your doctor a better idea of your problem and help specify additional tests
- Are there things I can do to help myself?
There are changes that you can make to enhance your quality of life. Two key factors are diet and exercise, but be sure to discuss changes to your diet and level of exercise with your doctor before making them.
- Where can I find more information?
You can find a number of incontinence information sources on the Internet, including:
- National Association for Continence (NAFC)
- The Simon Foundation for Continence
- The Canadian Continence Foundation
Find other resources for information on incontinence
- How does the female urinary system work?
The female urinary system includes kidneys, two ureters, a bladder, and a urethra. The kidneys remove waste from your blood and continuously produce urine. The ureters are tube-like structures that move urine from your kidneys to your bladder. Your bladder stores the urine until it flows out of the body through another tube-like structure: the urethra.
Female Urinary Tract
Although not technically part of the urinary system, the sphincter muscle plays a major role because it controls the flow through the urethra.
Normally, your bladder stores urine and then releases it, but if any part of your urinary system fails, incontinence can occur.
Used with permission from The Canadian Continence Foundation
- Do women experience specific kinds of incontinence?
There are certain kinds of incontinence more common in women. Stress incontinence affects one in every three women, commonly after multiple births. Stress incontinence usually causes intermittent leakage of small amounts of urine, which often happens with exercise, coughing, sneezing, or laughing. Other causes include damage to the pelvic region or the sphincter muscle.
- How is incontinence evaluated in women?
The first step is to see a doctor experienced in treating incontinence. Urologists specialize in the urinary tract, and some have expertise in the female urinary tract.
Gynecologists and obstetricians specialize in the female reproductive tract and childbirth. A urogynecologist focuses on urinary and associated pelvic problems in women. Some nurses and other healthcare providers provide rehabilitation services and teach behavioral therapies such as fluid management and pelvic floor strengthening.
To diagnose the problem, your doctor will first ask about symptoms and medical history. Your pattern of voiding and urine leakage may suggest the type of incontinence you have. Your doctor may also recommend tests:
- Bladder stress test, where you cough vigorously as the doctor watches for loss of urine
- Urinalysis and urine culture, where your urine is tested for infection, urinary stones, or other causes
- Ultrasound, where sound waves create an image of the kidneys, ureters, bladder, and urethra
- Cystoscopy, where a doctor uses a thin tube with a tiny camera to see inside the urethra and bladder
- Urodynamics, a test to measure pressure in the bladder and the flow of urine
- A voiding diary will give your doctor a better idea of your problem and help specify additional tests
- Is bladder weakness more common in women during menopause?
A common cause of bladder weakness is reduced control of the muscles that control the bladder, which can occur with menopause.
- Do women get specific types of incontinence after menopause?
There are certain kinds of incontinence more common in women after menopause. Stress incontinence affects one in every three women, commonly after menopause. Stress incontinence usually causes intermittent leakage of small amounts of urine, which often happens with exercise, coughing, sneezing, or laughing. Other causes include damage to the pelvic region or the sphincter muscle.
- How does the male urinary system work?
The urinary system includes your kidneys, two ureters, a bladder, and a urethra. The kidneys remove waste from your blood and continuously produce urine. The ureters are tube-like structures that move urine from your kidneys to your bladder. Your bladder stores the urine until it flows out of the body through another tube-like structure: the urethra. Although not technically part of the urinary system, the sphincter muscle plays a major role because it controls the flow through the urethra. Normally, your bladder stores urine and then releases it, but if any part of your urinary system fails, incontinence can occur.
Used with permission from The Canadian Continence Foundation
- Do men get specific kinds of incontinence?
Overflow incontinence happens when there is more urine created than the bladder can hold. Overflow incontinence happens when the bladder fails to contract as it should or to release urine due to an obstruction of the urethra. It can be caused by an enlarged prostate gland, also known as benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy, and by surgery for prostate cancer.
- What causes incontinence in men?
For the urinary system to perform normally, muscles and nerves must work together to hold urine in the bladder and then release it at the right time.
Nerve problems can occur at any age and may be caused by disease, condition, or injury:
- Diabetes over the long term may cause nerve damage that affects bladder control
- Stroke, Parkinson’s disease, and MS all affect the brain and nervous system, so they can also cause bladder-emptying problems
- Overactive bladder is a condition in which the bladder squeezes at the wrong time. It may be caused by nerve problems or occur without any clear cause, and may come with two or all three of these symptoms:
- Urinary frequency, meaning urination eight or more times a day or two or more times at night
- Urinary urgency or the sudden, strong need to urinate immediately
- Urge incontinence where urine leakage follows a sudden, strong urge to urinate
- Spinal cord injury may affect bladder emptying by interrupting the nerve signals required for bladder control
- Can urinary incontinence be caused by prostate problems?
An enlarged prostate gland, also known as benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy, may squeeze the urethra and affect the flow of the urinary stream. Symptoms vary, but most commonly involve problems with urination, such as urgency and leaking or dribbling, more frequent urination, especially at night, and urge incontinence.
The two most common treatments for prostate cancer, radical prostatectomy (surgical removal of the entire prostate gland) and external beam radiation (radiation treatment targeted at the prostate gland), can cause prostate problems including urinary incontinence.
- How is incontinence evaluated in men?
The first step is to see a doctor who has experience treating incontinence. The doctor will ask about:
- Your medical history, how much fluid you drink a day, whether you use alcohol or caffeine, prescription and nonprescription medicines you take, will all help determine the cause of incontinence
- A digital rectal exam to check for prostate size and condition
- Tingling sensations or feelings of numbness or changes in sensation, muscle tone, and reflexes
For caregivers and loved ones
- How do I start a conversation with a parent if he or she is experiencing
Remember that it's normal to feel uncomfortable discussing something as private as incontinence with someone who used to change your diapers. There are conversations between relatives—especially between parent and child—that many of us would rather avoid. Urinary incontinence is a challenging exchange, but here are some tips to get it started:
- Avoid denying the problem; don’t pretend it’s not happening.
- Take an empathetic approach. If the person becomes defensive, remember that she may feel embarrassed – your parent is not angry with you, more likely she is angry about the problem.
- Take a team approach and make it clear that you want to work together to find a solution; it may help to bring your parent some educational information that can help reinforce that he isn't the only person with these symptoms and help you begin the conversation.
- Establish an open honest dialogue, encouraging your parent to talk about severity, how long he has had the symptoms, changes over time, and impact on daily activities
- Talk about incontinence products that can help your loved one continue to lead a normal, healthy life
- What are some of the common challenges of a caregiver?
Being a caregiver is a stage of life that millions of people go through. If you are a caregiver, here are a few of the challenges you may face in caring for a loved one:
- Role reversal is difficult in any situation but especially tough when you are providing intimate personal care for the person who used to change your diapers. Transitioning from a son or daughter to a caregiver in a relationship can be complicated but also rewarding.
- Marital stress is another common issue among caregivers. Many caregivers report experiencing strain on their marriages.
- Financial stress is often a fact of life for caregivers
- 34% dip into their savings
- 60% have their lifetime earning potential negatively effected
- Many quit work or go part-time
- Many need to leave their jobs early every day or telecommute
- Long distance caregivers typically spend nearly $400/month out of pocket for travel alone
These challenges will probably feel overwhelming at times, so make sure that you are getting the support you need to stay healthy.
About Childhood Incontinence
- How common is childhood incontinence?
Incontinence occurs less often after age 5. About 10% of 5-year-olds, 5% of 10-year-olds, and 1% of 18-year-olds experience incontinence. It is twice as common in boys as in girls.
- What causes nighttime incontinence or bedwetting?
Wetting at night or bedwetting after age 5 is more common than daytime incontinence. Experts do not know what causes nighttime incontinence. Most young people who experience it are physically and emotionally healthy. Probable causes include slower physical development, an overproduction of urine at night, a lack of ability to recognize bladder filling when asleep, and infrequently, anxiety. For many, there is a strong family history of bedwetting, suggesting a genetic connection.
- What causes daytime incontinence?
Daytime incontinence may be caused by urinary infection, anatomic abnormalities, and an overactive bladder. Many children with daytime incontinence have abnormal elimination habits, the most common being infrequent voiding and constipation.
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Acknowledgements: information in this section is based on several sources, including the Web sites of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the Mayo Clinic, the Canadian Continence Foundation, the Caregiver Partnership, the International Foundation for Functional Gastrointestinal Disorders, Inc. (IFFGD), and Caring.com. Find links to these and other Web sites in our Resources section.