Incontinence in Healthcare
– What You Need to Know

What is Incontinence?

As a healthcare professional, you probably already have all of the basics about incontinence in place. However, before we dive further into the practical advice, it is helpful to establish exactly what we’re talking about – So, what is incontinence?

Urinary incontinence can be defined as the “complaint of involuntary loss of urine” (5). Meanwhile, fecal incontinence is defined as the “involuntary loss of solid or liquid stool” (6). The severity of incontinence ranges from the occasional leak to complete loss of control of bladder or bowel movements.

Incontinence is often associated with aging, but in reality, incontinence can affect people in all age groups. Women are predisposed to incontinence due to pregnancy, childbirth, and menopause. Meanwhile, incontinence in men is also more common than most people think, with the primary causes being prostate issues, diabetes, and certain types of medication.

There are many different types and causes of incontinence. Subsequently, there are also many different treatments and preventative measures available.

The Urinary System

To understand what happens during leakage episodes, whether fecal or urinary, it is essential to have a basic grasp of the urinary system, which consists of the kidney, ureters, bladder, and urethra.

In adults, both kidneys filter approximately 200 liters of blood a day from renal blood flow, allowing toxins, metabolic waste products, and excess ions to be excreted while keeping essential substances in the blood. Ninety-nine percent of this filtrate is returned to circulation by reabsorption so that only about 1–2 liters of urine are produced daily. Urine travels from the kidneys via the two ureters into the bladder.

The urinary bladder is a muscular sac in the pelvis, just above and behind the pubic bone. When empty, the bladder is about the size and shape of a pear. The bladder is flexible and expands with the amount of urine in it, allowing for urination to be infrequent and controlled. Normal functional bladder capacity in adults ranges from approximately 300-400 ml of urine before having to empty the bladder every 3-4 hours.

The muscle cells in the bladder are smooth muscle fibers, which means we can’t control them. As the bladder fills, it sends sensory information to the central nervous system and the brain, where we gain consciousness about the bladder filling. When the bladder is full, these signals tell us it must be emptied soon.

Two sphincters situated around the urethra help to close it and control urination. Once you are ready to urinate, the brain sends a signal to the bladder to make the bladder muscles contract. The signal is also sent to the outer sphincter to open or close the urethra. This forces the urine out through the urethra - the tube that carries urine from the body. However, for people living with urge incontinence, the bladder contracts, making it feel full even when it isn’t. Similarly, overflow incontinence occurs if the sensory nerves or the muscles around the bladder do not function properly, making it impossible or difficult to urinate.

Voiding typically occurs via initial relaxation of the pelvic floor muscles and the bladder neck followed by voluntary contraction of the detrusor muscle. Healthy voiding occurs promptly with strong continuous flow and complete emptying without pain or blood in the urine. When necessary, an individual should be able to defer voiding without leakage. Variations in any of these can be a sign of disease.

1.Consciousness centre (cortex)

2.Micturition centre

3.Spine

4.Reflex Arc S2

5.Bladder

6.Sphincter

7.Urethra

1.Kidney

2.Ureter

3.Bladder

4.Pelvic floor muscles and outer sphincter

At the same time, the pelvic floor muscles also have a vital role in making us able to hold in our urine. In fact, the most common cause of incontinence is the weakening of the pelvic floor muscles. Wеаk реlviс flооr muѕсlеѕ аrе unаblе tо hоld thе blаddеr, utеruѕ, аnd thе bоwеlѕ in thе рrореr рlасе, аnd аrе lеѕѕ еffесtivе in mаintаining finе соntrоl оvеr thе ореning аnd сlоѕing оf thе blаddеr аnd rесtum. For people living with stress incontinence, coughing, sneezing, jumping, or otherwise being physically active can lead to urine leakages because the pelvis is put under extra strain, and the muscles aren’t strong enough to hold back the urine.

Thеrе аrе mаnу соntributing fасtоrѕ tо thе dеtеriоrаtiоn in pelvic floor muѕсlе ѕtrеngth. Thе muѕсlеѕ grаduаllу bесоmе wеаkеr аѕ уоu аgе but prеgnаnсу, obesity, heavy weightlifting, and more, рut еxtrа ѕtrеѕѕ оr ѕtrаin оn thе аbdоmеn and thereby аlѕо lеаd tо a dесrеаѕе in muѕсlе tоnе.

Types and Causes of Incontinence

It is important to note that incontinence is not considered a disease but a symptom of an underlying condition. This means that there is always something causing the incontinence. Some causes are permanent, and some are temporary.

As mentioned, the most common cause of incontinence is the weakening of or damage to the pelvic floor muscles. However, incontinence can also be caused by underlying neurological disorders, prostate problems, obesity, chronic coughing, vaginal births, aging, and more practical problems such as poor access to the toilet, which can be a problem for people who are blind or physically disabled.

As such, it is always crucial to identify the cause of the incontinence before starting treatment.

The overall types of incontinence are:

• Stress incontinence
• Urge incontinence
• Mixed incontinence
• Functional incontinence
• Overflow incontinence
• Fecal incontinence

At the same time, incontinence might be temporary or permanent. Below, we have listed some of the causes of incontinence.

Treatment Options for Incontinence

All people should be able to become continent regardless of age, fragility, and diseases. Studies show that up to 70% of people with incontinence can be either cured or have their situation significantly improved through training, medication, or surgery (2).

One of the most minimally invasive and effective treatments for incontinence are pelvic floor exercises and pelvic floor physiotherapy, which can prevent, treat, and relieve the symptoms of incontinence. In some cases it can help to do some pelvic floor exercises. If you suspect that the patient has an overstrained pelvic floor the pelvic exercises should be replaced with relaxation and stretching exercises. Consult a physical therapist to learn more about these types of exercises.

Lifestyle changes can relieve symptoms and make everyday life with incontinence easier. These include staying hydrated, staying active, and maintaining a healthy body weight. For some people, avoiding spicy foods, alcohol, and caffeinated beverages also helps relieve symptoms.

Depending on the type of incontinence, a specialist may advise different treatments. For instance, a doctor or specialist can prescribe medications that reduce the unintentional tightening of the bladder and thus reduce symptoms for some types of incontinence.

If these treatments do not work, it is sometimes possible to treat incontinence with surgery. 

Who can be Affected by Incontinence?

Estimating exactly how many people live with incontinence worldwide can be difficult. This is, among other things, because people feel ashamed about their condition and do not seek help from their medical practitioner. Therefore, they also do not appear in any statistics. However, in 2018, GFI (Global Forum on Incontinence) estimated that 8,7% of people over the age of 20 live with incontinence. This means that 423 million people worldwide are affected.

While incontinence can happen to anyone, it is more common in older people, especially in women, and the prevalence of incontinence increases among those living in nursing homes. Still, it is a misunderstanding that incontinence is an inevitable result of aging and that nothing is to be done about it.

The Effects of Living with Incontinence

Living with incontinence isn’t just a physical problem. The effect on a person’s mental health can be devastating and have many negative consequences, including social, economic, and behavioral.

In most cultures, human excretions belong to the intimate sphere and are something we are expected to have control over. Control is practiced in childhood and is part of our primary socialization, which is deeply embedded in us, and difficult to free ourselves from them.

Incontinence is often perceived as self-inflicted by those living with it, and they learn to hide their problem from close friends, family members, and even their significant others for years. Studies show it takes six years before seeking professional help for incontinence (8).

Losing control of the body's excretions often leads to fear and anxiety about losing face and dignity towards the environment and oneself. This fear can also be directed towards healthcare professionals and their reaction to the sight and smell of the excretions.

Living with urinary or fecal incontinence is, therefore, often associated with embarrassment and shame, which can ultimately lead to social isolation and the loss of quality of life. Subsequently, people with incontinence also often experience poor mental health, with different studies showing a high prevalence of comorbid psychiatric disorders such as depression (4).

Living with incontinence also presents more surprising side effects, such as a much greater risk for falls and fractures, especially in older adults. It is hypothesized that this occurs because older adults have a reduced capacity to divide their attention. Thus, an elderly person focused on needing to get to the restroom quickly may become unaware of the potential hazards in their path to the bathroom or may become inattentive to controlling their posture or body movements, which increases the risk of falling. This can lead to hospital admissions (9).

Further, people with regular incontinence also often experience skin infections such as IAD (incontinence-associated dermatitis) and fungus due to overexposure to moisture and an interruption in the skin’s natural micro-climate due to a pH change from urine or/and feces.

Caring for People with Incontinence

During a person’s first consultation with their doctor or healthcare practitioner, finding the type and cause of incontinence is the first step before finding the proper treatment for the individual patient. The goal is to cure the incontinence or significantly reduce the symptoms. Hereafter, we can give advice concerning beneficial products and lifestyle changes that may relieve their symptoms.

It’s essential to support the person living with incontinence to take control of the problem rather than letting the problem control them. Most importantly, this is done by making a proper assessment to identify the case and type of incontinence. Next, it can be helpful to advise the patient on product choice and give practical tips such as keeping an incontinence product with them at all times and how to take care of their skin and perineal area to avoid odor and skin irritations. As inspiration, you can find more useful tips for people living with incontinence here.

Further, when caring for people living with incontinence in nursing homes or other long-term care facilities, there are many things we, as healthcare professionals, can do to make the person feel more comfortable.

To maintain dignity and quality of life for those living with incontinence, here are some points to be aware of:

1. It is crucial to properly assess the cause and type of incontinence to find a treatment that can minimize or cure the incontinence.
2. Choosing the right product to help residents avoid leakages. Make a proper assessment of the resident’s product needs by measuring their hip size and urine output to find the absorption needed. Remember that one product doesn’t fit all and that a bigger product is not always better. Find the product as small as possible and as large as necessary.
3. Make sure that managing residents’ incontinence care does not come off as being an inconvenience to you. In a tight schedule with many tasks, it can be difficult not to seem like you are in a rush. However, during incontinence care, residents are exposed and feel vulnerable.
4. Be discreet when checking residents’ incontinence products. Don’t do it in social settings where the residents can feel embarrassed.
5. Make sure to take proper care of residents’ perineal skin. It is estimated that nearly 1 in 5 people with incontinence also have problems with IAD (incontinence-associated dermatitis) (3). Read how to prevent IAD in this article.
6. Make sure the resident or patient is hydrated. People living with incontinence tend to avoid drinking too much fluid to prevent them from having to urinate. This can irritate the bladder, which needs the flush of urine from proper fluid intake.
7. Prevent constipation with a diet high in fiber and encourage residents to drink enough fluid (for an average person, approx. 1,5 l/day).
8. Don’t let incontinence products replace toilet visits. Training good toilet habits and planning assisted toilet visits are essential. It helps maintain the normal function of going to the toilet.

This article has been written in collaboration with in-house nurses at ABENA.

(1-9) All sources are available upon request. 

ABENA’s Solutions

ABENA offers a wide range of incontinence pads to help with continence management and improve the quality of life for those living with incontinence.

Our incontinence supplies cover everything from incontinence pads in numerous sizes and shapes to bed protection products such as absorbent underpads and protective sheets. We even have specialized products like fecal incontinence pads, gender-specific products such as male incontinence pads shaped for the male anatomy, and junior products.

Each type of incontinence can lead to different degrees of leakage, so it is crucial to find the right incontinence product for your needs.

Do you want to know more?

Get in touch with one of our in-house nurses by filling out the form below.

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