
Incontinence
Incontinence is the inability to control the release of urine, feces, or both. It is a common condition that can affect people of all ages, but it is more prevalent in older adults and women, especially after childbirth or menopause.
There are two main types of incontinence.
Urinary Incontinence: This refers to the loss of bladder control and can occur in different forms:
- Stress Incontinence: Leakage occurs during activities that increase abdominal pressure, such as coughing, sneezing, laughing, or exercising.
- Urge Incontinence: A sudden, strong urge to urinate followed by involuntary leakage. This is often linked to an overactive bladder.
- Overflow Incontinence: Involuntary leakage due to an overfilled bladder that cannot empty completely.
- Functional Incontinence: Caused by physical or cognitive impairments that prevent reaching the bathroom in time.
- Mixed Incontinence: A combination of two or more types, commonly stress and urge incontinence.
Fecal Incontinence: This refers to the inability to control bowel movements, leading to accidental leakage of stool. It can result from conditions like rectal muscle damage, nerve damage, or chronic diarrhea.
Incontinence can be caused by various factors, including:
- Weak pelvic floor muscles or damaged tissues (common after childbirth or surgery).
- Neurological disorders like multiple sclerosis or stroke.
- Urinary tract infections (temporary incontinence).
- Medications, hormonal changes, or certain medical conditions like diabetes.
- Lifestyle factors such as obesity, smoking, or excessive caffeine intake.
Recognizing incontinence involves being aware of specific symptoms that indicate difficulty controlling urination or bowel movements. Here are the common signs to watch for:
Symptoms of Urinary Incontinence
- Leaking Urine: Dribbling or small leaks during activities like coughing, sneezing, laughing, or exercising (stress incontinence). Leaking when rushing to the bathroom after a sudden, intense urge to urinate (urge incontinence).
- Frequent Urination: Needing to urinate more than usual, often disrupting daily activities or sleep.
- Strong Urgency to Urinate: Feeling a sudden, uncontrollable urge to urinate even if the bladder isn’t full.
- Inability to Fully Empty the Bladder: Feeling like you still need to urinate after using the bathroom (common in overflow incontinence).
- Bedwetting: Unintended urination during sleep.
- Functional Issues: Difficulty getting to the bathroom in time due to physical or cognitive challenges.
Symptoms of Fecal Incontinence
- Accidental Stool Leakage: Unintended passage of stool, whether solid or liquid.
- Difficulty Holding Gas or Stool: Struggling to control the release of gas or bowel movements.
- Urgency: Sudden and intense need to have a bowel movement with little warning.
- Frequent Soiling: Staining underwear due to minor leakage or incomplete bowel movements.
- Feeling of Incomplete Emptying: A sensation that the bowel wasn’t fully emptied after using the restroom.
Other Clues
- Avoiding social activities due to fear of leakage or not finding a restroom in time.
- Using pads or protective garments frequently to manage leaks.
- Recurrent urinary tract infections (UTIs) linked to bladder dysfunction.
Pregnancy is a significant contributor to incontinence, particularly urinary incontinence, due to the physical and hormonal changes that occur during this time. Here’s how pregnancy can lead to incontinence:
Increased Pressure on the Bladder
As the uterus grows, it places pressure on the bladder, reducing its capacity and causing increased urgency and frequency of urination. The additional weight from the baby also strains the pelvic floor muscles, which support the bladder and urethra, leading to leakage during activities like coughing, sneezing, or laughing (stress incontinence).
Hormonal Changes
- Relaxin and Progesterone: These hormones are essential for preparing the body for childbirth. They relax ligaments and muscles in the pelvis, including the pelvic floor. However, this softening can reduce bladder and urethral support, increasing the risk of leakage.
- Estrogen Decline: A drop in estrogen during late pregnancy and postpartum can affect the urethral lining and bladder function.
Weakening of the Pelvic Floor
The pelvic floor muscles stretch and bear extra weight during pregnancy. Over time, this can weaken the muscles, reducing their ability to control the bladder and leading to leakage. This effect is often more pronounced in women carrying multiples (twins, triplets) or those with larger babies.
Changes in Bladder Sensitivity
Pregnancy can alter bladder sensitivity and its signals to the brain. Some women experience an overactive bladder, where the need to urinate becomes sudden and urgent (urge incontinence).
Vaginal Delivery and Trauma
While incontinence often begins during pregnancy, it may worsen after vaginal delivery due to:
Pelvic Floor Injury:
Vaginal delivery can cause trauma to the muscles, connective tissue, and nerves that support bladder control.
- Episiotomy or Tears: Perineal tears or surgical incisions may damage structures involved in urinary control.
- Prolonged Labor: Long pushing stages may increase the risk of pelvic floor dysfunction.
Postpartum Factors
- Prolapse: After delivery, pelvic organ prolapse (such as bladder or uterine prolapse) can develop, contributing to incontinence.
- Delayed Recovery: The pelvic floor may take time to regain strength, especially without targeted rehabilitation.
- C-Section Considerations: While cesarean deliveries can reduce pelvic floor trauma, they do not eliminate the risk of incontinence since pregnancy itself places strain on these structures.
Prevention and Management
We can help minimize the risk or manage incontinence during and after pregnancy. Contact us today.
Yes, incontinence can affect sexual activity and intimacy, both physically and emotionally. Many people with incontinence experience challenges related to sexual function, but these can often be managed with the right interventions. Here’s how incontinence can impact sex and what you can do about it:
Physical Discomfort or Symptoms:
- Urinary Leakage During Sex: Pressure on the bladder during penetration or orgasm can cause urine leakage, known as coital incontinence.
- Vaginal Dryness or Irritation: Hormonal changes (e.g., postpartum or menopause) may contribute to discomfort.
- Fecal Incontinence: Though less common, leakage during intimacy can cause significant distress.
Pain or Discomfort:
- Weak pelvic floor muscles or underlying conditions, like pelvic organ prolapse, can make sex physically uncomfortable or painful.
Emotional and Psychological Effects:
- Fear of Leakage: Anxiety about accidental urine or stool leakage during intimacy can lead to avoidance of sex.
- Body Image Concerns: Some people feel embarrassed or self-conscious about their condition, which can affect confidence and desire.
- Relationship Strain: Incontinence-related challenges may create emotional distance between partners.
Reduced Libido or Sexual Response:
- Chronic stress, hormonal imbalances, or pelvic floor dysfunction can diminish sexual arousal or make it difficult to achieve orgasm.
Incontinence is not always permanent and can often be treated or managed effectively, depending on its cause, type, and severity. While some cases resolve on their own, especially after childbirth or a temporary condition like a urinary tract infection (UTI), others may require medical intervention or lifestyle changes.
Factors that determine whether incontinence is permanent:
Underlying Cause:
- Temporary conditions like UTIs, constipation, or pregnancy-related changes often improve with treatment or postpartum recovery.
- Chronic conditions, such as nerve damage or severe pelvic organ prolapse, may require ongoing management.
Type of Incontinence:
- Stress Incontinence: Often improves with pelvic floor exercises, physical therapy, or, in severe cases, surgery.
- Urge Incontinence: Manageable with medications, bladder training, or lifestyle changes.
- Overflow Incontinence: May require treatment for the underlying cause, such as an enlarged prostate or weakened bladder muscles.
- Mixed Incontinence: A combination approach is typically effective.
Timing and Treatment:
- Early intervention, such as pelvic floor therapy, lifestyle adjustments, or medical care, can significantly improve or resolve symptoms. Delayed treatment may lead to more persistent issues.
Severity of Pelvic Floor Damage:
- Minor damage from pregnancy, childbirth, or aging can often be rehabilitated.
- Severe damage (e.g., from multiple childbirths, trauma, or surgery) may require more intensive interventions.
Preventing incontinence involves maintaining the health and strength of your pelvic floor muscles, adopting healthy lifestyle habits, and managing conditions that could contribute to bladder or bowel issues. While not all causes of incontinence can be avoided, following these strategies can significantly reduce the risk:
Strengthen Your Pelvic Floor
- Pelvic Floor Exercises: Regularly practicing pelvic exercises helps keep the pelvic floor muscles strong and supportive. These exercises are especially important for women during and after pregnancy, as well as for men with prostate concerns.
- Consider Physical Therapy: A pelvic health physical therapist can assess your pelvic floor function and provide tailored exercises to prevent weakness or dysfunction.
Maintain a Healthy Weight
- Excess body weight places additional pressure on the pelvic floor and bladder, increasing the risk of incontinence. Maintaining a healthy weight through a balanced diet and regular exercise can help reduce this strain.
3. Practice Good Bladder Habits
Avoid Overfilling the Bladder:
Empty your bladder regularly, but avoid going “just in case” too often, which can train the bladder to hold less.
Limit Bladder Irritants:
- Reduce or avoid caffeine, alcohol, carbonated drinks, and spicy or acidic foods, which can irritate the bladder lining and contribute to overactivity.
Stay Hydrated:
- Drink enough water to avoid concentrated urine, which can irritate the bladder, but avoid excessive fluid intake.
Prevent Constipation
- Straining during bowel movements weakens the pelvic floor muscles.
- Eat a high-fiber diet with plenty of fruits, vegetables, and whole grains.
- Drink plenty of water.
- Stay active to promote bowel motility.
Manage Chronic Coughing
- Chronic coughing from smoking, allergies, or respiratory conditions increases pressure on the pelvic floor. Quit smoking and seek treatment for chronic coughs to reduce this strain.
Protect Your Pelvic Floor During Pregnancy
- Strengthening Exercises: Perform pelvic floor exercises during and after pregnancy to prevent or minimize pelvic floor weakening.
- Body Mechanics: Avoid heavy lifting and practice good posture to reduce pressure on the pelvic floor.
Stay Active
- Regular exercise improves circulation and strengthens the core and pelvic floor muscles. Low-impact activities like walking, swimming, or yoga are particularly beneficial. Avoid exercises that cause repetitive heavy lifting or high-impact stress on the pelvic floor.
Seek Early Treatment
- If you notice early signs of incontinence, such as minor leaks during physical activity or urgency, address them promptly. Early intervention with lifestyle changes or physical therapy can prevent the condition from worsening.
Avoid Unnecessary Strain
- During Exercise: Use proper form and avoid exercises that place undue pressure on the pelvic floor, like heavy lifting without support.
- During Bowel Movements: Avoid straining by using a footstool to elevate your feet, which helps align the rectum for easier passage.
Contact us today for an internal pelvic floor examination or a confidential pelvic health consultation.