Continence Awareness
WHAT IS A HEALTHY BLADDER & BOWEL?
A healthy bladder should:
• empty between 4-8 times in 24 hours
• hold between 400-600mls of urine without leaking
• produce urine that is straw coloured, almost clear like water
If a bladder does leak urine this is not normal and is a sign of bladder dysfunction.
A healthy bowel should:
• empty no less than 3 times per week and no more than 3 times per 24 hours.
• Not leak faeces
• Produce a type 3-4 stool (Bristol Stool Chart)
Everyone has their own bowel habits and routine, however, this is the definition of a healthy bowel. Anything outside this range should be checked out as this is a sign of bowel dysfunction.
WHAT IS INCONTINENCE?
Incontinence is a symptom of bladder and bowel dysfunction and should not be ignored.
Definitions and Prevalence
Urinary Incontinence is defined as the involuntary loss of urine by the International Continence Society ( ICS 2019)
Men and Women experience urinary incontinence although more women experience the problem than men. The prevalence is 1 in 4 women and 1 in 10 men and the incidence increases with age.
Faecal Incontinence is defined as the involuntary loss of faeces. - when faeces is solid and/or - when faeces is liquid (ICS 2019)
One in ten people have a bowel problem including faecal incontinence.
It is important to understand the reasons why someone is incontinent or is experiencing issues with their bladder and bowel and when this happens.
Types
There are different types of incontinence:
Urge - When the sensation to pass urine or faeces is present and is urgent causing leakage with very little warning.
Stress - When exertion happens eg coughing, sneezing, transferring, walking . Usually no sensation to empty bladder or bowels as the incontinence happens due to a weakness within the pelvic floor muscle.
Passive - When there is no sensation to pass urine or faeces, no warning that this is going to happen
Functional - Inability to access toilet due to mobility or environment or dependency levels- sensation present. The Bladder and Bowel are generally functioning well with no identifiable dysfunction.
Overflow – Due to incomplete bladder or bowel emptying. Urinary outflow obstruction can be caused by prostate problems (men), strictures (narrowing of the urethra), a bladder stone or tumours alongside neurological conditions. Faecal Overflow is mainly caused by constipation and neurological bowel conditions.
It is, also, important to understand that many people experience bladder and bowel dysfunction but are not incontinent.
They may experience:
Nocturia – passing urine frequently during the night – more than twice per night
Frequency – passing urine more than 8 times in 24 hours or emptying the bowel more than 3 times in 24 hours
Urgency – experiencing a strong desire to pass urine or faeces but managing to hold on reaching the toilet
Incomplete Emptying – not completely emptying the bladder or bowel. This can result in incontinence or urgency
Constipation - a reduction in the number of stools passed, usually a hard stool ie type 1-2 on the Bristol Stool Chart
CAUSES
There are many reasons why someone experiences incontinence they include:
• Pelvic Floor Muscle Weakness – men and women
• Neurological problems eg Multiple Sclerosis, Stroke, Parkinsons
• Lifestyle factors – fluids – not enough can cause urinary urgency and constipation, poor weight control, smoking, poor diet
• Functional issues – restricted mobility, toilet access problems
• Cognitive ability – ability to recognise the sensation to empty bladder or bowels, recognition of socially acceptable place ie bathroom and toilet
• Prostate conditions (Men) – usually in men over the age of 40
• Cancer and cancer treatment especially radiotherapy
