Types of incontinence

Incontinence is a common problem, with urinary incontinence being more common. There are a number of different types of incontinence, which are described below.

Bladder

The three main types of bladder dysfunction are:

  • overactive bladder
  • stress incontinence
  • voiding difficulties.

Overactive bladder
A person with overactive bladder may not have incontinence but have symptoms that significantly affect their quality of life.

Symptoms of overactive bladder include:

  • frequency – needing to pass urine frequently
  • urgency – an urgent need to pass urine; at times the person may not reach the toilet in time and be incontinent
  • nocturia – waking during the night to use the toilet.

Stress incontinence
Stress incontinence is the involuntary loss of a small amount of urine when pressure increases in the abdomen, for example when coughing or sneezing. It is a problem that predominantly affects women and is usually caused by a weakness in the bladder neck or urethral sphincter. The muscles controlling the outflow of urine from the bladder are not as strong as they should be and therefore may let some urine escape when under pressure.

Weakness may be caused by a variety of factors:

  • surgery – particularly in men following prostate surgery
  • pregnancy and childbirth
  • obesity
  • menopause
  • chronic cough
  • chronic constipation.

Passive incontinence

When a person feels no urge to open their bowel. They are unaware that the rectum is full and ready to be emptied and cannot consciously control their bowel movements, therefore stools can pass without their knowledge.

Outflow obstruction

Is where the bladder neck is restricted. It is more common in men because as they age the prostate gland naturally enlarges, restricting the urethra and making it harder to pass urine. It may also enlarge as a result of cancer.

Other causes of outflow obstruction include urethral strictures and chronic constipation.

Symptoms of outflow obstruction include:

  • passing small, frequent amounts of urine
  • hesitancy in starting to pass urine
  • poor urine flow
  • post micturition (post urination) dribble.

Detrusor hypoactivity is where the bladder muscle is underactive and does not contract properly to effectively pass urine and empty. The bladder will stretch and potentially retain large volumes of urine.

It is caused by damage to the nerves supplying the bladder or to the lower spinal cord. It is usually experienced by people with a spinal injury and neurological conditions, such as multiple sclerosis and diabetic neuropathy.

Symptoms of detrusor hypoactivity include:

  • a lack of bladder sensation
  • an ability to go long periods of time without passing urine
  • overflow incontinence – if the bladder is overfull and can’t fully empty.

In both types of voiding difficulties people may experience frequent urinary tract infections.

Bowel

It is estimated that one in 10 people will be affected by bowel incontinence at some point in their life, although it is more common in women and older people.

Bowel incontinence is usually a sign of an underlying condition. The main types of bowel incontinence include:

Urge incontinence – when a person feels the urge to pass faeces but has to rush to make it on time.

Flatus (wind) incontinence – when a person feels the rectum filling but their body's nerves cannot tell whether it is wind or a stool.

Passive incontinence – when a person feels no urge to open their bowels. They are unaware that the rectum is full and ready to be emptied and cannot consciously control their bowel movements; therefore stools can pass without their knowledge.

Anal and rectal incontinence – the inability to control the muscles of the rectal canal and anal sphincter. If the nerves are damaged in the rectum control problems and leakage can occur.

Overflow incontinence – the leakage of watery faeces caused by a blockage of hard faeces. This can be mistaken for diarrhoea.

Dual incontinence is when both bowel and bladder control problems are experienced.

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