You wouldn’t be embarrassed if your car sprung an oil leak, would you?
Incontinence – a fairly innocuous word and yet it carries with it negative feelings, such as shame, embarrassment, and low self-esteem. But why is that? After all, every single one of us urinates and/or open our bowels on a daily basis.
And therein lies the crux of the matter – because we are human, things can sometimes go wrong, leading to loss of control when we need to go to the loo.
There really is no shame in that – the body is a complex and wonderful thing, and with so many mechanisms working flat out just to keep us seeing, breathing, hearing and – well – living, invariably one or more of them will malfunction from time to time. Incontinence just happens to be a malfunction of the muscles (and sometimes the nerves) which keep our waste products in check on a day to day basis.
So What Exactly IS Incontinence?
In very simple terms, incontinence is the inability to control our bladder (urinary incontinence) and/or bowel (bowel incontinence).
There are several types of incontinence:
Stress Urinary Incontinence
It is the most common and most recognised type of incontinence. Rather than mental stress being the trigger, however, SUU refers to physical stress (exertion) being placed upon the sphincter muscle responsible for holding urine in. So laughing, sneezing, coughing, and even physical activity can cause the leak. The sphincter muscle holds the urethra closed until we go to the loo – however, this muscle can become damaged and prevent it from holding the urethra closed tightly enough, so as soon as we cough or sneeze we get an ‘oops’ moment!
Urge Urinary Incontinence
It is when an overactive bladder sends messages that you need to pee and you need to do it now! This is further broken down into two categories – Urge Urinary Incontinence Wet (UUI-wet) is, as the name suggests, the urge to go and the inability to hold it, so there is some leakage of urine. The other type is Urge Urinary Incontinence Dry (UUI-dry) which is when you feel the need to pee but don’t leak before you can get to the loo. When the bladder, which is a muscle, fills up, nerves then send a message that it needs to be emptied. However, under normal circumstances, the signal to empty the bladder is not given until it is appropriate, i.e., when you are sitting on the toilet or standing at a urinal. When that signal is received, the bladder will start to contract, pushing the contents out. With UUI, the signals get confused, and the bladder will be told to start contracting before time – resulting in either a mad dash to the toilet or leakage before you get there.
It tends to happen as the result of nerve damage. The bladder fills with urine, but the brain doesn’t get the message that it needs to be emptied, so the bladder overfills and then spills over, causing a leak. This can be down to a number of neurological conditions, such as an injury to the spinal cord. It can also be caused by a prolapsed bladder, or, in men, an enlarged prostate.
Is, as the name suggests, the inability to hold faecal matter and/or wind, in. Whereas the issue of urinary incontinence is becoming much more widely recognised and accepted, bowel incontinence is still something of a taboo, when it really needn’t be. Bowel incontinence can be caused by a number of things, such as damage during childbirth (to the muscles and/or nerves), Crohn’s Disease, Ulcerative Colitis, Irritable Bowel Syndrome, Multiple Sclerosis or other neurological conditions. Ironically, bowel incontinence can also be caused by constipation – if the hardened faecal matter causes a blockage, liquid faeces can seep around and leak out.
How Common is Incontinence?
In short – very! To illustrate that fact, and to make you realise that, if you suffer from any form of incontinence, you are far from alone, here are some statistics:
- More than 200 million people worldwide suffer from some loss of bladder control, according to estimates by the World Health Organisation (WHO), in 1998.
- NHS figures suggest that up to 6 million people in the UK suffer from urinary incontinence to some extent.
- A report published in the BMJ stated that 1.4% of participants in a study of 10 116 people suffered from major faecal incontinence, and confirms that faecal incontinence is a ‘fairly common symptom’, particularly in older people.
How Can I Help Myself?
There are several things you can do to help fight against incontinence.
- Cut out caffeine – it is a known bladder irritant, and it also increases urine production. Cutting out not only coffee but also fizzy drinks, tea, energy drinks and hot chocolate can help with urinary incontinence. By drinking more water you will dilute the urine, which in turn is much less likely to irritate the bladder by being too concentrated. Water will also keep your stools softer, which is much easier to manage.
- Weight Loss – excess weight can put a burden on a weak bladder, contributing to stress incontinence.
- Pelvic Floor Exercises will strengthen the sphincter muscle responsible for controlling urine flow – the stronger the muscles the more control you will have. Imagine you are stopping pee mid-flow, and repeat this exercise throughout the day, it really helps. This is also helpful for bowel incontinence, as the pelvic floor muscles serve both bladder and bowel control.
- Bladder Training. If you find you are going to the toilet every, say, two hours, it can be helpful to take a toilet break every hour and a half, to prevent leakage or the desperate urge. Then gradually increase the time between visits, by a few minutes at a time. This can literally re-train the bladder.
- Keep a food diary. Certain foods can cause looser stools which tend to leak, or conversely, may cause constipation which can lead to faecal overflow. Identifying and avoiding these triggers can be a huge help.
- Gradually adding fibre to your diet, up to around 20 – 30g per day will help to keep your stools softer, which are easier to control. However, don’t add it all at once as this can cause excess wind and bloating.
Are There Any Supplements I Can Take?
As well as the lifestyle changes listed above, there are supplements available which can help incontinence.
Cranberry is a well-known aid to urinary health, particularly for the prevention of cystitis. But it is also a valuable addition to your toolkit when managing incontinence. Cranberries make urine more acidic, which in turn prevents the spread of bacteria but possibly more importantly (for self-esteem) it controls odour, so when leaks do occur that worry is reduced.
Magnesium aids both muscle and nerve function, and as we have seen they work together to control bladder and bowel function. It is thought to reduce the spasms in the bladder, meaning the bladder is much more likely to empty when you want it to.
Sage can be beneficial by encouraging normal healthy functions of the digestive tract. In addition, during menopause, (when incontinence can strike) the tissues of the urethra can thin due to the fall in oestrogen. This, In turn, can affect the efficacy of the sphincter muscle. Sage is a Phytoestrogen which can increase the levels of oestrogen in the body, and counteract this symptom.
Vitamin D. Research has shown that a deficiency in Vitamin D could compromise muscle strength and that by taking a Vitamin D supplement, stress incontinence could be greatly improved, by strengthening those all-important pelvic floor muscles.
Traditional Chinese Medicine is also a useful medium to use in cases of incontinence. The following herbs can be used as standalone treatments:
Bu Gu Zhi
Fu Pen Zi
Jin Ying Zi
Shan Zhu Yu
However, TCM is a complex procedure, in which the practitioner will look for ‘patterns’ in your symptoms, and then determine which herbs to use. In cases of incontinence, for instance, whether it is a disruption in the Qi (life force, or energy) in the bladder or kidneys, or sometimes even the blood, spleen or lungs. A blend of herbs will then be chosen which will be specific to the individual.
Incontinence is more common than you might think and is nothing to be ashamed of. It is simply a malfunction of one of the many systems of our body. With a few tweaks to our lifestyle – diet, weight, exercise – and the addition of one or more natural remedies, it is a condition which can be successfully managed.
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