Incontinence: Urinary and Fecal

Incontinence is the involuntary loss of bladder or bowel control.

Stress Urinary Incontinence (SUI):

• Involuntary loss of urine secondary to an increase in intra-abdominal pressure (coughing, sneezing, laughing, lifting, exercise, or transitional movements).
• Usually only a small volume of urine loss.
• Urethra (where urine exits) may have too much mobility and does not close completely (decreased urethral closure pressure).
• Generally caused by a weak pelvic floor.
• Pelvic floor strengthening (Kegels) have strongest evidence in research to be an effective treatment method.

Urge Urinary Incontinence (UUI):

• Sudden, involuntary loss of bladder control secondary to a strong and overwhelming urge to go to the washroom.
• You will have urine loss before you are able to make it to the toilet (inability to delay voiding).
• There can be a small amount of urine loss or a complete emptying of the bladder as a result of urge incontinence.
• May be caused by detrusor (bladder muscle) instability, weak or tight pelvic floor muscles, or an upregulated sympathetic nervous system.
• Bladder irritants must be taken into consideration.
• Urge inhibition techniques can helpful.

Overflow Incontinence:

• The bladder doesn’t empty normally and becomes very full (distended bladder).
• Constant loss of small amount of urine (dribbles).
• The bladder may also never feel completely empty.
• This can be seen with conditions such as diabetes, Parkinson’s, and after radiation to the pelvis.

Functional Incontinence:

• Involuntary urinary leakage which is associated with impairment of cognitive or physical function (broken hip), psychological unwillingness (dementia), or environmental barriers to the toilet.
• Little changes can make a big difference (e.g. Velcro fasteners on pants instead of buttons, bedside commode and/or overall improvement in mobility and strength).

Mixed Incontinence:

• Involuntary urine loss associated with increases in intra-abdominal pressure (stress incontinence) and with an intense urge to void (urge incontinence).
• It is very common to have mixed incontinence.

Fecal Incontinence (FI):

• Inability to control your bowel movements, causing involuntary leakage of stool (feces) from your rectum.
• Also called bowel or anal incontinence.
• Can be occasional leakage while passing gas.
• Can be complete loss of bowel control.

Post-prostatectomy Incontinence (PPI):

• Involuntary urine loss following prostate surgery.
• Can be related to stress, urge, or mixed incontinence.

Pelvic floor muscle training is the first line treatment for urinary incontinence in women with Level 1, Grade A evidence of having incontinence. This is the highest level of evidence, meaning pelvic floor muscle training should be the first step in a treatment plan.