Incontinence

Incontinence is the involuntary loss of urine or stool. Both women and men can suffer from it. The causes of incontinence can be very different. The cause determines which treatment is best. Incontinence problems can be temporary or permanent.

Types of incontinence

There are two types of incontinence: urinary incontinence and fecal incontinence.

Urinary incontinence
Urinary incontinence is the involuntary loss of urine. There are several different forms:

• Stress incontinence. Loss of small amounts of urine during coughing, sneezing, heavy exertion, heavy lifting, or jumping.
• Urge incontinence. Sudden urgency to urinate. This cannot be suppressed.
• Overflow incontinence. When the bladder, as it were, overflows. Then there is loss of drops of urine.
• Reflex incontinence. This is usually due to a neurological condition. Muscle control is no longer good.
• Pregnancy incontinence. During or after pregnancy, incontinence can occur. This arises from pressure from the uterus or hormonal changes.

Fecal incontinence
Fecal incontinence is the involuntary loss of stool.

Causes of incontinence

Loss of urine or stool occurs because the closure of the bladder, sphincter, or pelvic floor muscles does not work properly. When there is an urge to urinate or defecate, the pressure on the bladder or sphincter increases. The muscles provide counterpressure to hold urine or stool in. If these muscles cannot provide sufficient counterpressure, incontinence occurs.

Causes of a poorly functioning closure mechanism include:

• Getting older. Due to hormonal changes, the sphincters can become weaker.
• Childbirth. After childbirth, the pelvic floor muscles can be weakened. They can no longer exert pressure.
• Overweight. There is more pressure on the bladder and surrounding muscles.
• Gynecological operations. Surgery in the pelvic area can affect the muscles.
• Lack of exercise. Like all muscles, the muscles around the pelvis must be trained.
• Congenital abnormality.
• Prostate problems. In men, incontinence usually occurs due to problems with the prostate.
• Neurological conditions. Due to damage to the nerves that control the closure mechanism. Such as a spinal cord injury, MS (multiple sclerosis), or a stroke.
• Psychological problems.
• Cancer.
• Problems with the bladder.

Treatment for incontinence

In many cases, it is possible to get rid of incontinence or to cope with it better. There are many different treatments available:

• Training of the pelvic (floor) muscles. A pelvic physical therapist can help with this.
• Training of the bladder. When the cause is bladder problems, the bladder can be trained. A continence nurse can help with this.
• Medications. There are medications mainly for urge or overflow incontinence.
• Surgery. In some cases, surgery is useful, mainly in fecal incontinence. Here, the sphincter is repaired.
• Incontinence materials (aids). When incontinence cannot be fully treated, there are aids to collect urine or stool. Mainly for neurological problems or due to aging.
• Healthy lifestyle. A healthy lifestyle can also reduce problems.

Pelvic physical therapy for incontinence

Pelvic physical therapy is often recommended for incontinence problems. As stated, poorly functioning pelvic floor muscles are the problem. Through pelvic physical therapy, these muscles can be trained again. This often gives good results. 

Only incontinence problems in Alzheimer's disease do not respond to pelvic physical therapy. This group cannot consciously train the pelvic muscles. This also applies to some neurological conditions.

Find a good pelvic physical therapist near you.

The pelvic physical therapist discusses the symptoms and asks about habits regarding urination and defecation. In addition to the interview, the pelvic physical therapist performs a physical examination. They are specially trained to perform an internal examination. Many pelvic floor muscles can only be properly assessed internally. In this way, the bladder can also be examined. For example, in an overactive bladder. 

Muscles are often examined internally with a small device. This device can measure muscle tension. In this way, it is determined whether there is too much or too little pelvic floor muscle tension. The internal examination is only performed after explicit consent. More and more pelvic physical therapists also use ultrasound to look at the pelvic floor muscles and the bladder.

A pelvic physical therapist gives advice on posture, load, toilet habits, and eating and drinking habits. Breathing and relaxation exercises are also an important part of the treatment. The pelvic floor muscles can be consciously tightened and relaxed. This does have to be learned. This can be done by:

• Exercise therapy. These are exercises aimed at the pelvic floor muscles and also posture and relaxation exercises.
• Making contraction and relaxation of the muscles visible with ultrasound.
• Exercise therapy with myofeedback (internal equipment for measuring tension).
• Electrical stimulation. The myofeedback device can also provide electrical stimulation. These are small stimuli so that you can feel where the muscles are. Electrical stimulation can also work well for pain relief and an overactive bladder.

What can you do yourself for incontinence?

A healthy lifestyle helps in treating incontinence:

• Drink enough. People often drink less to produce less urine. But this is counterproductive. Concentrated urine causes more triggers.
• Be careful with alcohol, coffee, and carbonated drinks. These drinks irritate the bladder and increase urgency.
• Stop smoking. Smokers have to cough more, which greatly increases pressure on the pelvic floor.
• Keep or start exercising. There is often fear of exercising due to involuntary urine loss. But exercise actually helps prevent symptoms. Good blood flow and muscle contraction can reduce incontinence. Only sports with a lot of jumping are better avoided.
• Prevent overweight. Overweight increases pressure on the bladder and pelvic floor.
• Ensure a relaxed toilet posture and do not strain.

There are also nutrients that can irritate or support the bladder. A dietitian or nutritionist can help adjust the diet accordingly.