Around one in five people struggle with some form of urinary incontinence, meaning they sometimes lose control of their bladder. However, given the huge stigma surrounding incontinence, you’d think it was extremely rare.
“Any sort of involuntary loss of urine or faeces is a type of incontinence,” says Tracy Evans, a clinical team leader for the Continence Service at Southern Health NHS Foundation Trust.
“Lots of people don’t realise that they’re experiencing incontinence because they think it’s normal to wee a little bit when they laugh or cross their legs, particularly if they’ve had children.”
One of the most common misconceptions about incontinence is that it is just a normal part of ageing. Not so, says Evans. “You don’t just have to put a pad on and pretend it isn’t happening,” she adds, pointing out that around 70 per cent of incontinence problems are reversible.
“While losing urine involuntarily is certainly nothing to be ashamed of, it isn’t normal, and it is something that can be helped,” she says.
On the other hand, “total” incontinence – where someone loses complete control over their bladder or bowel – can hugely affect a person’s quality of life and stop them from doing the things that they would usually do.
This is common in people who suffer from dementia, over half of whom develop a form of urinary incontinence. Another common type of incontinence is “functional” incontinence, where people cannot physically make it to the toilet because of a disability. In both cases, the taboo surrounding incontinence can make it incredibly hard to cope with, both for carers and those living with incontinence.
So what can you do to manage your own incontinence or help a loved one who is struggling with theirs?
What is incontinence?
There are several types of incontinence, according to Evans and NHS England.
The tiny dribble that many people release when they sneeze, laugh or cough is often referred to as “stress incontinence”, as it occurs when extra pressure is put on the bladder. This type of incontinence is especially common in women who’ve had children. It is also the type of incontinence that is most easily managed and treated.
There are several other forms of incontinence that are also fairly common. “Urge incontinence is when your bladder doesn’t let you know when it’s time to go to the loo, likely because it doesn’t fill properly,” Evans says. “People who have urge incontinence can’t just wait to finish doing the dishes or for the adverts to come on – when they have to go, they really do have to go.
“There is also overflow incontinence where your bladder doesn’t empty properly, which can cause leaking. Then there is functional incontinence, where someone may not be able to get to the toilet on their own, for example, if they use a wheelchair, and this affects both bladder and bowel movements.”
Managing stress and urge incontinence
When it comes to managing stress incontinence, a few small lifestyle changes are often enough to correct the problem, says Evans. “It sounds counterintuitive but if you aren’t getting in enough fluids, this can increase your risk of incontinence.
“Our kidneys remove harmful things from our bodies and the waste product ends up in our bladders, so we need water to make that system function. If you don’t drink enough then your body can take control and release those toxins involuntarily.”
But how much is enough? “You should try to drink about 1.5 to 2 litres of water a day, which is about three or four pints. Significantly more than that isn’t good, however, as it could lead to an overflow,” Evans says.
“Your urine should be hay-coloured most of the time – if you’re always passing clear urine then either you are drinking too much or your system isn’t processing toxins properly. Likewise, dark urine shows that you’re drinking too little or that something is wrong.”
On top of that, what you drink is crucial to the health of your bladder. “Try to stick with either water or fresh juice diluted with water,” says Evans. “Try to avoid caffeine and carbonated drinks as these will just irritate your bladder and make things worse.
“As with most things, our weight does have an impact on our bladder function. If your BMI is over 30, there will be more pressure on your abdomen and pelvic floor from abdominal fat, so you’ll be more prone to having problems.”
For those who struggle with stress incontinence, it can be a good idea to do pelvic floor exercises. Evans says: “There are two types of muscle fibres on the pelvic floor: short fibres and long fibres. It’s important to exercise both. You can work out your longer fibres by squeezing and holding for a longer period and your shorter fibres by squeezing and letting go repeatedly.
“This isn’t a quick fix though. You need to be consistently doing pelvic floor exercises for about three months before you can see the full benefit.”
Pelvic floor exercises can also be helpful for those who have been diagnosed with urge incontinence. In this case, the NHS also recommends a course of bladder training. This involves learning different techniques to help lengthen the period of time you have between feeling the need to go to the lavatory and passing urine involuntarily.
There are also medications that can be offered to people who are experiencing stress or urge incontinence, which can be prescribed by a GP.
Incontinence and dementia
More than half of those living with dementia and as many as 70 per cent of those with Alzheimer’s disease develop incontinence and need help from their carers to manage this.
Incontinence commonly follows Alzheimer’s disease because the condition is marked by a decline in both a person’s ability to communicate and to learn new information. This disease usually impacts the parts of the brain that allow us to learn first, and while long-term memories might remain intact for years in a person with Alzheimer’s, it can be very difficult for them to form new memories such as where a bathroom is.
Trevor Salomon, 71, has been a carer to both his father and his wife, who was diagnosed with early-onset dementia in 2019.
“When someone is living with dementia, and especially with Alzheimer’s in particular, you almost know for certain that incontinence is down the road,” Saloman says. “It can be incredibly difficult for carers to manage as it feels so exasperating, but it is so important to try and approach it in a matter-of-fact way and remember that it is not your loved one’s fault.”
“When some people develop dementia, their brain no longer picks up their body’s signals that it’s time to go to the toilet,” Evans explains. “Other people with dementia might be fine at home, where their long-term memory lets them remember where the bathroom is, but in hospital or when visiting relatives they aren’t able to find it in time.”
Saloman’s wife developed incontinence as her symptoms of dementia worsened. “The best thing I can recommend to other carers is to try and have a conversation with your loved one while they are cogent enough to do that with you,” he says. “I told my wife, ’When this happens to you, please let me know so that I can help.’
“Unfortunately she still didn’t feel comfortable enough to ask for my help, but I do think that having that discussion made things easier for her – and for me – as time went on.
“I was able to reassure her from the start that I understood what was happening and that it was not her fault. Having that conversation early meant that when she did start to wet herself, I was able to offer help without the added stress of her having to worry about what I thought.”
Caring for someone with total incontinence
Both Evans and Salomon emphasise the importance of speaking to your loved one about their incontinence, which is almost certainly harder on them than it is on you.
“It can still be difficult for the person you’re caring for to open up and ask for your help – but letting them know that it’s not their fault and that there is nothing to be ashamed of is the best way to go,” Saloman says.
“Once the incontinence begins, it’s important to keep reminding them that they’re not to blame. There are also practical things you can do to preserve their dignity and avoid accidents.
“When my wife began struggling with incontinence, I took her for regular bathroom trips and encouraged her to use the loo, which was largely successful and helped her to keep her privacy.”
Evans agrees: “The most important thing is to be open about incontinence as much as you can, and try to avoid making someone feel dirty or belittled.
“Remember, while there is absolutely no shame in it, incontinence is not necessarily a natural part of ageing. There are things that can be done and some types of incontinence are reversible. Make sure that you see your GP – or take your loved one if they are experiencing incontinence – as often there will be help at hand.”
Pelvic floor exercises to stop leaks
These exercises help women strengthen the muscles in their pelvic floor and improve bladder control, reducing or even reversing incontinence.
You can exercise your pelvic floor muscles by imagining that you’re trying not to urinate or pass wind, tightening and releasing them repeatedly. The movements shouldn’t be visible to other people and shouldn’t involve squeezing your legs together.
Here are some exercises you can try:
- Squeeze your pelvic floor muscles for as long as you can, then relax them for four seconds. Repeat until you can hold a contraction for 10 seconds, 10 times, with four-second rests between them.
- Squeeze your muscles for just one second before relaxing them. Try to do this 10 times in a row. This should help you build up resistance to coughing, laughing or sneezing if you are experiencing stress incontinence.
Aim to complete these exercises three or four times a day. You may need to repeat them for a few months before your pelvic floor reaches full strength. It is important to be consistent in order to see an improvement in your ability to reach the toilet in time.
