There are an estimated 5 million Australians who experience incontinence. That’s 1 in 4 people.

Despite how prevalent incontinence is, there’s still a lot of stigma that surrounds it which discourages people from having open and honest conversations about the condition. We totally get it!

But that’s why we want to have as many incontinence conversations as we can to help reduce the stigma and empower those experiencing it - whether directly or indirectly - to speak up, seek help and live their most confident life. Because here’s the thing, having incontinence doesn’t have to mean your social life ends!

Keep reading for insightful answers to some frequently asked incontinence questions, brought to you by our continence nurse and ConfidenceClub ambassador, Jane Clarke.

Jane has over two decades of nursing experience and is extremely passionate about empowering people with incontinence, or those who care for someone who does, with tools to effectively manage the condition.

This is without a doubt one of the most common questions about incontinence - what is it exactly?

Well, incontinence is characterised by the involuntary or accidental loss of urine (wee) or stool (poo) from the body. Some other common terms for incontinence include bladder leaks, overactive bladder, bedwetting and soiling among others.

Urinary incontinence, the most common form of incontinence, solely defines the involuntary loss of urine. This can range from light drips and dribbles when a person laughs or sneezes, to full voids of the bladder.

Faecal incontinence is defined as the involuntary loss of gas, liquid, or stool. It’s where a person is unable to control bowel movements and the gas, liquid or stool escapes from the rectum without warning. Similar to the different ways urinary incontinence can present, faecal incontinence can range from flatulence or light bowel leakage, up to full bowel voids.

Millions of people around the world experience incontinence, so regardless of the type you have just know that you are not alone.

One common mindset around incontinence is that it’s an “old person’s condition”.

This is not true - incontinence is not a normal part of ageing and can actually be a sign of an underlying issue. So it’s important not to just shrug the condition off and accept it as a part of growing old without seeking advice from a healthcare professional.

So if it’s not ageing that causes incontinence, what is it?

There are in fact multiple risk factors for incontinence. These include:

• Weak pelvic floor muscles

• Pregnancy and childbirth

• Menopause

• Obesity

• Enlarged prostate, prostate cancer

• Mobility and cognitive impairment

• Surgery (such as prolapse, prostatectomy, hysterectomy)

• Health conditions such as diabetes, dementia, stroke

• Neurological conditions or disorders

• Genetic conditions such as down syndrome

• Developmental conditions such as autism

There are also more temporary contributors to incontinence such as urinary tract infections, constipation, medications and food and drink irritants (caffeine and alcohol for example).

While we’ve discussed the major two types of incontinence being urinary and faecal, there are also subtypes of the condition.

Stress Incontinence:

Stress incontinence occurs when there is an increase of pressure, or stress, in the abdomen which causes downward pressure on the bladder. This stress can include actions such as coughing, laughing, sneezing, running, or heavy lifting. During these activities a small amount of urine can leak out, especially if the pelvic floor muscles, which usually help keep the bladder neck closed, are weak or damaged. Stress incontinence is more common in women, but can occur in men, especially after prostate surgery.

Urge Incontinence:

Also known as overactive bladder (OAB), urge incontinence occurs when there is a short, sharp, sudden contraction of the bladder muscle which can cause leakage or a full bladder void. Essentially, the person with UI can’t hold until they reach a bathroom. Urge incontinence can be brought on by a urinary tract infection, or be the result of nerve damage, stroke and other health conditions. Stress and urge incontinence can also occur in combination - this is known as mixed incontinence.

Functional Incontinence:

Functional incontinence is the term used when a person either can’t make it to the toilet in time, or can’t recognise the need to go to the toilet. This refers to both urinary and faecal incontinence, and can occur if you have issues with mobility, cognition, or you don’t have easy access to toilet facilities.

Physical disabilties can impact a person’s ability to use the bathroom, and cognitive conditions such as Alzheimer’s can mean the brain doesn’t recognise the body’s signal of needing to use the bathroom, or they may be disoriented in trying to find bathroom.

Overflow Incontinence:

This occurs when the bladder isn’t emptying properly, and small amounts of urine will ‘spill over’ and leak when the bladder volume is at maximum capacity. This is a common side-effect for conditions that obstruct the bladder, such as enlarged prostate or prolapse, or because of damage to the nervous system which controls the bladder’s function. This is a very serious condition because urinary retention can damage the detrusor (the muscle that contracts to push urine of of the bladder into the urethra) and cause urine to ‘reflux’ up towards the kidneys, affecting the renal function.

Reflex Incontinence:

This type of urinary incontinence occurs when there is no associated warning or urge to use the toilet, and the bladder muscle contracts spontaneously. This type of incontinence is more likely to occur due to nerve damage from trauma, such as spinal cord injury, or in combination with neurological conditions, such as multiple sclerosis. 

Bowel Dysfunction:

Like urinary incontinence, bowel dysfunction can occur from a myriad of conditions and lifestyle factors. Faecal incontinence can occur because of transient factors, such as infection (gastro), diet, or food poisoning. Recurring faecal incontinence may be due to an underlying condition, such as IBS, Crohn’s, Coeliac disease, or damage to the muscle or nerves which control defecation.

It’s also important to note that faecal incontinence can occur because of faecal impaction, whereby mucous produced by the intestinal wall can make its way around solid stool in the intestinal tract and appear like diarrhoea. This is called ‘overflow’ and is generally mucous-like and pale in colour.

Faecal and urinary incontinence can certainly coexist. The bladder and bowel share the same pelvic space and nerve pathways, so oftentimes if the structures or nerves supporting and supplying these organs are damaged, the result will be bladder and bowel dysfunction.

Also, bowel issues can indirectly affect bladder function. For example, an impacted bowel can reduce the bladder’s capacity to hold urine and even obstruct the passage of urine from the body. Because of this, treating bowel dysfunction can sometimes also resolve bladder issues.

Incontinence is most often associated with the elderly or women during pregnancy and postpartum, but the condition actually affects many walks of life.

When it comes to urinary incontinence, women are the most likely group to experience the condition over men. However, it can affect all genders and ages. The same goes for faecal incontinence, it can affect men, women and children.

Incontinence treatment and management options will very much depend on the cause of the incontinence.

Lifestyle Factors:

Improvements to incontinence symptoms can in some cases be achieved through simple lifestyle changes. These can include:

• Reducing caffeine and alcohol consumption

• Switching to a diet rich in whole foods and reducing intake of processed foods

• Losing weight

• Quitting smoking
  
  

Pelvic Floor Exercises:

As mentioned earlier, a weakened pelvic floor can be a contributing factor to incontinence. So in some cases, using exercises that help to strengthen the pelvic floor muscles can improve bladder and bowel control. They’re especially helpful for those with stress and/or urge incontinence.

While there are simple pelvic floor exercises for beginners you can try at home, it’s always recommended you seek professional assistance from a pelvic physiotherapist. They can assess your pelvic floor muscles and tailor an exercise program specifically for your needs.

Medications:

Medications are also available which can improve bladder storage, prevent constipation, and improve the consistency of bowel motions. These should first be discussed with a pharmacist or GP.

Surgeries and Procedures:

For bladder and bowel dysfunction related to structural issues, more invasive interventions such as Botox injections or surgery may be necessary. These are generally performed by a medical specialist, such as a urologist or colorectal surgeon. Incontinence surgery is something to be considered after more conservative treatments (pelvic floor rehabilitiation, medication, etc.) have been exhausted.

Catheters are another measure used for facilitating bladder emptying. External catheters are worn by men and applied like a condom with a tube and collection bag attached. Intermittent catheters are small tubes inserted into the bladder via the urethra to empty urine and then removed. Intermittent catheterisation is usually performed at regular intervals throughout the day.

Long term, indwelling, or foley catheters remain in the bladder to facilitate urinary drainage. They are inserted via the urethra or through a small incision made above the pubic line into the bladder. Long term catheters are emptied either by a valve, or via a collection bag.

Incontinence Aids:

If the above treatment options are not appropriate or fail, people suffering with incontinence may opt to use absorbent products.

Many of these products contain super absorbent polymers (SAPs) which hold large volumes of liquid, drawing fluid away from the skin and keeping the wearer dry and comfortable for extended periods. Absorbent products come in many shapes and sizes depending on the severity of incontinence and the needs of the individual.

Our ConfidenceClub range of incontinence aids - including pull-up pants, slips, pads and furniture protectors - are made wit ultra-dry technology that absorb and disperse liquid quickly and effectively so you can continue to live life comfortably and confidently!

If you’re not sure which products are right for your needs, don’t hesitate to contact us and speak to one of our friendly and knowledgeable product specialists. They can help you find the best product for your level of incontinence. Otherwise, you can try our online Help Me Choose quiz where you’ll be asked a few simple but comprehensive questions before being recommended your top matched products.

This will differ in terms of your type and severity of incontinence. Here is a cheat-sheet of sorts for which products can be used for different types of incontinence:

• Pads and guards are used to manage light bladder leaks only - with pads for women, and guards for men.

• Pull-up pants are designed for those with moderate urinary incontinence and some faecal incontinence.

• All-in-one slips are recommended for those with low-mobility and/or no bladder or bowel control.

Then of course there are accessories such as bed and furniture waterproof protectors and booster pads that add an extra layer of protection and absorbency to pull-ups and slips.

Many types of incontinence are reversible. Again, this very much depends on the underlying condition causing the incontinence.

Treatments may simply involve behaviour and lifestyle changes, including weight loss, changing the type and amount of fluid intake, improving dietary choices, quitting smoking, managing chronic diseases, and being diligent in performing pelvic floor muscle exercises.

Medications may resolve incontinence, and, procedures and surgeries can also offer at least temporary if not permanent resolution of bladder and bowel dysfunction.  

Unfortunately, sometimes incontinence cannot be resolved, such as in neurological conditions, or in advancing degenerative conditions. In these cases, specialised healthcare providers can recommend the best management plans for sufferers.

Whether you have incontinence, or you care for someone who does, you’re never alone. There are a number of incredible resources and support services available for the condition. These include:

• Continence Foundation of Australia, phone 03 8692 8400

• National Continence Helpline, phone 1800 330 066

• My Aged Care Information Line, phone 1800 200 422

• Carers Australia, phone 1800 242 636

• Pelvic Floor First 

• Lifeline for mental health support, phone 13 11 14, 24 hours a day 7 days a week

For emergencies, call 000.

Talk openly about continence issues to alleviate any distress or shame the person with incontinence may be harbouring. Acknowledge that incontinence is a common problem and a symptom of an underlying condition, it is not intentional. Try and keep a relaxed attitude when accidents happen and have supplies close at hand to manage accidents quickly and effectively.

There are a multitude of continence aids available to suit individual needs. There are also state and federal schemes to help with the supply and purchase of incontinence products. For advice, you can contact the Continence Foundation of Australia, call the National Continence Helpline, or contact customer service of continence product providers, such as ConfidenceClub, to point you in the right direction.

Think ahead about access and safety. Choose ‘easy access’ clothing, such as pants with an elasticated waist band rather than buttons and zippers. Keep urinals or commodes handy and in easy reach and portable urinals are available for car trips. Keep a night light on overnight and remove trip hazards from the path to the toilet. Consider raised toilet seats and grab rails if the person is unsteady on their feet. Signs identifying the toilet can help if people are experiencing memory loss. Lastly, try not to rush the person and always ensure their privacy and dignity is respected.

You also have the person’s skin health to be mindful of. Incontinence places the sufferer at greater risk of skin breakdown. Wet and soiled pads should be changed as soon as possible and cleanse the affected area afterwards with warm water or water-based wipes. Barrier creams applied sparingly to the genitals, groins and sacrum can also effectively prevent irritation. It is best to use gloves if you are assisting and always practice good hand hygiene afterwards. Please note, pads, gloves, and wipes cannot be flushed down the toilet – these should be disposed of through the normal household waste.

Some signs that should prompt medical attention include the passing of infrequent hard stools suggesting the person is constipated, infrequent urination or having to strain to pass urine, persistent diarrhoea, a breakdown in the person’s skin that does not get better with good hygiene and barrier creams, or you suspect a urinary tract infection (UTI). Symptoms of UTI include cloudy, smelly, or blood-stained urine, pain on urination, increased tiredness, lower back or loin pain, sudden complete loss of bladder control or increased urinary frequency, and confusion/forgetfulness which is out of character for the person.

Carer burnout and exhaustion is common when caring for someone with incontinence. Remember to plan breaks to give yourself time to recharge. If you do start to experience strong negative emotions, like anger, stress, depression, or frustration speak with your GP or a mental health professional.

For immediate mental health support, call Lifeline on 13 11 14 available 24 hours a day, 7 days a week. For emergencies, call 000

As mentioned, there are a variety of disposable and washable continence products on the market, including pads, pull up pants, and slips (nappy style pants). The style and capacity of the product will very much depend on the person’s individual needs and preference. Other useful products might include disposable gloves, wipes, nappy bags, barrier cream, and hand sanitiser.

To help keep surrounds free from stains and odours, there are also mattress and pillow protectors, waterproof bedding, absorbent washable and disposable bed and chair pads, absorbent non-slip floor mats, and cleaning products.

Assistive devices may also be useful, such as extendable bottom wipes, slide sheets, commodes, urinals, bidets, raised toilet seats, and toilet frames.

Specialist healthcare professionals, such as Occupational Therapists and Continence Nurse Advisors, are great resources in providing advice on suitable resources when caring for someone with incontinence.

 

Poor mobility can be a challenge when changing a person’s incontinence aid. Disposable products including slips and pads may be easier to change than pull up pants, as these don’t require complete removal of clothing to apply.

If a person is bed bound and needs to have their continence aid changed, they can be assisted to roll from side to side to remove and replace the aid. Have the bed flat and side rails up on the far side of the bed to prevent any falls, or have another person support the individual while you are changing them.

Once the person is assisted onto their side, the wet or soiled aid can be carefully unfastened, removed from between the legs, and rolled until it is tucked under the person’s bottom, then carefully roll them back over on their other side, whereby the aid can be removed from the opposite side. The person’s bottom and genital area can then be cleaned while they are on their side, and barrier cream applied before positioning the new aid. Placing a towel, disposable pad or ‘bluey’ underneath the client is a good idea to protect bedding when performing personal hygiene.

Once the client is cleaned and dried, the new aid is applied in a similar fashion -placed between the legs and fastened on one side, with the remainder rolled and tucked under the bottom, ready to be retrieved and fastened on the opposite side once the person rolls over.

Once the aid is fastened, the person can then be positioned comfortably with pillows and bed clothes replaced. Remember toileting is a private matter, so privacy and dignity should always be maintained.

Living with incontinence will take some lifestyle changes, but we have to stress that it doesn’t need to control your life!

We understand that it can be challenging adjusting to this new way of life, but we hope after reading the above - and what’s to come - your spirits are lifted.

Some daily management tips for incontinence you may find helpful are:

Plan Ahead:

If you’re heading out for the day, ensure you’ve packed a bag with your continence aids and even a spare change of clothes in case of any accidents. Taking a waterproof protector to use on your car seat is also helpful in protecting against any accidental leaks. Checking where bathrooms are at the place you’re heading to can also ease your mind as you’ll know ahead of time where to go should you need one urgently.

Avoid Triggers:

As mentioned, certain foods and drinks can trigger incontinence episodes. Be mindful of what you’re consuming as it can really make a difference in your symptoms.

Stay Hydrated:

Now this one can confuse people sometimes because they think, “if I’m experiencing urinary incontinence I shouldn’t drink too much water!” But that couldn’t be further from the truth. While, yes, your doctor may suggest some adjustments to your liquid intake, keeping hydrated is crucial to maintaining bladder and bowel function and helps you avoid things like a urinary tract infection (UTI).
 

Keep Active:

Maintaining a health weight and continuing to move your body if you can will help in maintaining your bladder and bowel health. Some research has shown that a five-unit increase in body mass index (BMI) is associated with a 60% increase in the risk of urinary incontinence [1]. Alternatively, if you lose 10% of your body weight, that can lower your risk of urinary incontinence episodes by 50% [1].

There is never anything to be ashamed of if you’re feeling as though your mental health is taking a toll because of your incontinence experience. But please know, you are not alone and there is help available.

Please reach out to someone if you need help. You can speak to your GP about your mental health, and they may provide you with a referral to speak with a psychologist or other mental health professional.

There are also a number of free resources available to you 24 hours a day, 7 days a week. These include:

• Lifeline - call 13 11 14 or text 0477 13 11 14

• Beyond Blue - call 1300 224 636

• Suicide Call Back Service - call 1300 659 467

• Kids Helpline - call 1800 55 1800

• Mensline - call 1300 78 99 78

For emergencies, call 000 immediately.

We hope this article has provided you with helpful information and practical tips for both urinary and faecal incontinence - both for those experiencing it, and those caring for someone who does.

Remember, if you need any assistance in choosing incontinence management products we are just a phone call, email, or WhatsApp message away! Find out how to contact us.