What are the types of incontinence?

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Incontinence can be divided into two main types - urinary and fecal incontinence. The first one refers to inability to control urine flow, while the second type is marked by inability to control bowel movements. Urinary incontinence is more common than inability to control bowel movements and is further subdivided into the following types:

Urinary Incontinence

Stress Incontinence
This type of incontinence is the involuntary loss of urine associated with activities that increase physical stress and pressure in the abdomen and bladder, such as laughing, sneezing, coughing, exercising, heavy lifting and having sex.
With this type, urine leaks due to weakened pelvic floor muscles and tissues. Pregnancy and childbirth can stretch and weaken a woman’s pelvic floor muscles. Other things that can lead to stress incontinence are being overweight or obese, taking certain medications or, in men, having prostate surgery.

If urine leaks out when you jump, cough, or laugh, you may have stress incontinence. Any physical exertion that increases abdominal pressure also puts pressure on the bladder. The word "stress" refers to the physical strain associated with leakage. Although it can be emotionally distressing, the condition has nothing to do with emotion. Often only a small amount of urine leaks out. In more severe cases, the pressure of a full bladder overcomes the body's ability to hold in urine. The leakage occurs even though the bladder muscles are not contracting and you don't feel the urge to urinate.

Stress incontinence occurs when the urethral sphincter, the pelvic floor muscles, or both these structures have been weakened or damaged and cannot dependably hold in urine. Stress incontinence is divided into two subtypes.

  • Urethral hypermobility — the bladder and urethra shift downward when abdominal pressure rises, and there is no hammock-like support for the urethra to be compressed against to keep it closed.
  • Intrinsic sphincter deficiency, problems in the urinary sphincter interfere with full closure or allow the sphincter to pop open under pressure.

Many experts believe that women who have delivered vaginally are most likely to develop stress incontinence because giving birth has stretched and possibly damaged the pelvic floor muscles and nerves. Generally, the larger the baby, the longer the labor, the older the mother, and the greater the number of births, the more likely that incontinence will result.
Age is likewise a factor in stress incontinence. As a woman gets older, the muscles in her pelvic floor and urethra weaken, and it takes less pressure for the urethra to open and allow leakage. Estrogen can also play some role, although it is not clear how much. Many women do not experience symptoms until after menopause.
In men, the most frequent cause of stress incontinence is urinary sphincter damage sustained through prostate surgery or a pelvic fracture.
Lung conditions that cause frequent coughing, such as emphysema and cystic fibrosis, can also contribute to stress incontinence in both men and women.

Overflow Incontinence
People with this type of incontinence usually have difficulties emptying their urinary bladder. Overflow incontinence most often affects men. There’s no sense that the bladder is full (or empty) and the patient will lose urine without noticing it.
Causes include:

  • Weak bladder muscles
  • Nerve damage
  • Conditions that block the flow of urine, such as tumors or an enlarged prostate
  • Constipation
  • Certain medications

If left untreated, and the bladder can't empty, infections and other problems may occur.
Overflow incontinence occurs when something blocks urine from flowing normally out of the bladder, as in the case of prostate enlargement. It can occur in both men and women if the bladder muscle becomes underactive (the opposite of an overactive bladder) so you don't feel an urge to urinate. Eventually the bladder becomes overfilled, or distended, pulling the urethra open and allowing urine to leak out. The bladder might also spasm at random times, causing leakage. This condition is sometimes related to diabetes or cardiovascular disease.
Men are much more frequently diagnosed with overflow incontinence than women because it is often caused by prostate-related conditions. In addition to enlarged prostate, other possible causes of urine blockage include tumors, bladder stones, or scar tissue. If a woman has severe prolapse of her uterus or bladder (meaning that the organ has dropped out of its proper position), her urethra can become kinked like a bent garden hose, interfering with the flow of urine.
Nerve damage (from injuries, childbirth, past surgeries, or diseases such as diabetes, multiple sclerosis, or shingles) and aging often prevent the bladder muscle from contracting normally. Medications that prevent bladder muscle contraction or that make you unaware of the urge to urinate can also result in overflow incontinence.

Urge Incontinence
Urge incontinence, also called overactive bladder (OAB), is characterized by having such a strong urge to urinate the patient has problems reaching the toilet in time. It is usually a result of injury to nerves or muscles which help control urinary flow, but it can also be caused by some medical conditions.
Causes of overactive bladder include:

  • Damage to the bladder's nerves
  • Damage to other parts of the nervous system
  • Damage to muscles

Conditions such as multiple sclerosis, Parkinson's disease, diabetes, and stroke can affect nerves, leading to urge incontinence. Bladder problems, such as infections and bladder stones, and certain medications can also cause an overactive bladder.
Treatment options for urge incontinence include:

  • Timed voiding and bladder training – The patient completes a chart of the times they urinate, and the times they leak. They can observe patterns and then plan to empty their bladder before an accident would happen. You can also "retrain" your bladder, gradually increasing the time between bathroom visits. Kegel exercises are also helpful.
  • Medications, electrical stimulation, or surgery - Doctors sometimes prescribe medicines that block the contractions of an overactive bladder. Electrical stimulation of the bladder nerves helps in some cases. Surgery is reserved for severe cases. It aims to increase the amount of urine your bladder can store.

Often there is no identifiable cause for overactive bladder, but people are more likely to develop the problem as they age. Postmenopausal women tend to develop this condition, perhaps because of age-related changes in the bladder lining and muscle. It's estimated that 12.2 million adults in the U.S. are affected.
In addition, infections of the urinary tract, bladder, or prostate can cause temporary urgency. Partial blockage of the urinary tract by a bladder stone, a tumor (rarely), or, in men, an enlarged prostate (a condition known as benign prostatic hyperplasia, or BPH) can cause urgency, frequency, and sometimes urge incontinence. Surgery for prostate cancer or BPH can trigger symptoms of overactive bladder, as can freezing (cryotherapy) and radiation seed treatment (brachytherapy) for prostate cancer.

Functional Incontinence
Unlike other forms of incontinence, this type doesn't involve problems with the urinary system, muscles or nerves. Instead, it occurs when a person is unable to reach the bathroom in time to urinate because of physical or mental limitations. Urine leaking with this type of incontinence most often affects the elderly suffering from physical or/and mental diseases such as Alzheimer’s disease and arthritis preventing them from reaching the toilet in time
This is one of the most common types of urinary incontinence among older adults who suffer from arthritis, Parkinson's disease or Alzheimer's disease.
For example, if an illness rendered you unaware or unconcerned about the need to find a toilet, you would become incontinent. Medications, dementia, or mental illness can decrease awareness of the need to find a toilet. If a medication (such as a diuretic used to treat high blood pressure or heart failure) causes you to produce abnormally large amounts of urine, you could develop incontinence that requires a change in treatment. If you make most of your urine at night, the result might be nocturnal incontinence, or bedwetting.

Mixed Incontinence
Mixed incontinence is when a patient suffers from two types of incontinence simultaneously. Mixed incontinence typically affects women.
This most often involves characteristics of both stress and urge incontinence. It can include leakage of varying degrees with strenuous physical activity (stress incontinence) and an overwhelmingly strong, sudden, uncontrollable urge to urinate immediately, a sensation that doesn't let you make it to the toilet in time (urge incontinence).
The same factors that trigger stress and urge incontinence are involved in mixed incontinence - weakened pelvic floor muscles and poor connective tissue make you susceptible to leakage with activities that increase physical pressure in the abdomen (stress incontinence), whereas abnormal nerve signals trigger inappropriate contractions of the muscles in the bladder wall, creating the uncontrollable urge to go very frequently (urge incontinence).
Mixed incontinence also occurs in men who have had prostate removal or surgery for an enlarged prostate, and in frail older people of either gender.

Total Incontinence
This is the severest type of incontinence and it is marked by complete loss of control over urinary bladder resulting in a constant urine leakage. Individuals suffering from total incontinence often have a vesicovaginal fistula, an abnormal connection between the urinary tract and the vagina, or people who have suffered spinal cord injuries, multiple sclerosis or another disorder that affects nerve function. Total incontinence can be the result of anatomic abnormalities or a severe injury.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of IncontinenceSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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