incontinence: peeing with a sneeze, loss of bowel control is no laughing matter for 4 million canadians

the inability to control the bladder or bowels is a significant medical condition, the stigma keeps many people from seeking treatment.

incontinence is no laughing matter for 4 million canadians
there are several types of incontinence, according to the national institute on aging, with stress incontinence being the most common. getty
there are few things more embarrassing than not being able to control your bladder or bowels — except, perhaps, talking about it.

also known as incontinence, the inability to prevent the release of urine or feces affects almost four million canadians — a number that is growing along with our aging population — not only impacting quality of life, but also emotional health.

usually a symptom of something else that is going in the body, incontinence is a result of problems with the muscles and nerves around the bladder or bowel. this could be caused by damage done during childbirth, for example, or it could be related to diseases like obesity or diabetes.
despite the impact it has on a person’s life — there is often a fear of leaving the house in case of leakage — incontinence isn’t something people find easy to discuss, or even share with their doctor.

a 2020 population representative epidemiology survey published in the canadian journal of urology found there is a lack of awareness of the available treatments despite the acknowledgement that urinary incontinence is a significant medical condition. few people had actively engaged with treatments, and men remain less aware and less likely to seek help than women.



what is incontinence?

incontinence is not disease. rather, it’s a condition caused by an underlying issue, which makes seeing a healthcare professional for diagnosis and treatment important. this is especially true because in most cases, incontinence can be treated and controlled — if not cured.

urinary incontinence is the most common

the most common form of incontinence is urinary incontinence: the involuntary release of urine.
how does it happen?
your body stores urine in your bladder. during urination, your bladder muscles tighten to move urine into a tube called the urethra. at the same time, the muscles around the urethra relax and let the urine pass out of your body. when the muscles in and around your bladder don’t work properly, urine can leak. incontinence occurs when the muscles relax without warning.

there are several types of incontinence, according to the national institute on aging , with stress incontinence being the most common, particularly among middle-aged women.

stress incontinence happens when the urethra cannot handle the increased bladder pressure during exercise, coughing or sneezing. urge incontinence happens when a sudden bladder spasm prevents people from holding their urine long enough to get to the toilet. overflow incontinence occurs when small amounts of urine leak from a bladder that is always full. men can have trouble emptying their bladder if an enlarged prostate is blocking the urethra. diabetes and spinal cord injuries can also cause this type of incontinence.



 incontinence points to an underlying condition, which can be diagnosed by your healthcare professional. getty
incontinence points to an underlying condition, which can be diagnosed by your healthcare professional. getty


incontinence is caused by weakening of the pelvic floor muscles and can be linked to vaginal childbirth, the progress of a condition like multiple sclerosis or parkinson’s, injuries from an accident, or the consequence of medications or surgery.

studies have also linked urinary incontinence to obesity. a u.k. paper published in critical care obstetrics and gynecology concluded that, while a direct cause-effect relationship between obesity and incontinence has not yet been established, there is evidence that weight reduction can be beneficial to obese incontinent women.

and while aging is not directly to blame for incontinence, the changes that happen during the aging process may contribute to a weakened pelvic floor, such as the progressive decrease of estrogen for women as they age and after menopause, and the enlargement of the prostate gland for men.

fecal incontinence

fecal incontinence is the involuntary loss of stool from the bowel, ranging from occasional leakage when you pass gas to the complete loss of bowel control. it can be caused by chronic constipation, which may damage the walls of the rectum as well as the nerves that control bowel movements. constipation affects about 15 to 30 per cent of canadians.



other reasons for fecal incontinence include diarrhea (because loose stool is harder to control), muscle damage from vaginal childbirth and age-related weakening of pelvic floor muscles or the anal sphincter, and nerve damage from stroke, spinal cord injury, diabetes or multiple sclerosis, for example. about one per cent of people under the age of 65 and four to seven per cent of people over 65 have fecal incontinence .

treatments help you regain control

promising new therapies include a water-based gel delivered by small injections into the urethral wall to add bulk and strength to prevent urinary incontinence . the gel is similar to cosmetic facial fillers that remain in the body over time.

for women, there are non-surgical vaginal devices that can be inserted in the same location as a tampon or diaphragm without hormones or drugs to provide bowel control for fecal incontinence. patients use a detached pump to inflate and deflate a balloon on the insert that controls the rectum and prevents stool from passing before a trip to the bathroom. after a bowel movement, you inflate the balloon again.

medications, both over-the-counter and prescription, work to calm muscles and nerves to prevent bladder spasms, and improve stool consistency and slow down the movement of food through your intestine.



non-drug therapies include kegel exercises or pelvic floor muscle training which can be done with biofeedback equipment and electrical stimulation that help identify the right muscles to contract. bladder training helps people resist the urge to urinate and to gradually expand the intervals between urinating, and bowel training helps to restore muscle strength in your bowel wall or anal sphincter.
dietary changes make a difference, too, like avoiding caffeine and excessive alcohol, for example, which can irritate the bladder. drinking plenty of liquids and foods rich in fibre will improve the consistency of stool to help prevent fecal incontinence.
if incontinence symptoms are severe, surgery is also an option and includes repositioning the bladder for better control, and sacral nerve stimulation, where a pacemaker-like device is implanted under your skin — usually in the buttock — to block messages to urinate by an overactive bladder.
for fecal incontinence, a sphincteroplasty reconnects the separated ends of a sphincter muscle torn by childbirth or another injury. there is also an artificial sphincter implant for men who experience fecal incontinence after prostate cancer surgery.



for more information on incontinence, resources and support, contact the canadian continence foundation.
karen hawthorne in a toronto-based freelance writer. she can be reached here.
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