Overview

Adult Incontinence is described as the involuntary leakage of feces or urine from the human body. This condition affects people of all ages and can arise as separated events or as a chronic condition and can vary in severity from mild to moderate to severe according to the symptoms and the frequency of the leakage.

 

 Adult incontinence can occur more commonly in older people as a result of a concurrent medical condition or as a normal progression of aging. Considering that there is no solid prediction of incontinence incidence in old ages. The weakness that may occur in the bladder or the bowel can occur at any point in aging.

Incontinence can vary between men and women. In men, urinary incontinence is more common because of the natural enlargement of the prostate gland that happens with aging. The condition is called Benign Prostatic Hyperplasia (BPH) and as a result of the increasing size of the prostate, the pressure is put on the bladder that can lead to a condition of overflow incontinence. In women, incontinence is more common to occur after menopause resulting in a condition of stress incontinence.

In most cases, they initially experience leakage that causes other issues accordingly such as clothes staining and odours. These secondary issues can seriously cause psychological problems and affect the overall quality of life as well as the mental wellbeing of the adult.

Different Types of Adult Incontinence

Multiple types of adult incontinence may occur divided into two major categories the urinary incontinence and fecal incontinence.

1- Urinary Adult Incontinence

This condition is recognized by the unintentional leakage of urine outside the body and it is considered the basis for many other terms of incontinence. The adult urinary incontinence happens when the muscles and the sphincter that work together to hold the urine in the bladder weaken to a point that it could let the urine leak out. In other cases, nerve damage can be the cause as it alters the brain control of urination, and the message that stimulates the brain of the urination urge weakens so the bladder could get full with no reflex to make you go to the bathroom. Naturally, the muscles of the bladder wall relax when the bladder is full of urine. The bladder connects to your brain by a signal that it is full while the muscles are holding tight the urine inside until you finally respond to the signal and make it to the bathroom. Any dysfunction in this process can cause a different type of urine leakage.

 

• Stress Incontinence
  This condition is considered the most common type of adult urine incontinence as it is common to occur in women after giving birth. Involuntary urine leakage happens during any physical activity or normal body movement. It is mostly triggered by exercise that puts stress on the bladder. Sudden movements such as sneezing, coughing, laughing can trigger physical stress on the bladder that may develop the urine leakage in a response to the stress.
  
  - Urge Incontinence
   This type is defined by the sudden urge to urinate even if there is too little urine present in the bladder. This problem causes an uncomfortable feeling that you need to go to the bathroom right now. And may happen right after you leave the bathroom as you might not feel that you fully evacuated and need to return to the bathroom and you may repeat that multiple times.  
  
  -  Overflow incontinence
  This condition is often referred to as drip incontinence. As in this case, small amounts of urine leak out, and this may happen continuously. This problem occurs as a result of the failure of the full evacuation of the bladder and small amounts of urine leak out right after urination. You may not feel any urge to urinate but the amount of urine left in the bladder and failed to get out will drip involuntarily. This occurs often when there is a physical obstruction to the bladder that prevents it from the proper function. Because of this nature Overflow incontinence is more common in men as a complication of prostate enlargement. This enlargement acts as a physical obstruction to the fibro-muscular tube that begins at the lower opening of the bladder called the urethra. Obstruction to the urethra can occur at any level by the prostate and cause the overflow incontinence condition.
  
  - Functional incontinence
    This condition could be classified as an indirect form of incontinence because there is no problem with the bladder work in this case, but others contribute to the inability of urination or passing the faeces can be seen. These contributions could be related to other conditions that affect brain function such as Alzheimer's disease. The brain can no longer receive the message from the bladder or the individual can't respond physically and get to the bathroom.
  

2- Faecal Adult Incontinence

Faecal incontinence is defined by the inability to control your bowel movement, causing unexpected leakage of the stool from the rectum.  This might range from a small leakage of stool while passing gases or a full involuntary leakage of the stool with a complete loss of bowel control. The common causes of faecal incontinence include constipation, diarrhoea, haemorrhoids, muscular damage, or nerve damage.

1- Muscle damage
The injury that occurs at the anal sphincter or the muscular structure of the end part of the rectum may cause a difficult control of the stool. This damage can occur during childbirth especially with involved forceps during delivery.

2- Nerve damage
Injury to the sensory nerves of the rectum that transmit the message that the rectum is full of stool. This injury alters the control of the anal sphincter and leads to faecal incontinence. The nerve damage can be caused by chronic straining during bow movements, stroke, spinal cord injury, multiple sclerosis, and diabetic neuropathy.

3- Constipation
Chronic constipation may cause the masses of the stool to accumulate in the rectum and become dry and too hard to pass. This may cause a stretch and a weakness in the rectum muscles allowing the lighter stool to leak and pass from the rectum with no control. Chronic constipation also can cause nerve damage that may lead to faecal incontinence.

4- Haemorrhoids
The swollen veins in your anus or lower rectum can develop inside the rectum or under the skin around the anus. When the veins in your rectum swell, it prevents your anus from complete closing, which can result in stool leakage.

Treatment options for adult incontinence

For urinary incontinence at old age, the core of the treatment plan is to correct the causal problem plus controlling the symptom, thus, enhancing the quality of life for the adults.

The First-line treatment is typically constructed of:

1- Pharmaceutical Treatment:
Medication such as tamsulosin (Flomax) is prescribed for control of urge incontinence in geriatrics. Tamsulosin works by relaxing the over-contracted bladder muscles. Other medications such as Oxybutynin (Ditropan) and mirabegron (Myrbetriq) work by a similar mechanism of action to tamsulosin.

2- Surgical Treatment:
Multiple procedures are performed to correct a specific causal problem of incontinence. The surgical option may be considered as a starting point and followed with other treatments. And some surgical procedure may correct the cause permanently.

Botox Injection
A minimally invasive procedure is performed using Botulinum toxin type A to be injected into the bladder muscle causing it to relax. This permanent relaxation increases the storage capacity of the bladder. Therefore, decreasing the frequency of the urge incontinence episodes you experience.

Nerve stimulator device
This treatment is recommended for old people with severe urge incontinence cases. The physician will implant the device under your skin and set it to send an electrical pulse to the bladder muscle to regulate the urination and treat the urge episodes. 

Sling Procedure
This procedure is mostly performed in females and helps to reduce stress incontinence. The vaginal sling procedure works by closing the urethra and bladder neck. The urethra is the tube that delivers the urine from the bladder to urination. If weakness occurs to the pelvic floor muscle that supports the bladder the surgeon will create a sling using your tissue to hold up the bladder neck and keep the urethra closed.

Prolapse surgery
This surgery is performed to correct the bladder position if it dropped out of the normal position it should be in. The bladder prolapse repair procedure relieves the pressure out of the pelvic cavity. This could be performed in a parallel with the sling procedure to prevent the risk of incontinence that may arise with the prolapse surgery. 

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  3- Lifestyle modifications

Fluid Intake control
Limit fluids. You can control the frequency of incontinence episodes by controlling the intervals between your fluid consumption, and decrease the amount of fluid you drink at one time. Avoid drinking large amounts of water at once and you better limit your fluid intake at night if you have a problem with nocturnal incontinence. Alongside the fluid intake control, you should avoid the beverages with a known diuretic effect such as caffeine-containing beverages like coffee, soda, and tea. You should also limit alcohol consumption because it increases the need for urination.

Urination control
You can set a schedule to go to the bathroom. By this schedule, you can set a regular time intervals so you can control how many times you go to the bathroom. This will train the bladder to hold the urine and gradually increase the time between bathroom visits.

Pelvic floor exercise
  The muscles that you voluntarily use to stop urinating are located in the pelvic floor. A performing exercise known as Kegel exercise to strengthen these group of muscles help you to hold urine in the bladder for a longer duration. The pelvic floor exercise is performed by squeezing the muscles of the hip bones in the pelvis. Repeating this exercise will help you control the time intervals between bathroom visits. This will help both urge and overflow incontinence.

 

Products that help to manage incontinence

Various products can help prevent the leakage of the urine and prevent the odour of the urine.

1. Absorbent Incontinence pads
These absorbent pads are similar to the pads used for menstrual periods but different in the ability to absorb more fluids. The incontinence pads are placed sticking to the underwear to soak up the leakage of the urine and prevent its odour. They have a hydrophobic layer that draws the fluids away from the internal surface of the pads; leaving your skin dry and protect it from the irritation and the odour.

2- Diaper briefs: 
This product consists of an absorbent incontinence pad that is built into a pair of disposable briefs. This system offers high absorbability and is structured to be used for the long term. The diaper briefs offer protection all over the day with minimal changes required. They also offer overnight protection that keeps the adult comfortable and dry all night.

3- Disposable Under-pads
Absorbent disposable pads are made to offer protection to the mattress from the leakage of the urine. The disposable under-pad is placed above the mattress or the furniture and offers fast and secure absorbance to any leaking fluids to keep both the user and the furniture dry for a long period. The disposable pads are used in healthcare facilities and hospitals to protect the elderly and non-conscious patients from urine leakage. They could be used at home for the same function and with the same efficiency. 

4- Pull-up Pants
This product is designed to restrain the urine or stool leakages, the pull-up pants are undergarment products that fit both genders and they can be pulled up or down like any other underwear. They help individuals who have moderate to heavy urine or stool incontinence. The pull-up pants give the user a comfortable feeling of normal underwear with maximum protection against heavy leakage. They are made from thicker materials than conventional products, thus, they have higher absorbance compared to most incontinence products. The overnight pull-up pants are designed to contain accidental leakage and control bad odours.