Types of incontinence

Stress incontinence

Stress incontinence is involuntary leaking of urine during moments of increased pressure in the abdomen as with exertion, coughing or sneezing. The pressure on the bladder cannot be absorbed entirely by the pelvic floor. The leakage can vary from single drops to a dribble. Stress incontinence occurs most often in women.

Weakening of the pelvic floor leads to the urethra not being fully squeezed close. This occurs with:

• Elderly women under the influence of hormonal changes
• Pregnancy and childbirth
• Overweight
• Chronic coughing
• Operations near the bladder, intestines and uterus
• Prolapse

Urge incontinence

Urge incontinence is involuntary leaking of urine associated with or directly preceded by a sudden irresistible urge to urinate. Large quantities of urine leak as a result.

Urge incontinence can have a number of causes:

• Conditions affecting the bladder (cystitis)
• Conditions affecting the nervous system (disrupting muscle control)
• Impediments in emptying the bladder
• Consumption of bladder-irritating foodstuffs like coffee, carbonated beverages, alcohol and chocolate
• Overweight
• Operations on/radiation of the pelvic region
• Incorrect use of the pelvic floor muscles
• Stress

Mixed incontinence

Mixed incontinence is a combination of different types of incontinence. It often refers to the combination of stress and urge incontinence, because that is the most common combination.

The causes are the same as those of the different types of incontinence. Often the causes of stress and urge incontinence occur together.

Overflow incontinence

With overflow incontinence or drip incontinence, the bladder is constantly full (overfull). The bladder regularly leaks drops or dribbles of urine. This type of incontinence occurs most often in men.

The most common causes of overflow incontinence are:

• Reduced strength of the bladder muscle. For example, in diabetes or when taking medication (such as antidepressants)
• Constriction of the urethra For example, with an enlarged prostate, stones or growth in the uterus or ovaries
• Overactive pelvic floor

Reflex incontinence

With reflex incontinence, there are aberrations in parts of the nervous system guiding the discharge of urine. The bladder muscles are incorrectly controlled, with urine leaking despite no urinary urge being felt.

Causes

Examples of neurological aberrations are:

• Paraplegia CVA (stroke)
• Spina bifida
• Spinal cord tumours
• Parkinson’s disease
• Multiple sclerosis

Functional incontinence

With functional incontinence, sufferers are not able to go to the toilet on their own due to physical or cognitive restrictions. The cause is thus not in the urinary tract or genitalia.

Functional incontinence is caused by:

• Dementia
• Motoric problems
• Visual problems

Total incontinence

With total incontinence of urine, the urinary urge is absent, so all urine leaks continuously (dropwise). With total incontinence of faeces, the urge is also absent and the leakage of faeces is uncontrolled. This form of incontinence occurs rarely.

The causes of total incontinence:

• Usually: congenital aberration of the urinary tract and/or nerves to the bladder and/or to the intestines and/or the nerves of the intestines.
• Occasionally: damage occurring later to the sphincter of the bladder and/or rectum, for example through a total rupture during childbirth or prostate removal

Fecal incontinence

Fecal incontinence means not being able to hold back faeces. This type of incontinence occurs for example:

• during episodes of diarrhoea.
• when a hard stool is stuck in the rectum (fecal thickening). This can lead to overflow diarrhoea: diarrhoea that flows past the hard stool.
• if soiling occurs: small bits of feces or rectal fluid leak out.

Fecal incontinence can last a short or a long time. That depends on the cause.

Causes of fecal incontinence include:

• Injury to the anus or spinal cord
• Chronically inflamed intestines, such as with Crohn’s disease and ulcerative colitis
• Pelvic floor damage
• Complication after haemorrhoid operation (operation on piles)