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TYPES OF INCONTINENCE

When most people hear the word “incontinence”, they instinctively think that the person looses the contents of their bladder or bowel completely with no control over either.  Actually, incontinence is a bit more complex than that.  There are many different forms of incontinence, and as you will see below retention of urine and/or feces is also a form of incontinence.  As noted from the main page of the site, incontinence is “the inability of the body to control the evacuative functions of urination and defecation”.  Notice that does not say the “loss of contents of the bladder or bowel”, but rather the “lack of control of the functions...”.  So, as you can see, incontinence involves a number of issues.  Here are the types of incontinence.


Stress Incontinence:  This type of incontinence is also referred to as “giggle” incontinence and is mostly seen in women.  This is urine leakage caused by pressure on the bladder from the abdominal muscles.  Usually, the urinary sphincter, the “valve” at the bladder neck that controls urine flow” allows a small amount of urine to pass when the person coughs, sneezes, laughs, strains (as when lifting a heavy object) or simply bends over.  Stress incontinence is usually caused by a weakening of the pelvic floor muscles that control the outflow of urine by such things as childbirth, neurological disorder, side effect of surgery or injury.


Urge Incontinence:  This is the type of incontinence that occurs when the urge to urinate is felt and you have to go NOW!  Urge incontinence can result in a small loss of urine or a full flood of a large volume of the bladder contents.  This type of incontinence is caused by strong contractions of the bladder (detruser muscle), also called “bladder spasms”.  The symptoms can be as simple as a strong need to urinate all the way up to severe, debilitating pain when the cramping hits with a sudden loss of bladder control.  This type of incontinence can be caused by bladder infections, neurological damage, injury or other diseases of the bladder.


Overflow Incontinence:  Overflow incontinence is exactly what it sounds like.  The bladder fills to full or overflowing and the pressure from the full bladder is enough to push small amounts of urine past the urinary sphincter that then dribble out of the urethra.  Usually overflow incontinence involves continuous small amounts (or dribbling) of urine.  It can be caused by an enlarged prostate, neurological injury, physical injury or diseases of the bladder and/or urinary system.


Functional Incontinence:  This type of incontinence is also referred to as “reflex” incontinence, as it involves urination without the awareness that the bladder needs to be emptied or the ability to control urination.  The bladder fills to a certain point and a reflex causes it to automatically empty without any action or control on the part of the individual.  The bladder may empty completely or may retain some urine.  Functional incontinence can be caused by spinal cord injury (usually above the T10 level), neurological disorder, complications from surgery, cognitive disorder (autism, developmental disability, etc..) and other causes.


Nocturnal Enuresis (Bedwetting):  Most often seen in children, bedwetting is the uncontrolled urination during sleep in which the person may be completely unaware that urination is occurring.  Nocturnal enuresis has MANY causes including, childhood trauma, mental illness, inability of the body to produce a hormone called Anti-Diuretic Hormone which slows the production of urine at night, and other causes.


Urinary Retention:  While not ordinarily thought of when one mentions incontinence, urinary retention is the inability to pass urine due a blockage of the urethra, inability of the urinary sphincter or detruser (bladder) muscle to contract or even anxiety.  Depending on the situation, retention can cause urine to back up into the kidneys and also can cause overflow incontinence as noted above.  Urinary retention has many causes such as an enlarged prostate, urethral stricture (narrowing), bladder or kidney stones blocking the urethra, neurological illness, spinal cord injury, physical injury to the bladder or urethra, mental health disorders and others.


Mixed Incontinence:  This is exactly what it sounds like.  Incontinence can consist of any or all of the types listed above.  This is usually the hardest to treat, as there are a NUMBER of causes and possible treatments.


Bowel Incontinence:  This is the involuntary passage of feces at inappropriate or unplanned times.  Like bladder incontinence, bowel incontinence can be caused by many issues such as abdominal or rectal injury, neurological disorder, spinal cord injury, Crohn’s Disease, Ulcerative Colitis, constipation, diarrhea  and cognitive disabilities.  Bowel incontinence can come in some of the same forms as mentioned above.