Urinary incontinence, the involuntary loss of urine, affects an estimated 25 million Americans, mostly women. For most, incontinence is the result of problems controlling the bladder. For people with a type called functional incontinence, however, the problem lies in getting to and using the toilet when the need arises.
Causes and Symptoms of Functional Incontinence
There are many possible causes of functional incontinence. Often, the cause is a problem that keeps the person from moving quickly enough to get to the bathroom, remove clothing to use the toilet, or transfer from a wheelchair to a toilet. This includes musculoskeletal problems such as back pain or arthritis, or neurological problems such as Parkinson's disease or multiple sclerosis (MS). Further compounding the problem, restroom facilities aren't always easy to get to or may not be set up for people with disabilities.
In other cases, functional incontinence may result from problems with thinking or communicating. A person with Alzheimer's disease or other forms of dementia, for example, may not think clearly enough to plan trips to the restroom, recognize the need to use the restroom, or find the restroom. People with severe depression may lose all desire to care for themselves, including using the restroom.
Sometimes medications can cause functional incontinence. For example, if strong sedatives cause grogginess, the person may not recognize the need to use the restroom until it's too late.
Although there are several types of incontinence, doctors suspect a diagnosis of functional incontinence when there are other medical conditions that make getting to the bathroom difficult. However, a physical exam, medical history, and medical tests may be necessary to confirm the diagnosis or determine if other forms of incontinence are present that require treatment. For example, Parkinson's and multiple sclerosis incontinence may be caused by both functional incontinence and urge incontinence that occur because damage to the nerves makes urine control difficult.
Diagnosis and Treatment of Functional Incontinence
Treating functional incontinence requires treating the medical conditions that cause or contribute to the problem. For example, appropriate treatment for arthritis may make it easier to get to the bathroom quickly.
Treatment also requires addressing factors in the environment to improve accessibility.
If you suffer from functional incontinence, there are things you can do to reduce your risk of accidents. At home, make sure your bathroom is accessible and the route from your bathroom is uncluttered, which could help you avoid delays or falls. When out and about, know where the restrooms are, so you will not have to take time to ask directions or locate one when you need to go. Wear clothing that is easy to remove. For example, if arthritis in your fingers makes it difficult to work zippers, wear pants with elastic waists. If you have trouble transferring from a wheelchair to toilet, try to have someone with you who can help.
Sometimes simple behavioral treatments that help other forms of incontinence can be helpful in reducing accidents caused by functional incontinence. These treatments include:
Bladder training: This technique involves scheduling the amount of time between bathroom trips. You'll initially start by going every two hours. If you feel the need to go between trips, you should stand or sit still, contract the pelvic muscles, and concentrate on making the urge to urinate go away. Once the urge is under control, you can go to the bathroom and urinate. After you have stayed dry for two days, you should slowly increase intervals until you are able to go three to four hours without using the bathroom.
Pelvic muscle exercises:Pelvic muscle exercises, also called Kegel exercises, strengthen the muscles that support the bladder and urethra to prevent leakage. To do Kegel exercises you should focus on isolating your pelvic muscles, so that contractions are in these muscles. To learn how to do Kegel exercises, go to the bathroom and urinate. Halfway through, try to stop the stream of urine. This will help you identify the muscles you need to contract. Once you identify the muscles, do not practice while urinating. Do the exercises for about five minutes at a time as you go about your day. After a few weeks to a month you should start to notice some improvement. Practicing Kegel exercises may be helpful in preventing accidents as you try to get to the bathroom.
In addition to doing specific exercises to strengthen the pelvic floor muscles, walking can be helpful, because it improves your sense that the bladder is filling. This may enable you to recognize the need to urinate and head toward the bathroom before it's too late.
Devices and absorbent products. Protective pads and panty liners can help avoid embarrassing situations. A pessary, a plastic device inserted into the vagina, may help prevent urine leakage by supporting the neck of the bladder; it is most useful for stress incontinence. Vaginal weights are another option. The small weights are inserted into the vagina and your pelvic muscles contract to hold them in while you are standing. They should be used about 15 minutes a day, twice a day. A non-invasive device - pants with electrical pads - work by stimulating the muscles of the pelvic floor, and helping strengthen and re-educate the muscles that help control bladder leakage. Electrical stimulation is FDA approved for the treatment of SUI. It uses low-grade electrical current to stimulate weak or inactive pelvic muscles to contract. Regular electrical stimulation sessions can supplement or augment your pelvic muscle exercise regime. Additionally, a newly approved coin-sized device called a tibial neurostimulator that can be implanted in the lower leg and reduce symptoms.
Scheduled, timed, or prompted voiding: This involves setting a schedule for bathroom trips. If you make regular trips to the bathroom, you may be less likely to have to go in a hurry. In nursing homes, scheduled or prompted voiding can be helpful for dementia patients, who may not recognize when they need to use the bathroom. Bathroom trips can be planned for times when the patient's bladder is likely to be full.
Although these methods require motivation and effort, for many people with functional incontinence, they can make a difference between having accidents and staying dry.