Functional Urinary Incontinence

Functional incontinence occurs where your bladder and urinary tract are functioning properly, however due to age, illness or disability you are unable or unconcerned about making your way to the bathroom to empty your bladder. As a result, you often have a full bladder and leak. The term functional incontinence can also refer to urinary leaks as a result of medication which cause you to produce more urine than normal (diuretics) or lose the urge to urinate.

The impact on quality of life can be widespread, effecting carers, family and friends as well as the individual suffering. An estimated 3 million people suffer from functional incontinence in the UK. With the majority unable to go to the toilet independently.

If you or someone you know are affected by functional urinary incontinence, the National Institute for Health and Care Excellence recommend watching out for the following 'red flag' signs that further damage is occurring:

  • loin pain - an early sign of kidney failure and kidney disease
  • blood in the urine - an early sign of bladder cancer
  • recurrent catheter blockage - an early sign of bladder stones occurring
  • recurrent urinary tract infections (three or more within 6 months) - an early sign of bladder cancer and/or bladder stones

If you become aware of any of the above issues occurring, you must seek treatment as soon as possible.


Symptoms of Functional Urinary Incontinence

You may suffer from functional incontinence if you leak urine, or empty your bladder fully as a result of not:

  • having access to a toilet
  • having the mobility to get to a toilet in time
  • being able to communicate that you need the toilet
  • being able to find your way to a bathroom due to visual impairment
  • being able to undo your clothes quick enough to reach the toilet
  • being bothered by urinating on yourself
  • realising you need the toilet
  • being comfortable using an available toilet, preferring to urinate on yourself

Causes of Functional Urinary Incontinence

There are many reasons why you might be unable to reach a suitable toilet before you cannot hold your urine in any longer:

  • Learning/cognitive disability - If you suffer with a learning disability, it may taken longer to develop the same bowel and bladder control as peers of the same age.
  • Mobility - Issues with mobility may come about as a result of age, injury or illness. Using a toilet may be so challenging that using pads or a catheter may be a suitable solution.
  • Inability to communicate - It could be due to language skills, hearing issues, aphasia (as a result of a stroke or other brain injury), or dysphasia (as a result of multiple sclerosis or similar condition which disrupts short-term memory, verbal fluency and attention). You may be unable to ask where the bathroom is or be unable to express that you need the toilet.
  • Confusion - Sufferers of Dementia may not be aware of where a toilet is located, or be anxious about asking the individuals around them.
  • Environmental factors - People with Autistic Spectrum Disorders may be unable to use toilets in an unfamiliar place. Individuals with visual impairment may be unable to use inaccessible bathrooms with support.
  • Restrictive clothing - Suffers of arthritis or muscular dystrophy, for example, may find it difficult to undo the buttons and zips on most trousers. They may be unable to remove these clothes in time to reach the toilet.
  • Anxiety - Often due to one or more previous experiences, some individuals may feel embarrassment and stress about using the bathroom. As a result they limit toilet breaks and only go when they believe other people are unaware.
  • Attitudes from carers, friends and relatives - If you begin to suffer as a result of one of the causes mentioned above, this can be further intensified if the attitude from those around you is negative and demeaning.

To read more about these causes, and the events that can lead to you developing any form of urinary incontinence, visit the Causes and Diagnosis page.


How to Stop Functional Urinary Incontinence

There are a number of conservative treatments available which the individual suffering and the caregiver (if available) can help with.

Patient directed techniques include:

  • Bladder retraining - If you have the potential to voluntarily contract your pelvic floor, then you can increase its strength (and hence the control over your bladder) through regular pelvic floor exercises.
  • Behavioural management, timed voiding and habit retraining - You can train your bladder to better suit your situation. By urinating on a regular schedule, such as every hour. Then slowly increase the time between bathroom trips until you meet an optimum schedule which suits your lifestyle whilst still preventing leaks.
  • Maintaining a healthy weight - To avoid unnecessary extra pressure put on the bladder.
  • Avoiding diuretics - Such as caffeine and spicy food.

Caregiver dependent techniques include:

  • Prompted voiding - Assist the individual in going to the bathroom to routinely empty their bladder.
  • Supplying underwear and clothing that is easy to remove - So they are able to independently use the bathroom.
  • Remove physical barriers - This can be all that is needed to resolve functional incontinence. This may be making the bathroom more accessible by adding a grab bar and clearing the pathway to the bathroom.
  • Urinary catheter - In situations where there is no carer around or funding available to improve bathroom accessibility, you may look for a solution that can allow urination in situ. This may be where a urinary catheter is a suitable treatment - a flexible tube that carries urine out of the bladder into a drainage bag, through your urethra or through a small opening in the lower tummy. Using a urinary catheter comes with the responsibility of maintaining it correctly. Common issues include urinary tract infections when the bag is not changed or the area kept clean as required.

To read about the other treatments available for general urinary incontinence, visit our incontinence treatment page.


Sources

Harvard Medical School. (2014). Types of urinary incontinence. [online] Harvard Health Publishing, 2014. [viewed 19/04/18]. Available from: https://www.health.harvard.edu/bladder-and-bowel/types-of-urinary-incontinence

Health Quality Ontario. (2008). Ontario Health Technology Assessment Series. Behavioural Interventions for Urinary Incontinence in Community-Dwelling Seniors: An Evidence-Based Analysis. [online] 8(3), p1-52. [viewed 19/04/18]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3377527/?report=reader#__ffn_sectitle

Khandelwal, C. Kistler, C. (2013). American Family Physician. Diagnosis of Urinary Incontinence. [online] 87(8), p543-550. [viewed 23/04/18] Available from: https://www.aafp.org/afp/2013/0415/p543.html

Multiple Sclerosis Trust. (2017). Dysphasia. [online] Multiple Sclerosis Trust, 2017. [viewed 23/04/18]. Available from: https://www.mstrust.org.uk/a-z/dysphasia

National Institute on Aging. (2007). Urinary Incontinence in Older Adults. [online] National Institute on Aging, 2007. [viewed 19/04/18]. Available from: https://www.nia.nih.gov/health/urinary-incontinence-older-adults

NHS Trust. (2017). Urinary catheter: Overview. [online] NHS Trust, 2017. [viewed 19/04/18]. Available from: https://www.nhs.uk/conditions/urinary-catheters/

NICE. (2012). Urinary incontinence in neurological disease: assessment and management. [online] National Institute for Health and Care Excellence. [viewed 19/04/18]. Available from: https://www.nice.org.uk/guidance/cg148/resources/urinary-incontinence-in-neurological-disease-assessment-and-management-pdf-35109577553605

Periyakoil, V. S. Johnson, S. Yeo, G. (2008). Physician Assistant, A Guide to Clinical Practice. Chapter 28 - Geriatric Medicine. [online] 4, p526-551. [viewed 19/04/18]. Available from: https://www.sciencedirect.com/science/article/pii/B9781416044857500329

Royal College of Nursing. (2016). Barriers to maintaining continence. [online] Royal College of Nursing, 2016. [viewed 23/04/18]. Available from: https://rcni.com/hosted-content/rcn/continence/barriers-maintaining-continence

The National Aphasia Association. (2018). Aphasia Definitions. [online] National Aphasia Association, 2018. [viewed 23/04/18]. Available from: https://www.aphasia.org/aphasia-definitions/