What is Total Incontinence?

Total incontinence is the continuous and total loss of urinary control and is the severest type of incontinence. It causes either continuous leakage or periodic uncontrolled emptying of the bladder’s contents. In total incontinence, your bladder becomes incapable of storing any urine.

Incontinence can be a scary and humiliating condition. Catherine DuBrau, Clinical Chief of the Division of Geriatric Medicine at Massachusetts Medical School asserts, “incontinence not only causes great unhappiness but can also increase disability, social isolation and health care costs”. However, you should know that incontinence is not as rare as you may think. It affects one in four women middle-aged or older, and 15% of all men aged 60 years or over.



What can Cause Total Incontinence?

Urinary incontinence occurs when the muscles of the bladder controlling the flow of urine relax involuntarily. Total incontinence is often caused by a neurogenic bladder. This is generally a name given to people who lack bladder control due to a brain, spinal cord or nerve problem. Nerve problems are often the result of Multiple Sclerosis, Parkinson’s Disease or Diabetes. Nerves in the body are in control of how the bladder stores or empties urine, and problems with these nerves can cause huge problems with the functioning of the bladder. A neurobladder is also often caused by infection of the brain or spinal cord. However, the condition is often even caused by heavy metal poisoning, stroke, spinal cord injury or pelvic surgery. A study in 1987 followed the health of 692 patients who underwent bilateral pelvic lymphadenectomy and radical retropubic prostatectomy from 1978 through 1984. Pulmonary embolus developed in 19 patients and severe to total urinary incontinence occurred in 34 of the patients.


Total incontinence can also be caused by an anatomical defect present from birth. It is common for individuals who are born with problems of the spinal cord to develop total incontinence. Spinal cord injuries that impair the nerve signals between the brain and the bladder are another common cause. In many cases, a fistula, a condition when a tube or channel develops between the bladder and a nearby area can cause total incontinence. This is an abnormal connection between the urinary tract and the vagina. Urinary tract infections can also cause total incontinence.                                                             


Surprisingly, various medications such as diuretics, antihypertensive drugs and sedatives can also cause total incontinence. If you suspect medications may be worsening your leakages, let your Doctor know about all the medicines you take, both prescription and over-the-counter. Common medicines drugs that can worsen incontinence are the following:


  • High blood pressure drugs
  • Antidepressants and Incontinence
  • Sleeping Pills
  • Diuretics

How can you Manage Total Incontinence?


It is important to remember that incontinence is not a disease in its own right, but something that is caused by a combination of problems, habits and sometimes medications. Total incontinence is often a symptom of something else going on in the body, and should always be assessed and diagnosed by a healthcare professional. Total incontinence is a life-changing condition and you shouldn’t feel embarrassed talking about it to get the best treatment. When visiting your GP, they will ask about your symptoms and may carry out a pelvic examination to outline any potential causes.


Surgery is a common method of treatment for when the cause of your symptoms is something that can be fixed through surgery. You should seek a surgeon who has done a fellowship in urogynecology or reconstructive surgery if you are considering surgery.The most frequently performed method of surgery for total incontinence is repositioning the neck of the bladder. For men who have incontinence after prostate cancer surgery, an artificial sphincter implant is the most useful option. In this treatment, silicone rubber device is fitted around the urethra. It can be inflated or deflated to control urination. A sacral nerve stimulation device is another option of surgery, which involves a device that can be implanted in the body to help stimulate nerves, improving bladder function.


Sling surgery may be considered as a treatment for urinary incontinence from prostate surgery. This consists of placing a sling beneath the urethra. It is attached to either muscle tissue or the pubic bone. The is compressed and raises the urethra, giving the urethra greater resistance to pressure from the belly. Clean intermittent catheterisation (CIC) is another popular technique that can be used to empty the bladder at regular intervals, reducing your number of accidents. A continence adviser will teach you how to place a catheter through your urethra and into the bladder. However, it is important to have regular tests for a urinary tract infection if you are using a catheter.


A lifestyle change you can make to improve your condition is to eat much healthier. Being overweight can increase the frequency of leaks. You can, therefore, reduce the frequency of your accidents through maintaining a healthy weight and doing more frequent exercise. If you have frequent accidents during the night, try and drink less in the hours before you go to bed. You can also use products such as pads or disposable underwear to manage your incontinence with confidence. Look for highly absorbent products that you can wear comfortably throughout the day. All-in-one products and incontinence pants with a pad are recommended products for those with severe incontinence.




Do not add to the problem!


Many drugs have been found to make incontinence worse. These include alcohol, blood pressure medications and alpha blockers and anti-psychotics. Try and avoid caffeinated beverages, as these irritate the bladder and can increase the frequency of leaks. Total incontinence is a difficult condition to live with, however, you can make life easier by following these simple lifestyle tips.

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