Incontinence

What is incontinence?

Urinary incontinence is any form of unwanted urine loss in adults. In children who are not yet continent at night, it is known as enuresis nocturna. We will not be discussing the latter condition. People may also be faecally incontinent. A correlation has been found between behaviour problems and urinary incontinence but not with faecal incontinence ³⁹³  and we will therefore be discussing urinary incontinence only here.

What are the complaints associated with urinary incontinence?

There are several types of incontinence that all present differently. ^{396 , 598}

• Stress incontinence is involuntary urinary loss that occurs during exercise or straining, or during sneezing or coughing. Stress incontinence is linked to a failure of the mechanism that closes the bladder when there is a pressure increase in the abdomen. Risk factors are: pregnancy, childbirth, overweight, chronic cough, pelvic surgery and injury to the sphincter after prostate surgery.
• Urge incontinence is involuntary urinary loss in combination with, or immediately preceded by, a sudden, irresistible urge to urinate. The reflex urine-retention mechanism does not work properly. Anxiety about incontinence can then create a vicious circle. The cause is sometimes a bladder condition (such as a bladder infection), an outflow obstruction (such as an enlarged prostate), a cervicectomy or a condition of the nervous system. In addition, drinking caffeinated beverages can play a role. Urge incontinence is classified under the overactive bladder syndrome.
• Mixed incontinence is involuntary urine loss that occurs both when abdominal pressure increases and in association with a sudden urge to urinate.
• Reflex incontinence results from the spontaneous contraction of the bladder in the absence of a normal urge to urinate. It is a result of damage to the central nervous system, for example as the result of a stroke or a spinal cord injury.
• Overflow incontinence is when the pressure in the full bladder is too strong for the retention mechanism, usually as a result of reduced bladder strength (due, for example, to diabetes) or an outflow obstruction (such as an enlarged prostate). Some medicines, such as anticholinergics, may also cause overflow incontinence.
• Continuous incontinence is usually associated with the formation of a fistula (tube), for example after an injury, pelvic surgery or circumcision.

Research has shown that urinary incontinence in people with intellectual disabilities is linked to challenging behaviour (aggression, self-injurious behaviour and challenging behaviour in general). Since that research involved only cross-sectional studies, the causal effect is unclear and it is not known if there is a common underlying pathology. ^{393 , 394 , 395}  

People with intellectual disabilities sometimes find it impossible to communicate their symptoms. The people around them may then notice only a change in behaviour.

How common is incontinence in the general population?

Between a quarter and more than half of all adult women have urinary incontinence. Prevalence increases with age. In women under the age of fifty, stress incontinence is the most common form; in older women, urge incontinence or mixed incontinence are more prevalent. ³⁹⁶

In the general population, the prevalence of incontinence ranges from 11 to 34% in older men and from 3 to 5% in middle-aged or younger men. This is usually urge incontinence or mixed incontinence, and only rarely stress incontinence. ⁵⁹⁸

How common is incontinence in people with intellectual disabilities?

In an English study of a group of 73 adults aged 20 to 64 years, 27.4% had incontinence. The percentage in an older group of 134 people aged 65 and over was 49.3%. ³⁹⁴

Another large English study of 1023 adults with intellectual disabilities found that 35.3% had incontinence. ³⁹⁷

A Dutch study of 346 adults with intellectual disabilities found that 26% suffered from urinary incontinence. ³⁹⁸

People with Down syndrome do not seem to have urinary incontinence more often than other people with intellectual disabilities (23%). ³⁹⁹

Medication to control behaviour that is sometimes given to people with autism can have urinary incontinence as a side-effect. ⁵⁹⁹