What is Functional Incontinence, its Causes & Treatments?

What is functional incontinence?
Physical, cognitive or environmental barriers that prevent a person from being able to go to the toilet on time, and on their own without mishap, is called functional incontinence.

Although bladder or bowel issues aren’t part of functional incontinence, they can also be present. In women, these other types of incontinence are usually:

• Stress incontinence. This is when urine or faecal matter is leaked when the person coughs, laughs, sneezes or otherwise applies pressure to the pelvis. It’s caused by a weak pelvic floor muscle, which can be corrected through exercises if the person is capable of performing them
• Urge incontinence. This is the sudden, urgent need to urinate with minimal, if any warning. The bladder contracts or spasms spontaneously, not allowing enough time to reach the toilet.
• Mixed incontinence is when both stress and urge incontinence are present.

Causes of functional incontinence
The barriers that causes functional incontinence fall into three categories; physical, cognitive and environmental. Sometimes functional incontinence can be caused by a combination of various obstacles as well as the bladder and bowel function issues as described above.

Physical barriers include mobility, dexterity and sight impairments. All of these can hinder a person’s ability to get to the toilet, adjust clothing and get onto the seat in time to pass urine or a bowel movement. Effectively using toilet paper may also pose an issue.

Mobility issues can be the result of a disability, the use of a wheelchair or walking aid or even just a fear of falling when rushing, especially among the very elderly. Being unable to get up and out of a chair or bed independently, as well as onto a toilet, can lead to incontinence.

Arthritis can impede being able to undo belts, buttons and zips quickly enough.

And poor eyesight can make finding the toilet, as well as confidently being able to get on to it, very challenging.

Cognitive barriers include all the diseases that cause dementia. Forgetting where the toilet is and what to do when you get there is one aspect of functional incontinence; the other is interference of messages between the bladder, bowel and brain. Messages can become muddled, not giving the person enough time to get to the toilet or not recognising the message that their bladder or bowel is full. You can read more in this article, Does Dementia Cause Incontinence?

Intellectual disability and brain injury can have a similar effect to dementia. Messages between the bladder, bowel and brain can be distorted and memory of when and what to do in the toilet can be lost.

Being non-verbal can also impact continence. If a person needs to ask for assistance to get to the toilet, this and other communication barriers can lead to incontinence.

Environmental barriers are, perhaps, the most frustrating as they’re usually unexpected and can affect people who otherwise have control of their bladder and bowel. While much has been done to improve access to public bathrooms, at a private home, you may discover too late that the toilet is inaccessible for your needs. This could be due to stairs, a narrow hallway or doorway, or a restrictively small space. This can be the difference between getting to the toilet in time and not making it.

This situation is very embarrassing because it catches you unprepared, and off-guard in a social situation.

What to do about functional incontinence
The first thing you must do, whether it’s you or someone you care for who has functional incontinence, is talk with your doctor.

While they’re probably already managing the key cause, there are things they can check. These include:

• Infection. While a UTI or Urinary Tract Infection is usually well-recognised by women, symptoms among the elderly can be mild or even non-existent. An infection of the urethra, bladder or kidneys can trigger incontinence, so if it has happened suddenly, ask your doctor to check. Diagnosis occurs from testing a urine sample for the infection-causing bacteria, and treatment is a course of antibiotics.
• Medication. Some medications contribute to incontinence, especially those with a diuretic effect (increasing urine production). Your doctor can check side-effects of any regular medication and, if appropriate, make any adjustments or substitutions.
• Condition status. Incontinence could be a sign that the condition causing it, such as arthritis, has become worse. That may initiate a re-evaluation of current treatment, which could also improve functional continence.
• Cancer. Incontinence can be a symptom of bladder cancer. Although the continence issues cancer can cause aren’t functional, if there’s also stress and urge incontinence present, it’s worth having it checked out – just to be sure. Keep in mind that bladder cancer is relatively rare: it’s only 3% of all cancers diagnosed and is more likely to occur in older men. Still, always best to have it investigated and ruled out than ignored.
• Referrals. The doctor can refer you to a Continence Nurse or other health care specialists. They can help develop a plan, including changes at home, to manage on-going incontinence better.

Managing functional incontinence
Functional incontinence can’t usually be corrected long-term, but there are ways to manage it.

For physical barriers, consider:

For cognitive barriers, try:

Environmental barriers are often the most difficult to manage as they’re typically unexpected. You may be at a café or restaurant, travelling or at a friend’s house when you discover that getting to the toilet is going to be very difficult. To prepare for these situations, it may be best to ‘expect the worst’ and use a disposable product like TENA Pants - just in case.

If you’re a carer, you may find this article, Practical Tips for Carers Managing Incontinence at Home, useful.

The phycological toll of functional incontinence
Be aware that functional incontinence can have a significant and detrimental impact on a person’s wellbeing. Whether it’s you or someone your caring for, the condition can cause feelings of embarrassment and shame. It can also be an indicator of deterioration, which can produce feelings of loss. It can interfere with everyday activities such as sleep, outings and social interactions, reducing resilience, enjoyment and quality of life.

The emotional stages of incurable incontinence can mirror grief, including denial, anxiety, frustration, anger and depression. You can read more about these in this article; Incontinence can take a psychological toll on men

If you or the person your caring for is experiencing low mood because of incontinence (or any other reason for that matter), take action. Speak with your doctor about a referral to a psychologist or contact your local mental health organisation; Beyond Bluein Australia and the Mental Health Foundation in New Zealand.

Additional articles that may be of interest to carers are:

• Tips for Carers: Discussing Incontinence
• Reducing the Stress of Incontinence Care
• Why it’s Important to Take Care of You

Products for managing functional incontinence
Choosing the right product for you (or the person you care for) is essential in optimising management. TENA has an extensive range of Women’s Products and Specialist Products which are ideal for those requiring additional support.

With such a selection, TENA has developed a Product Finder Tool to assist in identifying the right one for your needs. This online program steps you through a short series of questions, then suggests products that may be suitable. You can even order free samples. If the samples you request aren’t quite right, come back to the website and try something else. That’s because here at TENA, we’re committed to helping you find the best product for your situation.

Sources:

• https://www.continence.org.au/pages/functional-incontinence.html
• https://www.healthline.com/health/overactive-bladder/functional-incontinence#prevention-and-treatment
• https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/symptoms-causes/syc-20352808

Asaleo Care makes no warranties or representations regarding the completeness or accuracy of the information. This information should be used only as a guide and should not be relied upon as a substitute for professional, medical or other health professional advice.