Functional Incontinence: Symptoms, Causes and Prevention

What Is Functional Incontinence?

Functional incontinence is when a person is unable to recognize the need to go to the toilet. Oftentimes, functional incontinence can be caused by a malfunction of the urinary, muscular, or neurological systems. According to the Urology Care Foundation, 25 to 33 percent of Americans deal with urinary incontinence in some form; however, it is more common in the elderly. Also, those in the late stage of Alzheimer’s disease often have problems with functional incontinence. It’s important to know that functional incontinence is not a disease and can often be controlled or even cured.

Signs and Symptoms of Urinary Incontinence

The main symptom of functional incontinence is urine leakage. It may be a small amount or the entire bladder. Other symptoms may include: 

• Leaking urine during day-to-day activities.
• Feeling a sudden and strong urge to urinate.
• Wetting the bed while sleeping.
• Leaking urine without any urge and failing to make it to the toilet in time.

If you experience any of the symptoms listed above, notify your primary care provider so you can discuss the next steps on how to manage it. 

Types of Urinary Incontinence

There are a variety of reasons and underlying problems that can cause the complex system that controls our bladder to not function properly. Incontinence is divided into the following categories:

• Functional incontinence - This is when your urinary tract is functioning properly but an illness or a disability is causing urine leakage. Functional incontinence can affect anyone with a condition where it is difficult to reach the bathroom. Plus, certain medications, such as diuretics, and disabilities such as dementia can decrease awareness of when to use the bathroom.
• Overflow incontinence - According to Harvard Health Publishing, overflow incontinence occurs when something blocks urine from flowing out of the bladder normally. This can be caused by a prostate enlargement that closes off the urethra, or another urine blockage from something such as a tumor or bladder stone. Overflow incontinence is also common in neurological disorders, such as Multiple sclerosis.
• Stress incontinence - This condition has nothing to do with emotional stress. Rather, the “stress” is associated with the physical strain associated with urine leakage. If your bladder leaks during exercise, coughing, sneezing, laughing or lifting heavy objects, you may have stress incontinence. This is the most common type of incontinence for younger and middle-aged women. 
• Urge incontinence - This happens when someone has a very strong “urge” to urinate; however, they are unable to make it to the toilet. 
• Mixed incontinence - This is a combination of stress and urge incontinence. Mixed incontinence can occur in men who have had prostate removal as well as the elderly. An overactive bladder is different, and not the same as incontinence.

What are the Causes of Functional Incontinence? 

According to the National Institute on Aging, causes of functional incontinence include:

• Weak bladder muscles
• Overactive bladder muscles
• Weak pelvic floor muscles
• Damage to nerves that control the bladder from diseases such as multiple sclerosis, diabetes, or Parkinson’s disease
• In men, blockage from an enlarged prostate 
• Diseases such as arthritis that may make it difficult to get to the bathroom in time
• Pelvic organs that are out of place

Conditions Which can Cause Persistent Urinary Incontinence in Senior Adults

Urinary incontinence can be temporary or persistent, depending on its cause. Functional incontinence in senior adults is usually persistent due to an underlying symptom of other chronic conditions. Here are some conditions that can cause urinary incontinence in senior adults:

• Neurological Conditions such as Alzheimer’s and Dementia
• Mental Illness
• Blindness or Poor Eyesight
• Impaired Mobility
• Medications
• Chronic Conditions such as prostate cancer
• Injuries (broken legs, arms, hips, etc.) 

Why are Seniors More at Risk for Functional Incontinence?

According to a report from the American College of Clinical Pharmacy, urinary incontinence affects up to 30 percent of community-dwelling older adults and more than 50 percent of nursing home residents. As you get older, the muscles in your bladder and urethra lose some of their strength. With age, your bladder may reduce the amount of urine it can hold; therefore, increasing the chance for urine to involuntarily release. In addition, neurological conditions such as Alzheimer’s and Dementia put the elderly at a heightened risk of incontinence as those neurological conditions mainly affect the older age group. 

Functional Incontinence Treatment and Prevention

If you or a loved one suffers from urinary incontinence, there is no need to feel embarrassed. There are a variety of treatment and prevention options to help – from using a toilet schedule to adjusting your diet. These types of lifestyle changes are the main thing one can do to treat or prevent incontinence. 

Use a Toileting Schedule

Using a toileting schedule can help you or a loved one prevent functional incontinence. A caregiver can use a toileting schedule to help the person they are caring for use the bathroom on a fixed schedule -- usually every 2 hours. Write down how often you or a loved one is continent on the 2-hour schedule, and adjust the time accordingly. This process designates a time for urination and reduces episodes of functional incontinence

Fluid Adjustment

Drinking fluids excessively – especially alcohol – can worsen bladder problems and can increase one’s need to urinate. Certain drinks, such as coffee, tea and other caffeinated beverages, carbonated drinks and acidic juices can irritate the bladder and lead to incontinence. However, it is important to stay hydrated. Not drinking enough water can cause a buildup of body waste in urine and lead to incontinence. 

Nighttime Leakage

To manage and prevent nighttime leakage, limit your fluid intake before bedtime. Try and urinate right before you go to sleep and cut out any irritating fluids. As well, you can make your trip to the bathroom easy and make sure no obstacles are in the way. You could even use a nightlight. If need be, incontinence pads and products can provide additional protection.

Diet Adjustment

Make sure to avoid foods that can make functional incontinence worse. These include citrus fruits, tomato-based food, spicy foods, sugars, artificial sweeteners and chocolate. Try to consume foods high in fiber to avoid constipation, as constipation is a major cause of aggravated urinary incontinence. These include lentils, beans, fresh vegetables and fruit. 

When to Talk to Your Primary Care Provider

If urinary incontinence is something that interferes with you or a loved one’s day-to-day life, do not hesitate to reach out to your primary care provider. At One Medical Seniors, we care about our patients and give them the time they need to talk with professionals who care, listen and can address their health needs, concerns and goals. 

As we’ve learned, neurological disorders such as Alzheimer’s can cause functional incontinence. Learn more about the stages of Alzheimer’s.