The impact of Urinary Incontinence

It is often too easy to feel that you are the only one dealing with bladder problems, because of the private nature of the condition, and wider social embarrassment around the issue. However, things are gradually beginning to change. For example, many women are now more open about the issue of stress incontinence following childbirth. Men with prostate problems and related continence difficulties are becoming more open about these too, however, the topic remains a difficult problem to discuss that is often hidden.    

The reality is that bladder difficulties can affect anyone at any time in their lives, and while it’s true that women and older people may be disproportionally affected, our experience shows that many younger people  and men have to deal with this issue too.   

It is often hard to get a true picture or accurate statistics on the number, due to the hidden nature of the condition and fact that many people are reluctant to seek medical help from health care professionals. But it is estimated that in the UK alone, between 3 and 6 million people have some degree of urinary incontinence

(NHS England - , International Continence Society).

As more people begin to talk about the issue, with personal stories appearing online and in the news media, this will hopefully encourage people living with the condition that they are far from alone and that help, and support is available.

Mental health is another area that people struggle to talk openly about. But with high profile awareness campaigns, some even backed by the Royals, things are beginning to slowly change.

Many ideas have been put forward as to why continence problems have not always enjoyed the full attention of the health care profession, with the stigma around the condition being one of these. Another reason put forward is that ‘No one ever dies of incontinence’, and while this is basically true, the condition can have a devastating effect on an individual’s life and sense of self, especially, in terms of loss of dignity and low self-esteem, which can have a significant impact on mental health. As with many health conditions, the relationship between continence difficulties and mental health is a great deal more complex.

In terms of research into this area, there is a lot of scientific data to show that having one of these, can increase the risk of you developing the other but of course, this is not always a certainty. And the relationship between the two is often described as being multi-directional.

For example, if you spend your time worrying about not making it to the bathroom in time, or having leakage, it’s unsurprising you may suffer from increased levels of anxiety and stress. In addition, bladder problems can often lead to feelings of low self-esteem and lack of dignity and shame. The condition can lead people to want to stay at home all the time, which can cause isolation that may increase the risk of people developing low mood and depression. 

Equally, individuals with mental health problems such as anxiety and depression, often report higher rates of bladder difficulties, such as overactive bladder and urge incontinence. This has led several research teams across the world to investigate the relationship between these two conditions with scientists from Leicester University in the UK suggesting that the two issues may ultimately have the same underlying cause. Low levels of serotonin are thought to be an important factor in both problems. There is now a growing body of scientific evidence from across the globe that links the two conditions together, although, it must be re-iterated that just because you have one condition, it doesn’t automatically mean you will develop the other, just that your chances of doing so may be increased.

Of course, we also all know how mood/emotions can have an impact on your bladder, as anyone who has ever had to go for a job interview or exam will tell you, this makes you anxious which in turn then often causes you to need the loo, and that this can have an impact on your bladder and/or bowels. This is related to the so-called ‘flight and fight’ mechanism, which we all experience when subjected to increased stress or fearful situations. Other familiar bodily changes that people may experience when under stress include things like increased heart rate, breathing, sweating, and trembling. This is an evolutionary adaptation to prepare us for when we needed to run away from the proverbial ‘sabre-toothed tiger’, but less useful when preparing to give a presentation. 

In addition, when people have a ‘panic attack’, many experience the sudden need to rush off to the toilet to empty their bladder and/or bowels, and conversely, having bladder leakage in a public setting can often cause people to have an ‘anxiety attack’. This highlighting the circular nature of our emotions and bladder/bowel control, and as anyone (such as a soldier or police officer) who’s ever been put in a truly terrifying or life threatening position will tell you, , it’s not uncommon for an individual to lose control of their bladder and/or bowels in that situation. Therefore, it’s not surprising that the stresses and strains of everyday life can have an impact on our continence.

If you experience these types of difficulties, it’s important to remember that you are not alone, and millions of people have problems in this area too. But due to the stigma around continence issues, as well as mental health, they are not widely discussed.

Talking

Again, there are many things that can be done that may really help. For example, being honest about the impact that your bladder difficulties and/or mental health is having on you, is helpful, as is being open about your difficulties and potentially seeking help. Don’t be afraid to talk to trusted friends or health care professionals about your emotions regarding this area. In our experience talking to numerous continence nurses and doctors over the years, many highlight individuals being in floods of tears after finally being able to discuss their difficulties, and rather than being dismissive, health care professionals say how this really helps them to realise the impact that these issues have on people. Therefore, learning to manage your stress and anxiety through whatever means applicable, be that mindfulness, talking to a friend, or even going for a walk in the countryside, this can greatly help both your mind and your body. With society and health care professionals now more than ever realising the importance of a healthy mind and body, and greater understanding of how the two sides are inextricably linked, there is growing awareness of the impact that continence difficulties can have on mental health and vice versa. In the future, this should therefore make it easier for people to discuss this subject more openly.

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