4th October 2019,
Kenley LJ Kuoch, Geoffrey S Hebbard, Helen E O’Connell, David W Austin, Simon R Knowles
Urinary incontinence (UI) is defined by The International Continence Society as “the complaint of any involuntary loss of urine”.1 The prevalence of UI has been suggested to be around 3.0%…
The full contents of this page is only available to subscribers.
To view this content please login or subscribe
Urinary and faecal incontinence substantially impacts upon physical health and is associated with significant psychological distress and reduced quality of life. Due to stigma and embarrassment, many patients do not see their general practitioner (GP) for management of incontinence. This article aims to summarise the forms and causes of incontinence, highlight the psychological mechanisms associated with incontinence, and provide management recommendations for GPs.
Urinary and faecal incontinence substantially impacts upon physical health and is associated with significant psychological distress and reduced quality of life. Due to stigma and embarrassment, many patients do not present for management of their incontinence.
The objective of this article is to summarise the forms and causes of urinary and faecal incontinence, highlight the psychological mechanisms and psychopathology associated with incontinence, and provide management recommendations.
Urinary and faecal incontinence can have a significant impact on an individual’s psychological wellbeing and quality of life. Psychological factors may either contribute to or arise from incontinence and should be addressed as part of the overall management plan.
- International Continence Society. Evaluation and treatment of urinary incontinence, pelvic organ prolapse and faecal incontinence 2009 [cited May 24th 2018]. Available from: http://www.ics.org/publications/ici_4/files-book/recommendation.pdf
- Crome P, Smith AE, Withnall A, Lyons RA. Urinary and faecal incontinence: Prevalence and health status. Reviews in Clinical Gerontology. 2001; 11(2):109–113.
- Norton C, Whitehead W, Bliss D, Metsola P, Tries J. Conservative and pharamcological management of faecal incontinence in adults. The International Continence Society; 2016. [cited 10 May 2018]. Available from: http://www.ics.org/Publications/ICI_4/files-book/comite-16.pdf
- Menees SB, Almario CV, Spiegel BMR, Chey WD. Prevalence of and Factors Associated With Fecal Incontinence: Results From a Population-Based Survey. Gastroenterology. 2018 May; 154(6):1672–1681 e3.
- Sambach H, Equit M, El Khatib D, Schreiner-Zink S, von Gontard A. Therapy-resistant urinary incontinence and enuresis. Monthly pediatrics. 2011; 159(6):565–571.
- Riemsma R, Hagen S, Kirschner-Hermanns R, Norton C, Wijk H, Andersson KE, et al. Can incontinence be cured? A systematic review of cure rates. BMC Med. 2017 Mar 24; 15(1):63.
- Wyndaele M, Hashim H. Pathophysiology of urinary incontinence. Surgery (Oxford). 2017; 35(6):287–292.
- Ueda T, Tamaki M, Kageyama S, Yoshimura N, Yoshida O. Urinary incontinence among community-dwelling people aged 40 years or older in Japan: Prevalence, risk factors, knowledge and self-perception. International Journal of Urology. 2000; 7:95–103.
- Ge J, Yang P, Zhang Y, Li X, Wang Q, Lu Y. Prevalence and risk factors of urinary incontinence in Chinese women: a population-based study. Asia Pac J Public Health. 2015 Mar; 27(2):NP1118–31.
- Debus G, Kastner R. Psychosomatic Aspects of Urinary Incontinence in Women. Geburtshilfe Frauenheilkd. 2015 Feb; 75(2):165–169.
- Price H. Incontinence in patients with dementia. British Journal of Nursing. 2011; 20(12):721–725.
- Russell B, Buswell M, Norton C, Malone JR, Harari D, Harwood R, et al. Supporting people living with dementia and faecal incontinence. British Journal of Community Nursing. 2017; 22(3):110–114.
- Milsom I, Altman D, Cartwright R, Lapitan MC, Nelson R, Sillén U, et al. Epidemiology of urinary incontinence (UI) and other lower urinary tract symptoms (LUTS), pelvic organ prolapse (POP) and anal (AI) incontinence. Paris: Ltd HP; 2012.
- Leng WW, McGuire EJ. Obstructive uropathy induced bladder dysfunction can be reversible: Bladder compliance measures before and after treatment. J Urol. 2003; 169(2):563–566.
- Leng WW, Davies BJ, Tarin T, Sweeney DD, Chancellor MB. Delayed treatment of bladder outlet obstruction after sling surgery: Association with irreversible bladder dysfunction. J Urol. 2004; 172 (4 Pt 1):1379–1381.
- Staskin D, Hilton P, Emmanuel A, Goode P, Mills I, Shull B, et al. Inital assessment of incontinence. 2005. Available from: http://www.ics.org/Publications/ICI_3/v1.pdf/chap9.pdf
- Guinane J, Crone R. Management of faecal incontinence in residential aged care. Australian Journal of General Practice. 2018; 47(1–2):40–42.
- Sinclair AJ, Ramsay IN. The psychosocial impact of urinary incontinence in women. The Obstetrician & Gynaecologist. 2011; 13:143–148.
- Paquette IM, Varma MG, Kaiser AM, Steele SR, Rafferty JF. The American Society of Colon and Rectal Surgeons’ clinical practice guideline for the treatment of fecal incontinence. Dis Colon Rectum. 2015; 58(7):623–636.
- Avery JC, Braunack-Mayer AJ, Stocks NP, Taylor AW, Duggan P. Psychological perspectives in urinary incontinence: A metasynthesis. OA Women’s Health. 2013; 1(9).
- Avery JC, Stocks NP, Duggan P, Braunack-Mayer AJ, Taylor AW, Goldney RD, et al. Identifying the quality of life effects of urinary incontinence with depression in an Australian population. BMC Urology. 2013; 13(11):1–9.
- Nygaard I, Turvey C, Burns TL, Crischilles E, Wallace R. Urinary incontinence and depression in middle-aged United States women. Obstet Gynecol. 2003;101:149–156.
- Miner PB. Economic and personal impact of fecal and urinary incontinence. Gastroenterology. 2004; 126:s8–s13.
- Rockwood TH, Church JM, Fleshman J, Kane RL, Mavrantonis C, Thorson AG, et al. Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence The Fecal Incontinence Severity Index. Dis Colon Rectum. 1999; 42(12):1525–1532.
- Jorge JMN, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993; 36(1):77–97.
- Vaizey CJ, Carapeti E, Cahill JA, Kamm MA. Prospective comparison of faecal incontinence grading systems. Gut. 1999; 44:77–80.
- Macmillan AK, Merrie AE, Marshall RJ, Parry BR. Design and validation of a comprehensive fecal incontinence questionnaire. Dis Colon Rectum. 2008 Oct; 51(10):1502–22.
- Sansoni J, Hawthorne G, Fleming G, Marosszeky N. The revised faecal incontinence scale: a clinical validation of a new, short measure for assessment and outcomes evaluation. Dis Colon Rectum. 2013 May; 56(5):652–9.
- Abrams P, Avery K, Gardener N, Donovan J. The International Consultation on Incontinence Modular Questionnaire: www.iciq.net. The Journal of Urology. 2006; 175:106–1066.
- Sandvik H, Seim A, Vanvik A, Hunskaar S. A severity index for epidemiological surveys of female urinary incontinence: Comparison with 48-hour pad-weighting tests. Neurourol Urodyn. 2000; 19:137–145.
- Sansoni J, Marosszeky N, Sansoni E, Hawthorne G. The development of the Revised Urinary Incontinence Scale (RUIS). National Health Outcomes Conference - Australian Health Outcomes Collaboration Wollongong, Australia. The University of Wollongong; 2008Available from: http://ro.uow.edu.au/cgi/viewcontent.cgi?referer=https://www.google.com/&httpsredir=1&article=1066&context=gsbpapers
- Rockwood TH, Church JM, Fleshman J, Kane RL, Mavrantonis C, Thorson AG, et al. Fecal Incontinence Quality of Life Scale Quality of life instrument for patients with fecal incontinence. Dis Colon Rectum. 2000; 43(1):1–16.
- Wagner TH, Patrick DL, Bavendam TG, Martin ML, Buesching DP. Quality of life of persons with urinary incontinence: Development of a new measure. Urology. 1996; 47(1):67–71.
- Pajak R, Kamboj SK. Experimental single-session imagery rescripting of distressing memories in bowel/bladder-control anxiety: a case series. Front Psychiatry. 2014; 5:182.
- Pajak R, Langhoff C, Watson S, Kamboj SK. Phenomenology and thematic content of intrusive imagery in bowel and bladder obsession. Journal of Obsessive-Compulsive and Related Disorders. 2013; 2(3):233–240.
- Wong JY, Fong DY. Anxiety mediates the impact of stress on psychosomatic symptoms in Chinese. Psychol Health Med. 2015; 20(4):457–68.
- Shaheed H. The hypertonic pelvic floor. Australia: Continence Foundation of Australia; 2019 [cited 2019 20/03]. Available from: http://continence.org.au/news.php/577/the-hypertonic-pelvic-floor
- Cosci F. “Bowel obsession syndrome” in a patient with chronic constipation. Gen Hosp Psychiatry. 2013 Jul–Aug; 35(4):451 e1–3.
- Kamboj SK, Langhoff C, Pajak R, Zhu A, Chevalier A, Watson S. Bowel and bladder-control anxiety: a preliminary description of a viscerally-centred phobic syndrome. Behav Cogn Psychother. 2015 Mar; 43(2):142–57.
- Porcelli P, Leandro G. Bowel obsession syndrome in a patient with ulcerative colitis. Psychosomatics. 2007 Sep–Oct; 48(5):448–50.
- Kuoch KLJ, Meyer D, Austin DW, Knowles SR. Development and validation of the bladder and bowel incontinence phobia severity scale (BBIPSS). Journal of Cognitive Psychotherapy. in press.
- Forte ML, Andrade KE, Butler M, Lowry AC, Bliss DZ, Joanne LS, et al. Treatments for fecal incontinence [Internet]. Rockville, US: Agency for Healthcare Research and Quality; 2016.
- Australian Psychological Society. Evidence based psychological interventions in the treatment of mental disorders: A literature review. 3rd ed. Australia; 2010.
The downloadable PDF version of this article is only available to subscribers.
To view this content please login or subscribe