Continence for Young Adults

Overview

Incontinence is a common health condition and affects around 5 million people over the age of 15 in Australia³. Incontinence is also a common childhood condition. While many hold the belief that incontinence will improve with age, in some cases incontinence can persist into adolescence and young adulthood.

This can have significant psychological impacts, leading to academic under-achievement, poorer self-image, and challenges in peer relationships⁵.

Facts about Incontinence in Adolescents

• Reported incontinence prevalence rates in adolescents and young adults vary from 3% to 4% for urinary incontinence, and around 1% for faecal incontinence ⁵
• The risk of incontinence will increase with developmental, neurological, and anatomical anomalies, which may be present at birth or acquired in childhood ¹
• Behavioural factors can also impact on bladder and bowel function, such as diet, fluid type and intake, withholding, or poor toileting behaviours

Urinary Incontinence

Wetting the bed, called nocturnal enuresis, is quite common in childhood. If children who wet the bed are left without treatment, nocturnal enuresis can carry on into adolescence and early adulthood. Nocturnal enuresis can occur due to several different causes, including:

• Deep sleep—not waking with the urge to urinate. This could be due to a sleep disorder, or attributed to the sedating effects from medication, alcohol, or illicit drugs.
• Large volumes of urine—for some people, their kidneys work overtime at night and produce more urine than the bladder can hold, resulting in accidents.
• Small bladder capacity—a person might have a bladder that cannot expand to hold much urine, or experience symptoms of overactive bladder, whereby the bladder contracts frequently and without warning. Being constipated, consuming too much caffeine, or having a urinary tract infection can also cause symptoms of overactive bladder.

What is Nocturnal Enuresis?

Nocturnal enuresis can occur with or without the presence of daytime bladder problems. Concurrent daytime bladder problems could include urinary frequency, urgency, hesitancy, and loss of urine. Urinary incontinence in adolescents and young adults can be more complex than in children², and help should be sought from an experienced healthcare professional if day or night-time incontinence is experienced.

Treatment

Unfortunately, stigma and shame still surround the topic of incontinence, and the Continence Foundation of Australia predicts that 70% of people with incontinence will not seek help (2024). However, incontinence can certainly be improved and in some cases cured with the right interventions and treatment.

How can you address both urinary and faecal incontinence?

• This could include improving your diet and avoiding or minimising certain foods or fluid.
• Improving hydration and incorporating healthy bladder and bowel habits.
• Pelvic floor muscle exercises done regularly will also help improve control, while exercise that strains the pelvic floor should be avoided.
• For nocturnal enuresis, a temporary alarm system might be recommended to help teach your body to wake with the urge to void, which can often resolve night wetting altogether.

If these conservative measures fail to improve your continence, medications may be recommended for treatment of some bladder and bowel complaints.

What to consider when a conservative measure to improve continence and overactive bladder fails:

• For bowel issues, medications may be recommended to treat either constipation or diarrhoea or target the underlying gastrointestinal issue contributing to incontinence.
• Medications may be prescribed for an overactive bladder to help the bladder relax and hold more urine. In some cases, Botox injections into the bladder can further help the bladder relax and resolve symptoms.
• Nocturnal urine production can be reduced with prescribed medication if this is causing night wetting.
• Medication might be required in the short term or the long term and some of these medications can have side effects, so it is important to ask your prescribing healthcare professional about duration and possible side effects.
• In severe cases, surgery may be suggested to restore continence. Surgery is usually recommended after all other options have been explored.

If continence cannot be restored or an individual chooses not to undergo invasive procedures, there are multiple management strategies available.

What are some continence management strategies?

• Absorbent continence aids come in both disposable and washable options, in the form of pads, pants, furniture protectors, and bed clothes.
• Portable urinals, easy access clothing, and environmental modifications can all make living with incontinence much easier, while maintaining dignity and social engagement.
• Funding for continence supplies is also available through insurance schemes or government subsidies to relieve the financial burden of living with incontinence.

Good Bladder and Bowel Habits for Everyone

• Minimise carbonated, caffeinated, and alcoholic drinks, as these can be bladder irritants.
• Maintain adequate hydration. Do not restrict drinking in an attempt to minimise leakage.
• Eat a healthy balanced diet with plenty of fruits, vegetables and whole grains.
• Position yourself comfortably on the toilet, lean forward with feet apart and knees bent.
• Ensure you fully empty your bladder or bowel when going to the toilet and do not rush.
• Try not to use the toilet ‘just in case’ and avoid straining when opening your bowels.
• Regular pelvic floor muscle exercises can help strengthen the muscles responsible for bladder and bowel control.

If you experienced frequent episodes of urinary of faecal incontinence, speak to a healthcare provider or call the Continence Foundation of Australia Helpline on 1800 33 00 66. Remember that early diagnosis and treatment are essential to prevent the condition from worsening and to maintain quality of life.

References

1. Bain, M., Couchman, M., Spivak, A., Zivkovic, D., Vukovi, D. (2024). Continence management in adolescence. Continence, 11. Available from:

https://doi.org/10.1016/j.cont.2024.101683

2. Continence Foundation of Australia. (2023). Bedwetting in Teenagers and Young Adults [online]. Available from:

https://continence.my.salesforce.com/sfc/p/#A0000000KUc9/a/5K0000008IXx/scmufjVQHOxw.GCObDvzSWzG7GV2e2UjoNC4nEoO4ns [accessed 24 September 2024].

3. Continence Foundation of Australia. (2024). Key Statistics on Incontinence. Available from:

https://www.continence.org.au/about-us/our-work/key-statistics-incontinence [accessed 24 September 2024].

4. D’Ancona, C.D., Haylen, B.T., Oelke, M., Herschorn, S., Abranches-Monteiro, L., Arnold, E.P., Goldman, H.B., Hamid, R., Homma, Y., Marcelissen, T., Rademakers, K., Schizas, A., Singla, A., Soto, I., Tse, V. and de Wachter, S. (2019). An International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction. Neurourology Urodynamics, 38, pp.433–477. Available from: DOI: 10.1002/nau.23897

5. Whale, K., Cramer, H. and Joinson, C. (2017). Left behind and left out: The impact of the school environment on young people with continence problems. British Journal of Health Psychology, 23(2), pp.253-277. Available from:

https://doi.org/10.1111/bjhp.12284

Jane Clarke

Continence Nurse Consultant

Jane is a Continence Nurse Consultant with over 25 years of experience. She has worked in public health, private enterprise, and industry spheres, and has achieved a Masters in both Nursing and Business Administration. Jane is passionate about health equity and education. In her spare time Jane loves spending time in nature and exploring new places with her family.