About functional incontinence

Functional incontinence occurs not from bladder problems, but rather from the physical problems of getting to the toilet in time. Functional incontinence is therefore more a condition of circumstance than a problem with the bladder. It occurs when someone has difficulty in reaching the toilet or being able to remove clothing or transfer from a mobility device in a timely manner.

While functional incontinence occurs mainly in people who have mobility impairments, it can also be compounded when the restrooms aren’t disability friendly or accessible.

Fortunately, there are some steps you can take to protect against Functional Incontinence that can mean the difference between having accidents and staying dry.

What causes functional incontinence

There are many possible causes of Functional Incontinence, the most commonly reported problems are that a person:

• has to wait for another person to assist them onto the toilet.
• cannot move quickly enough to get to the bathroom, once they experience the urge to void.
• cannot independently remove their clothing in a timely manner.
• cannot independently transfer from a wheelchair onto a toilet.

Some causes of Functional Incontinence include:

• Blindness or poor eyesight — Sometimes unfamiliar surroundings can provide obstacles that prevent clear access to a restroom.
• Mobility impairment — Wheelchair bound people can often encounter obstacles that make getting to the bathroom difficult. They may also have to contend with restrooms that aren’t disability friendly.
• Musculoskeletal and Neurological conditions — These conditions impact significantly on being able to effectively access toilet in a timely manner. 
• Mental illness — Disorders of the brain that affect a person from recognising the need to go to the toilet and problem solving — Functional incontinence may arise from problems with thinking or communicating. For example, a person with dementia, may not be able to recognise the need to go to the toilet or plan a trip to the toilet. People with severe depression may also lose all desire to take proper care for themselves, including using a restroom.
• Medications — Some medications, like strong sedatives, can cause grogginess, leaving the person unable to recognise the need or get to the restroom until it's too late. Other medications, like fluid tablets (diuretics) used to reduce a person’s blood pressure or fluid build- up in the lungs and feet work by increasing the person’s need to urinate. If you are finding diuretics are the main cause of your Functional Incontinence, talk to your GP, they may be able to split the dose so that their affect is minimised. 
• Temporary illnesses and injury — Even a temporary setback such as severe back pain or a broken leg can result in a person not being able to get to and use a toilet in a timely manner. 

Functional incontinence treatment

Functional incontinence is best treated by first addressing the conditions that have contributed to the problem, to see if there are any modifications that can be made. Look within your environment - ask yourself if you can improve accessibility to the bathroom. The second option is to plan toilet breaks according to your usual bladder and bowel patterns. If you know you or the person you are caring for opens their bowel just after breakfast or urinates 30-minutes after lunch or dinner, you can then plan just beforehand to go to the toilet.

If you suffer from a medical condition that is causing Functional Incontinence, speak to your GP or specialist about possible treatments that may improve or restore your ability, to give you more timely access to the bathroom.

The key of course, is preventing episodes of Functional Incontinence occurring in the first place. Here are a few management techniques and tips to help you reduce the risk and perhaps avoid accidents both at home and when you’re out.

• Bladder training — This involves scheduling the amount of time between trips to the toilet. Initially you start by diarising your usual bladder pattern. You can download a bladder diary here. Once you know your usual bladder timing you can plan a trip to the rest-room 15-minutes prior. For more information on Bladder Training click here and check out the page on treatments for urge incontinence. Alternatively, you can plan a regular toilet visit 20-minutes or so after eating a meal or drinking a big glass of non-caffeinated drink. 
  
  Check out our page on urge incontinence for a simple method of reducing urinary urge as you make your way to the toilet. By regularly practicing your pelvic floor exercises with the aim of slowly decreasing your toilet visits to each three to four-hours.
• Pelvic muscle exercises — Also called Kegel exercises, are designed to strengthen the muscles that support the bladder and urethra to prevent leakage. Kegel exercises focus on isolating and strengthening your pelvic muscles. With practice, these exercises will be helpful in preventing accidents as you try to get to the bathroom.
• Keep Active — Increasing or maintaining your level of activity will be helpful as you will be more able to get to the bathroom before it's too late.
• Scheduled, timed, or prompted voiding — If you make regular, scheduled trips to the bathroom, you may be less likely to have to go in a hurry. Use your bladder diary results to assist you in scheduling these toilet visits. This way you will be more successful.

Also consider these handy tips that could further help prevent Functional Incontinence

• One of the most important things to do at home is to ensure you have good access to your bathroom. Make sure the way to the toilet is clear of clutter and floor rugs. Removing any obstacles can prevent you from falling or tripping on your way to the toilet. You might also want to think about leaving the bathroom door open and lights on at night so that the room is easy to locate and access.
• For those people with dexterity (hand functioning) problems, zips, clasps, belts and buttons can be a huge hindrance. If you need to get to the toilet quickly, make sure your clothing is easy to remove. As an example, try wearing pants with elastic waists.
• If you’re having trouble transferring from a wheelchair to toilet, have difficulties sitting on a low toilet or have problems getting off a toilet you may need to seek advice from an occupational therapist. These professionals know how to make it easier for you to get on and off a toilet without hurting yourself or your carer. They can assist you in selecting the correct type of devices such as, grab bars and raised toilet seats. To find a local occupational therapist, either contact the Occupational Therapy Association of Australia or your local area health service. You do not need to have a GP referral to see an Occupational Therapist, but your doctor may also be able to assist you in finding a local practitioner
• When you’re out, make it a point to know where the restrooms are. That way you won’t have to waste time asking for directions if you need to go. The National Continence Program has a toilet map that you can use to plan your trips. This map is especially helpful if you are traveling to and in unfamiliar places. You can also download a smart phone application from this site. This is a really fabulous map and it is regularly updated by both users and continence related organisations and professionals.

Depend® has a range of incontinence aids for both men and women specifically designed to absorb bladder leakage and give you confidence when out or when you’re with family and friends.