While arthritis doesn’t affect the function of the bladder or bowel directly, functional incontinence associated with the condition is common, with reduced mobility and joint stiffness often where the problems start. However, some of the measures taken to avoid problems can make matters worse.
Limited mobility can result in people with arthritis getting to the toilet too late. Some common compensatory measures taken to avoid accidents can actually exacerbate incontinence. For example, going to the toilet before feeling the urge may work for the short term, but can lead to the bladder losing its capacity over time, resulting in its emptying more often in increasingly smaller amounts.
Another compensatory measure is to reduce fluid intake in the hope of reducing the number of trips to the toilet. While this appears logical, the reverse is true; insufficient fluid causes the urine to become concentrated, which can irritate the bladder, causing to it empty more often. This also results in frequency and urge incontinence.
Stiffness, particularly in the hands and wrists, can make removing underwear and outer clothing difficult. Again, trying to compensate by going to the toilet before feeling the urge, or reducing fluid intake, can all risk frequency and/or urge incontinence.
The bladder empties when the bladder muscle contracts and pushes urine out through the urethra. As people get older, the bladder muscle can become overactive, resulting in more frequent contractions and more trips to the toilet. The two main symptoms of overactive bladder, frequency and urge incontinence, can worsen over time to the point where leakage occurs even before reaching the toilet.
People with arthritis are more prone to constipation, either because they are not as active as they used to be, or because they are limiting their fluid intake to manage their bladder.
Constipation is one of the main causes of urinary incontinence, particularly in older people. This is because an overfull bowel pushes on the bladder and restricts its capacity to hold urine, which can lead to frequency and urge incontinence. In addition, straining on the toilet because of constipation can stretch and weaken the pelvic floor muscles, which can lead to stress incontinence.
4.8 million (one in four) Australian adults have some form of incontinence. It has far-reaching impacts on quality of life and is associated with depression, particularly in women.
Incontinence is not normal, and should never be ignored. Fortunately, in the majority of cases, there is much that can be done to prevent or better manage incontinence.
The Continence Foundation of Australia recommends people with arthritis adopt a few simple steps, such as wearing clothes that are easily removed, and speaking to an occupational therapist about useful toilet aids.
The Foundation also recommends these five steps for good bladder and bowel control for everyone:
1. Eat a balanced diet that includes at least 30 g of fibre daily.
2. Consume about 1.5 -2 litres of fluid daily, limiting caffeine and fizzy drinks.
3. Exercise regularly.
3. Keep your pelvic floor toned.
4. Practise good toilet habits.
For more information, visit this website.
If you have, or are concerned about continence issues, speak to one of the continence nurse advisors on the free, confidential National Continence Helpline (1800 33 00 66), who can provide advice and information about arthritis-specific incontinence, and can put you in contact with your nearest continence service.