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Information Sheet 23 - Bladder and bowel problems (incontinence)

General information and where to get help.

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Incontinence affects around 4 million Australians and has a strong impact on the lives of people living with it. Support is available, not only for the person experiencing incontinence but also for their family and carers.

Australian Government support is provided through a dedicated helpline, resource development, education and access to support and assistance.

You are not alone

One in five Australians is affected by urinary incontinence and one in 20 by faecal incontinence across all nationalities, ages and genders.

It is more common and severe in women and people in older age groups, occurring in up to 40 per cent of people over 75 years of age. However, getting older on its own does not cause bladder and bowel problems.

Incontinence is not normal at any age.

Urinary incontinence

Urinary incontinence is the involuntary loss of urine from the bladder. It is not part of the normal function of the bladder and is always a symptom or sign of an underlying problem.

Urinary incontinence happens in different forms and has many possible causes. These include:

Stress incontinence

Stress incontinence is where there is leakage of small amounts of urine when you cough, sneeze, laugh, strain, lift or play sport. It occurs mostly in women, especially those who have had vaginal childbirth or have experienced the hormonal changes of menopause. Men may also experience stress incontinence after prostate surgery.

Urge incontinence

Urge incontinence is where you have loss of urine following a sudden strong urge to urinate. Causes can include stroke, an enlarged prostate gland, Parkinson's Disease, constipation or a long history of poor bladder habits. In some cases the cause is unknown.

Overflow incontinence

This is where urine loss may occur at inappropriate times due to the bladder emptying poorly, such as an enlarged prostate gland in men restricting the flow of urine, or a weak bladder muscle.

Functional incontinence

This occurs when a person's ability to reach or use the toilet is restricted due to a physical, mental or environmental problem such as reduced mobility, poor dexterity or coordination, loss of memory or poor building design.

Reflex incontinence

Is where there is loss of urine control resulting from damage to the nerves which control bladder function. This is most commonly found in people with spinal injuries.

Faecal incontinence

Faecal incontinence happens when a person has difficulty controlling their bowels. As a result they pass bowel motions or faeces and possibly wind, at the wrong time or in the wrong place. People with faecal incontinence may have urinary incontinence as well.

There are several possible causes of faecal incontinence:

Muscle weakness

Where the anal muscles and sphincter may be weak due to the effects of childbirth, some types of surgery (for example, for haemorrhoids/piles), or injury.

Severe diarrhoea

This may happen intermittently or all the time depending on whether it is caused by an infection such as gastroenteritis, side-effects of some medication such as antibiotics, irritable bowel syndrome, diverticulitis, an uncommon disease such as Crohn's disease, or where a person has had radiotherapy to the area.

Constipation and impaction

This is possibly the most common cause of faecal incontinence among older people and those with disabilities, and usually happens when there are hard bowel actions passed infrequently, interspersed with episodes of unpredictable faecal incontinence.

There are a number of factors that can contribute to constipation, such as a diet low in fibre, not enough fluids, reduced mobility, some medicines (eg painkillers) and various medical conditions.

Disorders of the nervous system

Faecal incontinence can sometimes be the result of disease or injury to the nerves. This may result in a lack of sensation so that the need to empty the bowel is not registered, or loss of nerve input to keep the sphincter muscles contracted and so keep the anus closed.

Disorders of the lower bowel

Cancer, and fistula and haemorrhoids may cause faecal incontinence.

As there are many possible causes and contributing factors to faecal incontinence it is important to visit a doctor to find out why it is happening.

The National Continence Program

The National Continence Program (the Program) commenced on 1 January 2011, in line with the Australian Government’s commitment to supporting the prevention and management of incontinence. The Program builds on the previous National Continence Management Strategy (the Strategy) which ran for 12 years from 1998.

The Program aims to improve awareness, prevention and management of incontinence to enable more Australians and their carers to live and participate in the community with confidence and dignity. This is achieved through a range of key priority action areas identified in the Program’s Strategic Framework and include:

• providing access to information and support to all target groups through multiple communica­tion channels;
• conducting communication activities to raise public awareness of risk factors and bladder and bowel health and the importance of healthy lifestyle behaviours; and
• providing information and support to Continence Aids Payment Scheme clients.

Continence Aids Payment Scheme

The Continence Aids Assistance Scheme (CAAS) ceased on 30 June 2010 and was replaced by the Continence Aids Payment Scheme (CAPS) from 1 July 2010.

The CAPS is an Australian Government scheme that assists eligible people who have permanent and severe incontinence, to meet some of the costs of their incontinence products.

The CAPS is a direct payment, made through the Medicare Program into an eligible person’s nominated bank account and provides flexibility and choice about where and when a person can purchase their incontinence products. A person can also choose to nominate a continence product supplier to receive the CAPS payment on their behalf.

In 2012-13 the CAPS payment amount is up to $521.00 (indexed annually). For new applicants the initial payment is based on a daily pro-rata amount depending on when your CAPS application is received by Medicare.

To be eligible for CAPS, applicants must be an Australian Citizen or permanent resident, 5 years of age or older and meet either one of the following requirements:

• The applicant has permanent and severe loss of bladder and/or bowel function (inconti­nence) due directly to an eligible neurological condition; OR
• The applicant has permanent and severe loss of bladder and/or bowel function (incontinence) caused by an eligible other condition, provided the applicant has a Centrelink Pensioner Concession Card entitlement, whether as a primary cardholder or a dependant of a cardholder;

OR

• The applicant has permanent and severe loss of bladder and/or bowel function (incontinence) caused by an eligible other condition and has a Department of Veterans Affairs Pensioner Concession Card or entitlement, whether as a primary cardholder or a dependent of a cardholder.

CAPS Application Forms and Further Information

The CAPS application form includes a health report component which must be completed by an appropriate health professional such as a continence nurse advisor, medical specialist or a general practitioner.

CAPS Application Forms are available by calling the National Continence Helpline on 1800 330 066*. You can also download a CAPS Application Form from the Department’s Bladder Bowel Website at www.bladderbowel.gov.au

Further information about the CAPS and a person’s eligibility for the Scheme is also available on the Department’s Bladder Bowel Website at www.bladderbowel.gov.au

For enquiries regarding the status of a CAPS Application or payment, call Medicare on 132 011* and select general enquiries.

Who can help?

• Your doctor;
• National Continence Helpline 1800 330 066* (the helpline can arrange telephone interpreters);
• Your community or health worker, continence nurse advisor, or physiotherapist;
• Special continence advisors at:
  • hospitals
  • community health centres
  • continence clinics.

Where to get additional information

The National Continence Helpline on 1800 330 066*

The National Continence Helpline is staffed by professional continence nurse advisors who offer free, confidential advice about bladder and bowel health. Helpline staff can refer people onto local continence services and provide information about continence products and Government continence subsidy schemes.

The Helpline can provide printed material on incontinence and related subjects including fact sheets available in 20 different community languages.

The Helpline operates 12 hours a day (8.00 am to 8.00 pm AEST), Monday to Friday. It is closed on national public holidays.

Bladder and Bowel Health Website

Bladder and Bowel Health Website at www.bladderbowel.gov.au

The Australian Government's Bladder and Bowel website promotes bladder and bowel health and provides information for people affected by incontinence, their families and carers, as well as to health professionals, service providers and researchers on the prevention, management and treatment of bladder and bowel problems. The website also provides continence information resources and information on continence assistance provided by the Australian Government.

The National Public Toilet Map

The National Public Toilet Map website at www.toiletmap.gov.au

To help people with incontinence maintain their freedom, independence and confidence the Australian Government developed an online map that identifies the location of over 16,000 toilet facilities across Australia. Information provided includes directions, opening hours, baby change facilities, disability access and parking.

The map also provides trip planning functions and downloading of GPS coordinates.

The website can also be accessed via a mobile or iPhone application providing a simple and quick way of finding a toilet while travelling.

The website can be searched for toilet locations by town, suburb, major parks, roads and travel routes. Specific maps can also be obtained from the National Continence Helpline on 1800 330 066*.

*Cost of phone calls

• Calls to 1800 numbers are generally free to the caller when made from a land line.
• Calls to 13 or 1300 numbers are charged at a low fixed amount to the caller when made from a land line.
• All calls made from mobile phones are charged at the rates applicable to each phone provider.
• All calls made from public phones are charged at the rates applicable to each phone provider.

All information in this publication is correct as at September 2012.

Disclaimer: This document is only a guide to the Government’s law and policies, and cannot take account of individual circumstances. The Australian Government Department of Health and Ageing recommends that you seek appropriate professional advice relevant to your particular situation.

D0943 September 2012
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