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Arthritis and bladder and bowel control

People with arthritis frequently experience issues with bladder and bowel control. Arthritis does not directly affect the bladder or bowel for most people. It is the loss of mobility and joint stiffness that prevents a person from being able to move quickly enough to get to the toilet on time and manage their clothing.

It is important that you seek help if you are not making it to the toilet on time, or having to go more frequently and urgently than usual. The good news is that it can be better managed.

Normal bladder and bowel control

Knowing how the bladder and bowel normally work will help you understand the problems you may be experiencing.

The bladder and bowel store and expel body waste. The bladder stores and passes urine regularly throughout the day. On average we should pass urine 4-6 times during the day and up to twice overnight. This will vary depending upon how much you drink, what you drink and how much you exercise and perspire. Your bladder should easily hold 350–500 mls. When it’s around half full you will start to become aware of your bladder filling. You should not go to the toilet with this feeling but put it off until the urge is stronger but not urgent.

The lower bowel stores and expels faeces (poo). The normal range for bowel movements is anywhere from three times per day to three times per week. The faeces you pass should be soft formed and easily passed with no straining.

The pelvic floor muscles play an essential role in giving us control over the bladder and bowel. When we hold on to go to the toilet we are relying on the pelvic floor muscles.

Control of the bladder and bowel is coordinated by the brain and nervous system, but getting to the toilet also requires mobility and dexterity.

So when you go to the toilet you should feel in control and not have to rush or leak before you get there.

Check symptoms of poor bladder and bowel control:

  • Leakage of urine with coughs, sneezes, or exercise
  • Leakage of urine on the way to the toilet
  • Passing urine frequently
  • Getting up twice or more overnight to pass urine
  • Frequent urinary tract infections
  • Feeling the bladder is not completely empty
  • Poor urine flow
  • Straining to get the bladder to empty
  • Rushing to the toilet – urgency to pass urine or open bowels
  • Unable to control wind
  • Constipation
  • Wetting the bed when asleep
  • Leakage from the bowel with the urge to open the bowels
  • Leakage from the bowel without the urge to open the bowels
  • Leakage from the bowel when passing wind

There are four main ways that arthritis may cause problems with bladder and bowel control:

1. Loss of mobility

This is often where problems start. On the occasions when you don’t make it to the toilet and you have an accident with your bladder, the seemingly logical thing to do is to go to the toilet before you need to go. This may work for a while but usually, you will find you are going to the toilet with increasing frequency, to beat the urge. People often limit the amount they drink - it seems logical that the less you drink the less you will need to go to the toilet. However, this strategy usually makes the problem worse because your urine becomes concentrated, causing bladder irritability. This leads to frequency and urgency.

2. Joint stiffness

Stiffness, particularly in your hands and wrists, can make removing clothing to use the toilet very difficult. Some people find they can get to the toilet on time but don’t have enough time to pull their underwear down. Again, people often start going to the toilet more frequently to give themselves more time to manage their clothes, and/or limit their fluid intake so they don’t need to visit the toilet so often. Instead, this leads to toilet frequency and/or urgency.

3. Overactive bladder (OAB)

This becomes more of a problem as we age. The muscle of the bladder is over-active giving us the urge to pass urine more often. The symptoms of OAB are frequency and urgency which can worsen over time to the point that you experience leakage before reaching the toilet.

4. Constipation

People with arthritis frequently develop constipation either because they are not as active as they use to be or they are wrongly limiting their fluid intake to manage bladder control problems. Constipation makes any bladder control problem worse and should be treated.

Preventing and managing poor bladder and bowel control

There are five things you can do to regain control of your bladder or bowel:

1. Eat well

Eat a healthy diet rich in dietary fibre to prevent constipation. We need at least 30gm of fibre each day. Eat at least 2-3 serves of fruit, 5 serves of vegetables and 5 serves of cereals and bread. It is important to get the balance right as just adding fibre to your diet without increasing your fluids can cause or make constipation worse. Please note that if the steps outlined in this section do not work in treating your constipation, ask your doctor about using laxatives.

2. Drink well

Drink around 1.5–2 litres of fluid each day to prevent bladder irritation and constipation, unless otherwise advised by your doctor. Drinking extra fluids is recommended in hot weather or when exercising. Spread your drinks evenly throughout the day, but tapering off toward bedtime. Water is best. Limit caffeine, alcohol and fizzy drinks as they can cause bladder irritation. Always have an extra drink of water following these drinks.

3. Exercise regularly

Keep moving! Aim to exercise for 30 minutes most days. Remember that walking is great exercise.

4. Tone up your pelvic floor muscles

Keep your pelvic floor muscles strong with a pelvic floor exercise programme. These are the muscles that give you control over your bladder and bowel. Use your pelvic floor muscles by squeezing to control the urgency to go to the toilet. When you feel the urge to pass urine or open your bowels, stop, stand still or sit down on a firm seat. Squeeze your pelvic floor muscles strongly. Think about something else rather than the urge. The urge should diminish or go away at this point so you can reach the toilet without rushing.

5. Practice good toilet habits

  • Go to the toilet when your bladder feels full or when you get the urge to open your bowels. Do not get into the habit of going ‘just in case’. Relax and take time to completely empty your bladder and bowel.
  • Get into the correct sitting position on the toilet: Sit on the toilet, elbows on knees, lean forward, your feet should be supported on a small footstool; this raises your knees to a good position.
  • Wear clothes that are easily removed.
  • There are a number of useful toilet aids available so talk to your doctor or occupational therapist about those that best suit your needs.

Who to contact for information, advice and support

Poor bladder and bowel control is a common problem for people with arthritis and it can impact negatively on the quality of life. It should not be ignored or dismissed as a ‘small’ problem. Seek help if you have poor control of your bladder or bowel. Incontinence problems can be treated, better managed or cured and should not interfere with your enjoyment of life.

For all enquiries: Continence Helpline: Call 0800 650 659 : Email: info@continence.org.nz.

This document has been developed by and remains the property of, the Continence Foundation of Australia

© Continence Foundation of Australia 2015