Prognosis

Incontinence is rarely life threatening. In most cases, if treated promptly, physical complications are not serious.

Emotional Effects

Urinary incontinence can have severe emotional effects. Depression is very common in women with incontinence. For example, in a 2003 study, 82% of women with severe incontinence and 41% of those with moderate incontinence reported at least 2 weeks of depression during the preceding year. Incontinence also has emotional effects on men. A number of studies of prostate cancer patients suggest that incontinence is a much more distressing side effect for men than impotence (also a side effect of prostate cancer treatment).

• Loneliness and humiliation. Because little public attention has been paid to this problem, the incontinent person often feels alone and humiliated. Many people with incontinence do not even seek medical advice for the problem. In one survey of doctors, nearly all of them reported that a patient's embarrassment and reluctance to discuss bladder problems is a major barrier to successful treatment.
• Shame. Many people experience a sense of personal failure.
• Helplessness. Patients often feel helpless and angry.
• Introversion. Patients may eventually curtail social activities, or even give them up entirely.
• Lack of confidence. Many people with incontinence believe that they are unemployable.

Disruption of Daily Life

To prevent humiliation due to wetness or odors, people with incontinence may have to alter their way of life.

• Errands become very difficult and need advanced planning.
• Public bathrooms may difficult to locate or unavailable. The problem is particularly severe for those with urge incontinence who have little time to reach a bathroom and have large volume spills.

Specific Effects of Incontinence in Seniors

• Older adults who are otherwise healthy may stop exercising because of leakage, which can increase their impairment.
• Incontinence can result in loss of independence and quality of life.
• It is a major reason for nursing home placement.
• Severe incontinence may require catheterization. This is the insertion of a tube that allows urine to continually pass into an external collecting bag. In such cases, complications are common, particularly infections.
• There is a strong association between urge incontinence and falls and injuries. In one large study, over half of women who reported incontinence experienced at least one fall over a 3-year period. This high incidence of falls may be due in part to the rush to the toilet in the middle of the night. Keeping a pan or portable commode near the bed may prevent injuries as well as improve sleep and general convenience.

Review Date: 12/21/2006
Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital.

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