Functional Incontinence

Functional incontinence is when a health condition prevents you from recognizing that you need to pee or getting to the bathroom in time. “Functional” means there’s a factor or barrier that causes you to lose control of your bladder. Examples include:

• A locked door or cluttered hallway
• Muscle pain or joint pain that make it challenging to remove clothing
• Medications or conditions that affect your awareness that you need to pee

About 30 million people in the U.S. have some type of urinary incontinence. Functional incontinence is common in older adults, people with chronic conditions and those living in long-term care facilities.

Other names for functional incontinence include functional urinary incontinence (FUI) and toileting difficulty.

What are the symptoms of functional incontinence?

Symptoms may include:

• Regularly leaking or dribbling pee, which you may not realize
• Fully emptying your bladder without meaning to
• Not being able to hold your pee long enough to get to a bathroom
• Leaking pee when changing position from sitting to standing

You also may smell pee on your clothes or areas around your house where you spend a lot of time. Some examples include your couch or bed.

Causes

There are many possible causes of functional incontinence, including:

• Physical barriers or obstacles
• Brain or memory conditions
• Nervous system conditions
• Musculoskeletal conditions
• Medications

Physical barriers

Physical barriers that can cause functional incontinence include:

• Poor lighting that makes it hard to see
• Stairs
• Closed or locked doors
• Clutter
• Crowds of people

Brain or memory conditions

Brain or memory conditions that can cause functional incontinence include:

• Alzheimer’s disease
• Dementia
• Delirium
• Intellectual disabilities

Nervous system conditions

Nervous system conditions that can cause functional incontinence include:

• Multiple sclerosis (MS)
• Parkinson’s disease
• Stroke

Musculoskeletal conditions

Musculoskeletal conditions that can cause functional incontinence include:

• Arthritis
• Muscle or ligament strains
• Spine hernia
• Spinal fracture
• Fibromyalgia

Medications

Medications that can cause functional incontinence include:

• Medicines that affect your ability to process thoughts, like sleeping pills
• Diuretics, which make you pee more often

Risk factors

Functional incontinence is the most common type of urinary incontinence that affects people who live in nursing homes. Some of the most common long-term conditions among nursing home residents include Alzheimer’s disease and other dementias, which are common causes of functional incontinence.

Complications

Functional incontinence may lead to complications, including:

• An increased risk of skin and urinary tract infections
• Social isolation, meaning you spend less time with loved ones or don’t go out in public much
• Anxiety
• Depression
• Decreased physical activity and mobility

Functional incontinence may also increase your financial burden because you need to spend a lot of money on incontinence pads and underwear.

How doctors diagnose functional incontinence

Your healthcare provider will review your medical history and ask you some questions, including:

• Are you receiving treatment for other conditions?
• What kinds of foods do you eat?
• How often do you eat?
• How much fluid do you drink each day?
• Do you drink alcohol or caffeine?
• Do you eat hot or spicy foods?
• How often do you get physical activity?
• What sort of physical activity do you do?
• Are you able to move around OK?

They may also recommend tests to help them confirm the diagnosis or figure out the cause. These may include:

• Pee tests (urinalyses) to look for signs of an infection
• Pelvic floor dysfunction tests to see how well your pelvic floor muscles work
• Urodynamic testing to see how well your nerves and muscles work, measure how strong your pee stream is and determine if there’s any pressure in or around your bladder

Your provider may also refer you to a specialist, such as a urologist or urogynecologist.

What are the treatments for functional incontinence?

Treatments depend on the cause.

For example, if arthritis makes it difficult or painful to unbutton or unzip clothing, it may help to wear clothes that are easy to take off. Examples include athletic shorts and sweatpants. If a medication causes functional incontinence, your provider can recommend an alternative.

Other treatment options may include:

• Incontinence pads or underwear that can absorb leaks
• Bladder training (timed voiding) to keep your bladder from getting too full
• A Foley catheter to drain pee into a bag outside your body
• A condom catheter that fits over your penis and collects pee into a bag outside your body
• Avoiding certain foods and beverages that can make functional incontinence worse

It’s also a good idea to keep a clear path to the bathroom at home. Make sure doors are open and there’s no clutter on the floor that could slow you down or make you trip. If you have trouble seeing, try carrying a flashlight in your pocket or installing extra lights. If you’re in public, noting where the bathrooms are before you need to pee can save some time.

When should I see my healthcare provider?

Schedule an appointment with your healthcare provider as soon as you notice symptoms of functional incontinence. They can help determine the cause and suggest ways to avoid leaks.

What can I expect if I have functional incontinence?

Sometimes, it’s a short-term issue that goes away once you treat the cause. For example, your healthcare provider might change your medications.

But long-term conditions are a common cause of functional incontinence. That means you may have bladder control difficulties for a long time — and possibly for the rest of your life. If that’s the case, your healthcare provider will recommend the best ways to manage the symptoms and reduce their impact on your life.