What is continence and how is it learned?
The word ‘continence’ comes from the Latin word continentia which means ‘a holding back’. Continence refers to self-control, it is the ability to hold back bodily functions from the bladder or the bowel.
‘Continence’ is the ability to voluntarily control emptying the bladder and bowels effectively in a socially acceptable place and hygienic way.[1]
How bladder and bowel control develops
When we look at the development of bladder and bowel control we realise that none of us are born continent. It is a skill we acquire. Of course if we acquire the skills to be continent, we can also lose them.
However, regaining continence skills when they have been lost is achievable for most people, provided they have the right support.
The age at which we develop continence varies according to our individual physical and social development, the natural maturation of our nervous system and our cultural back ground.
Basic continence skills
To understand continence it is helpful to consider the basic skills required. These are listed below in tabular format with some questions about what might affect a person’s skills:
| Basic skills | What might affect a person’s skills? |
|---|---|
| Skill 1: The ability to recognise the need for a bladder or bowel movement | How do you know you need to void or defeacate? Which individuals may find it difficult to recognise the need? |
| Skill 2: Identify the correct place to empty bladder/bowel | Who would find it difficult to identify the correct place? |
| Skill 3: Be able to reach the appropriate place | What could make it difficult/impossible for the individual to reach the toilet? |
| Skill 4: Be able to hold on until the appropriate place is reached and delay micturition/defecation until reached | What problems may prevent an individual from ‘holding on’ until they reach the toilet? |
| Skill 5: The ability to initiate a void/bowel movement when the right place is reached | What may prevent an individual from using the toilet? |
Problems with any of the above steps could put the person at risk of incontinence. With each individual, you need to look at what challenges there are and what actions are needed to overcome their particular challenges. These will be different for each person.
For many people, especially older people, there is a fine balance between continence and incontinence, and it does not take much to tip the balance.
References
1. NHS England. Excellence in continence care: Practical guidance for commissioners, providers, health and social care staff and information for the public. 2016.
2. International Continence Society Terminology. [Cited 23 July 2018] Available from: https://www.ics.org/terminology/19
Understanding Continence Promotion: Effective Management of Bladder and Bowel Dysfunction in Adults
Understanding Continence Promotion: Effective Management of Bladder and Bowel Dysfunction in Adults
