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Elderly Incontinence: What You Need to Know, Treatment Option, and Tips for Care

Merritt Whitley
By Merritt WhitleyMarch 31, 2021

For many people, a trip to the bathroom is something that can easily be delayed. But for 33 million Americans who experience bladder leakage daily, it’s not that simple.

Urinary incontinence isn’t something your loved one should simply accept or live with, according to the NAFC. In fact, there are many effective ways to treat elderly incontinence regardless of its cause. Learn more about the causes, types, treatment options, and more.

Is urinary incontinence a normal part of aging?

What exactly is urinary incontinence? It’s the involuntary loss of urine, according to the National Association for Continence (NAFC). Although incontinence can happen at any age, it’s generally more common in seniors.

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As you age, changes in the body can make elderly urinary incontinence more likely. One out of two women older than 65 experience bladder leakage sometimes, according to the Urology Care Foundation. It can be caused by typical aging, lifestyle choices, or a range of health conditions.

Elderly urinary incontinence can take on a few forms:

  • Some people may only leak urine occasionally
  • Others may constantly dribble urine
  • Some experience a complete lack of both bladder and bowel control

What causes urinary incontinence in the elderly?

From not drinking enough water to childbirth to a health condition such as diabetes, there are many different reasons behind urinary incontinence.

The following health issues can cause urinary incontinence in both women and men:

  • Multiple sclerosis
  • Alzheimer’s disease
  • Stroke
  • Parkinson’s disease
  • Constipation
  • Obesity

Common urinary incontinence causes in women include:

  • Prior pregnancies
  • Childbirth
  • Onset of menopause
  • Pelvic floor atrophy

For men, prostate problems are a common cause of urinary incontinence.

What are the main types of incontinence?

There are six common types of urinary incontinence:

  • Urge incontinence is the most common diagnosis, often referred to as an overactive bladder. It involves an urgent need to urinate resulting in the loss of urine before arriving at the toilet.
  • Total incontinence indicates your sphincter muscle is no longer workingIt results in constant and uncontrollable bladder leakage.
  • Stress incontinence occurs when an increase in abdominal pressure overcomes the closing pressure of the bladder. You may feel abdominal pain when you cough, sneeze, laugh, climb stairs, or lift objects. Stress incontinence is more common in women due to pregnancy and childbirth. However, it can affect men who’ve had prostate cancer or surgery.
  • Overflow incontinence occurs when your bladder never completely empties. Sufferers frequently feel the need to go and often leak small amounts of urine. This condition is often caused by an obstruction in the urinary tract system, or by a bladder that either has very weak contractions or isn’t able to contract at all.
  • Functional incontinence is incontinence caused by other disabilities. Neurological disorders, stroke complications, or arthritis can prevent someone from unzipping their pants quickly enough, resulting in an accident. People with functional incontinence feel the urge to urinate but aren’t physically able to plan or carry out a trip to the bathroom.
  • Mixed incontinence is a combination of more than one type of incontinence. People with mixed incontinence — especially women — usually have a combination of stress and urge incontinence. But people with severe dementia, Parkinson’s disease, or neurological disorders — as well as people who have had strokes — can have urge and functional incontinence.

How to deal with elderly incontinence

Your loved one may feel embarrassed by their accidents and avoid scheduling a doctor’s appointment. They may be using absorbent pads or protective underwear to help, but urinary incontinence is very treatable with medical assistance.

They may also hold off because they’re unsure what kind of doctor to see.  A primary care doctor, geriatrician, nurse practitioner, or urinary specialist are viable options. If your loved one feels comfortable with their primary care doctor, it’s generally good to start there.

Women can also find a urogynecologist, while men can visit a urologist.

What to expect at a doctor’s appointment for urinary incontinence

At your medical appointment, you’ll likely have:

  • A urinalysis to rule out infection or blood in the urine
  • Blood tests to check on kidney function, calcium, and glucose levels
  • A thorough discussion of your medical history
  • A complete physical exam, including a rectal and pelvic exam for women, or a urological exam for men

A patient may also be asked to bring a bladder diary to the first visit, or to create one before the second appointment.

In this journal, they will likely record:

  • Types of drinks they consume
  • Times they urinate throughout the day
  • How much they urinate, which is measured by placing a special measuring cup over the toilet to record volume
  • A description and frequency of their accidents

How do procedures pinpoint a diagnosis?

If the previous tests and exams don’t point to a diagnosis, the patient could undergo one of these procedures:

Bladder ultrasound and post-void residual (PVR)

After urination, an ultrasound wand is placed on the abdomen, creating a bladder scan to show if any urine remains in the bladder. This procedure usually takes around five to 10 minutes, and a catheter may also be placed into the bladder to drain and measure any urine left.

Cystography

A catheter is inserted, through which dye is injected into the bladder. An X-ray is then taken while the patient urinates, highlighting the urinary tract system. X-rays of the kidney, ureter, and bladder will be taken so the urinary system is completely visible.

Urodynamic testing

A catheter fills the bladder with water to measure the pressure in the bladder when it’s at rest, when it’s filling, and when it empties. This test looks at the anatomy of the urinary tract, the bladder’s functioning ability, and capacity of the bladder, as well as what sensation the patient feels.

Cystoscopy

The doctor views the patient’s bladder through a bladder scope, which acts like a telescope. It is used to check for capacity, tumors, stones, or cancer.

Behavioral therapy: The first treatment for urinary incontinence in the elderly

After a diagnosis is made, behavioral therapy is often the first urinary incontinence treatment for the elderly. This may involve:

Learning to delay urination

You can do this by gradually lengthening the time between bathroom trips. One can also practice double voiding, which is when a person urinates, waits for a few minutes, and then urinates again. This teaches the person to drain their bladder more thoroughly.

Scheduled bathroom visits

This is often effective for people with mobility issues or neurological disorders, even if this means someone else is in charge of taking you to the restroom.

Pelvic floor muscle exercises

Called Kegels, these exercises strengthen the muscles that help regulate urination. Usually one needs to practice these a few times a day, every day. Learning how to contract the right muscles can be confusing, but your medical provider or this step-by-step guide to performing Kegel exercises can help.

Fluid and diet management

Although diet alone can’t cure urinary incontinence, it can improve bladder control. Certain beverages like carbonated drinks and alcohol can cause your bladder stress. Even drinking coffee or tea while taking prescribed medication can aggravate it. Additional bladder irritants to avoid include milk, tea, honey, soda, and very spicy foods.

Medication for incontinence in the elderly

Medications are frequently used in combination with behavioral therapies. Here are some commonly prescribed options:

Anticholinergic or antispasmodic drugs

These are usually prescribed for urge incontinence. Examples include Vesicare®, Detrol LA®, Ditropan XL®, Oxytrol skin patch®, and Santura®. The most common side effect is dry mouth. Less common side effects include blurred vision, constipation, and mental confusion.

Antibiotics

These are prescribed when incontinence is caused by a urinary tract infection or an inflamed prostate gland.

H4) Tofranil® (imipramine) and Sudafed® (pseudophedrine)
These are used to treat stress urinary incontinence, and they work by tightening muscles around the bladder.

View a full list of drugs used to treat elderly incontinence and other related conditions.

Medical devices: Treatment for urinary incontinence in elderly females

In addition to medicinal treatments, these medical devices may be prescribed for women:

Urethra insert

This is a tampon-like insert that a woman places in her urethra, usually during activities related to her incontinence episodes, such as exercising. While wearing the insert, you’ll be able to urinate and have bowel movements. It’s a good option for senior women who want to remain active. It can be worn safely for up to eight hours, but just like a tampon, it will need to be changed as directed to avoid health and hygiene issues.

Pessary

This is an intravaginal device, similar to a diaphragm, that supports the bladder. It comes in different sizes. After it’s placed, it will need to be taken out, inspected, and cleaned by a health care provider every three months. You can purchase a single-use disposable pessary over the counter, but it’s best to check with your doctor or nurse practitioner to determine which option is best for you.

Surgical options for urinary incontinence

About 285,000 incontinence procedures are performed annually, up 7.5% from 2015. If other treatment methods don’t work, surgery may help.

These are common surgical procedures for urinary incontinence:

Sling procedures

For women, this supports a woman’s urethra by placing abdominal tissue or synthetic materials beneath it. For men, it involves making a cut between the scrotum and anus. Complications can include not being able to empty one’s bladder fully. However, this surgery is generally preferred because it’s well-known and has a history of long-term success.

Colposuspension

For stress incontinence, a cut is made into the lower stomach, and the bladder is lifted and stitched. The surgery can also be performed through one or more small cuts using surgical instruments, which is called a laparoscopic colposuspension. Both procedural types can help prevent long-term incontinence.

Artificial urinary sphincter

This is generally used for men with stress incontinence. A device is placed around the neck of the bladder. This fluid-filled, doughnut-shaped device holds the sphincter closed and is attached to a valve implanted in the testicles or, when used in women, the labia. To urinate, one presses the valve twice and the bladder empties.

Incontinence care tips for families

If your elderly loved one suffers from urinary incontinence, self-care can help avoid complications such as skin rashes, urine odors, and accidents.

Cleaning

For cleaning, use a mild soap such as Dove. Petroleum jelly or cocoa butter can protect the skin. Make sure to pat the skin dry.

Helpful incontinence care products

Having the right products on hand will provide you and your loved one some peace of mind in urgent moments and ease the stress of incontinence care. Common products include:

Absorbent briefs

Waterproof, vinyl briefs

Absorbent booster pads and liners

Disposable washcloth and wipes

Penile clamp

Washable, waterproof bed pads

Absorbent bed pads

Avoid falls

If they frequently run to the restroom, slip-and-fall accidents can happen more easily. Try to make the bathroom as accessible as possible at home. Use pads and protective garments or washable underwear until you find a successful cure.

Ask for help

If elderly incontinence is keeping your loved one isolated and unable to enjoy their favorite pastimes, talk to them about treatment options and encourage them to see a doctor. With the proper and appropriate treatment, your loved one could soon be enjoying life more fully.

Sources:

Merritt Whitley
Author
Merritt Whitley

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