For many people, a trip to the bathroom is something they can easily delay. But for roughly 13 million Americans who suffer from urinary incontinence, holding it in isn’t an option.
Although incontinence can happen at any age, it’s more common in older adults. According to the National Association for Continence, one in five individuals over the age of 40 suffer from overactive bladder or urgency or frequency symptoms, some of whom leak urine before reaching a restroom. In the nursing home population, at least 50 percent of residents have elderly urinary incontinence.
“Incontinence is a common part of aging but it is never normal,” says Dr. Lisa Rosenberg, M.D., of the University of Pittsburgh’s geriatric department. “Because it is so common, people think that they should accept it. In almost all cases, it is something a well-trained physician or nurse practitioner can help with. We can actually cure most of those people.”
The diversity of causes behind incontinence are vast and varied, from something as simple (and counterintuitive) as not drinking enough water to more serious conditions like an inflamed bladder wall. Several diseases can bring about incontinence, such as multiple sclerosis and Alzheimer’s disease. In women, prior pregnancies, childbirth, and the onset of menopause can lead to incontinence. In men, prostate problems can hamper urination. Even drinking coffee or tea or taking prescribed medications can aggravate your bladder. As one ages, changes in the body can make elderly urinary incontinence a more likely occurrence.
Elderly urinary incontinence can take several forms. Some people may only leak urine occasionally, others may constantly dribble urine, while still others experience a complete lack of both bladder and bowel control. Here are the main types of incontinence:
Your loved one may feel embarrassed by his or her accidents and avoid scheduling a doctor’s appointment. Or perhaps one is unsure of whom to see: a primary care physician, a nurse practitioner, or a urology specialist. Maybe your loved one is using absorbent pads or protective underwear. But the best reason to see a doctor is this: elderly urinary incontinence is a very treatable condition.
If your loved one feels comfortable with his or her primary care doctor, start there. Women can also find a urogynecologist while men could visit a urologist; either can see a geriatrician. Often, you can locate nurse practitioners who specialize in incontinence issues.
Whomever one sees, Rosenberg says, you should expect the following from a visit:
Often, a patient will be asked to bring a bladder diary to the first visit, or create this before her second appointment. In this journal, she records what she drinks, when she urinates, how much she urinates (placing a special “measuring cup” over the toilet bowl to record volume), and describe her accidents. If the medical provider skips any of these important steps, you may want to consider finding someone whoiswilling to evaluate your loved one’s situation properly and completely.
If the previous tests and exam don’t point to a diagnosis, the patient could undergo one or more of the following procedures:
After a diagnosis is made, a treatment for elderly urinary incontinence can include behavioral therapy, medications, medical devices, and surgery. “For the majority of the people in the community, it is 100 percent treatable. Most of the time, it’s a non-surgical treatment,” Smith says.
Usually the first line of treatment is behavioral therapy, which will often cure the incontinence. Treatments can include bladder training, scheduled bathroom trips, pelvic floor muscles exercises, and fluid and diet management. “The nice thing about behavioral therapies is that there are no side effects and the response is proportional to the work of the patient,” Rosenberg says.
Bladder training can involve learning to delay urination by gradually lengthening the time between bathroom trips. Or one can practice double voiding: after urinating, the patient waits a few minutes, and then urinates again. This teaches the patient to drain the bladder more thoroughly.
Scheduled bathroom trips are 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, strengthen the muscles that help regulate urination. Usually one needs to practice these a few times a day, every day, for the rest of one’s life-stopping can mean the return of incontinence. Learning how to contract the right muscles can be confusing, so a provider must check to see if the Kegels are performed correctly by inserting a finger in the anus or vagina to check pressure. Or one can work out with the aid of biofeedback. Transducers, connected to a computer, are placed on the body, and lines on a video monitor show when one is doing the exercises correctly.
Medications are frequently used in combination with behavioral therapies:
In addition to these treatments, medical devices may be prescribed for women, including:
If your loved one suffers from elderly urinary incontinence, self care helps avoid complications such as skin rashes and urine odors. For cleaning, use a mild soap such as Dove. Petroleum jelly or cocoa butter can protect skin. Make sure to pat the skin dry after urinating. If he or she rushes to the restroom, slip-and-fall accidents can ensue, so try to set up the home to make bathroom trips easier. Use pads and protective garments such as plastic or washable underwear until you find a successful cure, or if his or her treatment isn’t 100 percent effective.
Surgery is an option that is usually only discussed after all other treatment options have been tried. Although more than 150 surgical procedures exist, the following are the most common types:
Of course, the most important step is to seek professional medical help. If elderly urinary incontinence is keeping your loved one at home and away from his or her favorite pastimes, please realize that this is a highly treatable condition. With the proper and appropriate treatment, your loved one will soon be enjoying that stroll in the park or a night out at the movies again.
Update: January 2018