Can’t hold back?
Is nature calling to you? Do you often feel the urge to attend the restroom?
FYI, I am not an elderly. It maybe hard to admit but I experience this from time to time.
As people age, they may face different health problems. Different organ systems decline gradually and progressively. And for a lot of people, bladder problems are very common. In fact, it affects millions of people around the world.
Before we discuss urinary incontinence treatment for the elderly, let us first know the definition of incontinence, the different types and some of the causes.
What is Urinary Incontinence?
Urinary incontinence is a problem that affects people of all age groups but is more common in the elderly. A lot of our residents in the nursing home suffer from this condition.
Urinary incontinence is the involuntary or uncontrollable leakage of urine from the bladder due to loss of control or weakening of the urinary sphincter. A person may urinate even if they don’t want to.
It can be mild, which means leaking only a few drops, or severe, causing the undergarments and even the bed linens to be soaking wet.
The risk of experiencing urinary incontinence is higher in females than in men as they age.
It may first start with involuntary urination when a person coughs or sneezes, but it could also lead to a permanent condition.
This may happen because the muscles around or in the bladder do not work well. Urinary incontinence comes in different types and with different causes.
Most Common Types of Urinary Incontinence
1. Urge Incontinence (Overactive bladder)
This is the most common type of urinary incontinence in the elderly. It is characterized by the sudden and intense desire to urinate which is difficult to control, resulting in involuntary leakage of urine.
It occurs due to the overactivity of the detrusor muscle causing the bladder muscle to contract involuntarily even if the bladder is not full.
Possible causes may include bladder infection/inflammation/stones/cancer, neurological disorders such as Multiple Sclerosis, Parkinson’s disease or stroke, and spinal cord injury.
2. Stress Incontinence
This is the most common type of urinary incontinence for women who have given birth and post menopausal.
It happens when pressure is placed on the bladder during a physical activity such as coughing, sneezing, laughing, lifting something heavy, bending or exercising.
Causes may include damage to the pelvic floor muscles as they are stretched out during childbirth, or a weakened urinary sphincter as a result of the aging process.
3. Overflow Incontinence
This happens when the bladder becomes too full and urine starts to leak out. It is also sometimes referred to as dribbling.
This is due to a blockage in the urethral opening such as tumors/cancer, prolapse, stones or enlargement of the prostate causing the bladder not to empty completely.
It can also be due to the inability of the bladder to contract caused by some conditions affecting the nerves such as multiple sclerosis, diabetes, brain injuries, or as a side effect of certain medications with anticholinergic properties such as muscle relaxants and certain tricyclic antidepressants.
4. Functional Incontinence
This is when involuntary urination occurs as a result of a mobility or cognitive impairment; the older adult knows when he/she wants to urinate but they may not make it to the toilet on time. Maybe they are very slow in walking or they could not walk at all so they have to wait for someone to take them. Maybe they have dementia and are confused or have forgotten where the toilet is or how to use the toilet.
5. Mixed Incontinence
This is a combination of two or more types of incontinence, usually stress and urge incontinence. Symptoms will be a combination of both types.
Urinary Incontinence Treatment for Elderly
The treatment of urinary incontinence in elderly people depends on the severity of the problem, the type of urinary incontinence, and their lifestyle.
As a general rule, doctors will first suggest the simplest measures. Here are the most common treatments that are adopted for urinary incontinence in the elderly.
Certain drinks, foods, habits, and activities may cause or worsen incontinence in the elderly as they can irritate the bladder. Here are some helpful measures that can be implemented to possibly reduce or avoid the incidence of urinary incontinence:
- Quit smoking
- Avoid drinking alcohol, coffee, tea, and carbonated drinks
- Don’t drink too much or too little fluids. Aim for 6-8 glasses per day
- Avoid drinking fluids a few hours before bedtime, but drink enough all throughout the day
- Ensure you consume foods rich in fiber to avoid constipation
- Avoid going to the toilet too late
- Refrain from moving or lifting heavy objects
- Cut down or avoid eating spicy foods, oranges, grapefruit and other citrus fruits and chocolates
- Watch your weight. Eat a healthy, well-balanced diet and exercise regularly
- Wear comfortable clothes such as stretchable trousers or one with an elastic waist band
- Make sure to have easy access to the toilet; use a commode if necessary
This approach is mainly about how to control urination voluntarily to avoid leaking by modifying urination habits. This is useful for people whose cognition is still intact and can follow instructions so they can regain control of their bladder. It is also referred to as bladder training.
- Delayed urination
In this approach, the elderly is said to try to delay urination. The idea is to wait for a certain amount of time once they feel the urge to go. Maybe start with waiting for 10 minutes then gradually increase until they can hold up to 2-4 hours.
- Scheduled toileting/timed voiding
This involves going to the toilet maybe every 2-4 hours even if they don’t feel the need to go in order to establish a routine.
- Double voiding
This is done by urinating, then waiting for a few minutes in the toilet and trying to urinate again in order to completely empty the bladder.
Pelvic floor muscle exercise (Kegel’s exercise)
As urinary incontinence is caused by losing control over the bladder muscles, doing exercises that help to strengthen those muscles is a good choice for the treatment of incontinence in the elderly.
The success of this exercise depends on the elderly’s health condition and their ability to do it.
This is done by tightening or contracting the muscles that you use for urination. It should feel more tight at the back (near the anus) than in the front. Hold it for 5-10 seconds then relax for the same amount of time. This should be done 10x in a row three times a day.
To manage urge incontinence, do this exercise once the urge to urinate begins until it subsides, then walk to the toilet normally and do not be in a rush.
Similar with the behavioral therapies discussed above, incontinence may be controlled if they are done regularly and consistently.
Another treatment method to avoid involuntary urination in the elderly is taking certain medicines. This method is suggested usually when the situation is not improved by the lifestyle changes and behavioral therapies mentioned above.
Doctors may suggest some drugs in pill, liquid, cream or patch form including:
- Anticholinergic drugs – to relax overactive bladder muscles thereby preventing spasms.
Examples: oxybutynin and tolterodine
Side effects: dry mouth and constipation
- Antibiotics – to treat urinary tract infection which irritates the bladder
Examples: trimethoprim, cephalexin
Side effects: nausea, vomiting, diarrhoea, loss of appetite
- Alpha-blockers – to relax the prostate and bladder muscles in order to empty the bladder more efficiently
Examples: tamsulosin and doxazosin
Side effects: dizziness, low blood pressure, fainting
- Tricyclic antidepressants – to relax bladder muscles.
Side effects: irregular heartbeat, postural hypotension, dry mouth, constipation
- Topical estrogen– usually given in a low dosage to revitalize tissues in the vagina and urinary tract to prevent them from becoming weak. It doesn’t have side effects if used correctly.
Using medical devices and products
If urinary incontinence persists despite using the above treatments, there are some medical devices and products that can be used.
- Urethral insert – A disposable tampon-like device that can be inserted into the urethra before doing any physical activities like exercise or lifting something heavy to stop urine leakage. It can be removed before urination.
- Pessary – A soft plastic ring and an intravaginal device which holds the bladder in place to prevent urine from leaking.
- Catheter – A thin tube that is placed into the bladder to drain the urine
- Continence products – These are used not to treat but to manage urinary incontinence to maintain their comfort and dignity. They come in different types such as disposable pads, pull-up pads, reusable bed pads, sheath drainage, chair pads and pants.
If other treatment methods don’t work, or if the elderly is not compliant with medications and keeps removing the medical devices, surgery might be another option. It is recommended for people with blockage or narrowed urethra. Some of the surgeries for the treatment of incontinence in the elderly are:
- midurethral sling surgery – a narrow strip of synthetic tape is placed under the urethra using needles to improve support of the urethra to keep it closed and prevent leakage
- colposuspension – stitches are placed inside the vagina via an abdominal incision and attached to the supportive ligaments on either side of the pubic bone to support the bladder neck and the urethra
- artificial urinary sphincter – insertion of a mechanical device in your body to replace a dysfunctional urinary sphincter
- sacral nerve stimulation – a pacemaker-like device is surgically implanted under the skin, usually into the buttock to deliver electrical stimulation to the sacral nerves.
Please note that the content of this article is not intended to substitute a medical or professional advice, diagnosis or treatment. Consult your doctor or any qualified health professional for any questions you may have regarding your health or any medical condition.
Effects of Urinary Incontinence
As mentioned before, incontinence is common among elderly people. It is not a life-threatening medical condition but it can significantly affect a person’s quality of life to a varying degree.
- There’s the hassle of having to change your clothes or bed linens often.
- The possibility of developing skin infections like dermatitis due to constantly being wet.
- The risk of having urinary tract infection is increased.
- Elderly people are subject to a much greater risk of falls and fractures as they try to get to the toilet quickly.
- Some may develop feelings of social isolation, humiliation, fear and anxiety of being incontinent in public. Because of these feelings they tend to develop certain habits that may affect their lifestyle and overall health.
- Some people may not want to get out of the house for fear that they may not be able to find a toilet nearby.
- Some would limit their fluid intake throughout the day as they don’t want to go to toilet frequently, especially if they have mobility impairment.
- Working people may lose concentration in their work due to frequent toilet breaks.
- Some people with an overactive bladder may lose sleep as they have to keep getting up at night for fear that they might wet the bed.
- People with stress incontinence may not want to do any form of exercise or strenuous activity. They may even shy away from any social activities and other things that they normally used to enjoy doing.
- Some would not even want to go out with friends for fear that they will become incontinent when they laugh or sneeze and they will be talked about.
Early Diagnosis = Early Treatment
Although urinary incontinence is more common in the elderly, it is not a normal part of aging. Some people are embarrassed to admit that they are experiencing it so they try to hide it.
You should encourage your loved ones to talk about it and visit their doctor as soon as they experience any signs of leaking.
Remember, like any other disease or problem, the faster it is identified, the sooner it can be treated.
Yes, it can be treated.
Who knows, maybe all they need to do is to change some of their bad habits. It may take time to observe signs of improvement, but they should continue and not give up.
It must not stop them from being present in the community or from doing their daily activities.
Advise them to think of it this way…everybody around them may be incontinent, they are just good at hiding it.