Rita talks about one of the embarrassing problems that elders or their families face, urinary incontinence or lack of control of the bladder. Read more in the regular column, exclusively in Different Truths.
A trip to the bathroom is something most people can easily delay. But for the millions who suffer from urinary incontinence, delaying a bathroom trip isn’t an option. Although incontinence can happen at any age, it’s more common in older adults. Studies show that 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.
Causes and Symptoms
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 a person ages, muscles that support the bladder become weaker, making 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:
Types of Urinary Incontinence
Urinary incontinence is divided into three general types. You can potentially experience more than one type at the same time.
Stress incontinence is triggered by certain types of physical activity. For example, you might you lose control of your bladder when you’re exercising, coughing, sneezing, or laughing. Such activities put stress on the sphincter muscle that holds urine in your bladder. This can cause it to release urine.
Urge incontinence occurs when you lose control of your bladder after experiencing a sudden and strong urge to urinate. You may not be able to make it to the bathroom in time, once that urge hits.
Overflow incontinence can occur if you don’t completely empty your bladder when you urinate. Later, some of the remaining urine may leak from your bladder. This type of incontinence is sometimes called “dribbling.”
This diagnosis describes incontinence caused by other disabilities. For example, if a bad hip or knee makes a trip to the restroom a time-consuming process, accidents can ensue. Neurological disorders, stroke complications, Alzheimer’s disease or multiple sclerosis can also cause functional incontinence. Often the patient still feels the urge to void, but his mind cannot plan or carry out a trip to the bathroom.
Sometimes patients experience more than one type of incontinence. Usually, patients have a combination of stress and urge incontinence, especially women. But people who have severe dementia, Parkinson’s disease, neurological disorders, or have had strokes can suffer from urge and functional 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. You should expect the following from a visit:
- 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 one’s medical history
- A complete physical exam, including a rectal exam and a pelvic exam for women, and a urological exam for men
If the previous tests and exam don’t point to a diagnosis, the patient could undergo one or more of the following procedures:
After urination, an ultrasound wand is placed on the abdomen, creating a bladder scan to show if any urine remains. Or a catheter is placed into the bladder to drain and measure any urine left.
A catheter fills the bladder with water. This test measures the pressure in the bladder when it is at rest, when it’s filling, and when it empties. This test looks at the anatomy of the urinary tract, the functioning ability and capacity of the bladder, and what sensations the patient feels.
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.
The doctor views the patient’s bladder through a small telescope, checking for capacity, tumours, stones, or cancer.
Treatment and Practical Management
After a diagnosis is made, a treatment for elderly urinary incontinence can include behavioural therapy, medications, medical devices, and surgery.
Usually, the first line of treatment is behavioural therapy, which will often cure the incontinence. Treatments can include bladder training, scheduled bathroom trips, pelvic floor muscles exercises, and fluid and diet management. 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 into 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 behavioural therapies:
Anticholinergic or Antispasmodic Drugs
These are usually prescribed for urge incontinence. The most common side effect is dry mouth. Less common side effects include blurred vision, constipation, and mental confusion.
Estrogen therapy-with a vaginal cream, ring, or patch-is used to counteract the atrophy of the skin lining of the urethra and vagina in postmenopausal women.
These are prescribed when incontinence is caused by a urinary tract infection or an inflamed prostate gland.
In addition to these treatments, medical devices may be prescribed for women, including:
This is a tampon-like insert that a woman places in her urethra, usually during activities related to her incontinence episodes, such as tennis. The woman removes it when she needs to urinate. These are not as commonly prescribed, says nurse practitioner Smith, as they can be uncomfortable and can cause urinary tract infections.
This is an intra-vaginal device similar to a diaphragm that supports the bladder. A medical provider places the pessary, which needs to be taken out, inspected, and cleaned by the provider every three months.
Surgery to repair and lift the bladder into a better position is often the last resort for urinary incontinence treatment. It’s considered for people who can’t be helped by other forms of treatment.
The most important step for a senior citizen suffering from incontinence is to seek professional medical help. If elderly urinary incontinence is keeping your loved one at home and away from his or her favourite pastimes, please realise 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.
Photos from the Internet
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Rita Bhattacharjee is a communications consultant with extensive experience in managing corporate and internal communications for companies across diverse industries, including non-profit organizations. She is the co-founder of Mission Arogya and Arogya HomeCare and has recently relocated from the US to India to channel her skills towards social entrepreneurship to increase awareness and reduce disparity in public health. She also writes poetry, some of which have been published in reputed international journals.