Living with Urinary Incontinence

When an older adult is dealing with incontinence, embarrassment may stand in the way of seeking treatment.
Over 25 million Americans experience incontinence. Yet most seniors who are dealing with the condition may well feel that they are all alone, because this isn't a topic that comes up very often! They may avoid discussing the issue, even when family caregivers know there is a problem.

But it is very important that seniors discuss this issue with their healthcare provider. Left untreated, incontinence usually worsens, and can be the first step to a debilitating withdrawal from life, with decreased social connectedness, physical activity and intellectual stimulation. Incontinence causes skin irritation, interferes with sleep, and can lead to depression. It is so important to seek help for the condition.

What is urinary incontinence?

Urinary incontinence is the inability to maintain control over the release of urine from the bladder. The causes of incontinence vary widely, as does the degree of the problem. Incontinence may be brought on by illness, fatigue, confusion, or a hospital admission. It also may be caused by weakening of the muscles which control bladder outflow, disorders of the central nervous system or obstruction to the bladder.

It is helpful to be able to distinguish between the different types of incontinence:

  • Urge incontinence occurs often in seniors and can be the result of neurological damage, strokes, diabetes, or the aftermath of bladder infections or kidney stones. In this circumstance, the individual does not receive a signal in time to reach the bathroom before the bladder begins to empty itself.
  • Overflow incontinence occurs when small amounts of urine leak from a bladder that is always full due to such conditions as obstruction, constipation or nerve damage. In men, enlarged prostate is often the cause.
  • Stress incontinence means the involuntary passing of urine during any increase in abdominal pressure, such as coughing, sneezing, laughing or lifting heavy objects. It is often seen in women who have had relaxation of the muscles of the pelvic floor, usually due to childbirth.
  • Functional incontinence occurs when a person has normal bladder control, but is unable to get to the toilet on time because of a mobility problem. Alzheimer's and other types of dementia may also be a factor; people with these conditions may not be able to think about getting to the toilet or may forget how to get there and negotiate clothing.

Can incontinence be treated?

Many people believe that incontinence is just "a normal part of growing older." But this isn't necessarily true. Yes, incontinence becomes more common as we grow older, but in many cases, it can be treated effectively.
So at the first sign of incontinence, it is important to consult a physician to determine its cause and type. The person’s physician can diagnose and treat underlying diseases, check and reevaluate medications that might cause or increase incontinence, and evaluate the severity of the problem. The patient may be asked to keep a "bladder diary," recording incidents of incontinence and the amount and frequency of urination. Ultrasound and other tests provide an idea of bladder volume, as well as any blockages or other contributing factors.

A variety of treatments are available, including:

Bladder training. The patient keeps a chart of urination and leaking, and then works out a bathroom schedule, planning trips to the toilet at certain set times (for example, once an hour). 

Pelvic muscle exercises, such as "Kegels," can strengthen the bladder muscles and the muscles of the pelvic floor. This helps hold urine in the bladder longer. The time can be gradually extended so that urine is held for longer periods.

Medications. Some commonly prescribed drugs stop bladder contractions; others relax the muscles to prevent urgent or frequent urination. In post-menopausal women, estrogen pills, creams or patches may be prescribed.

Surgery. While only a physician can tell if treatment would be effective for any particular case, surgery can be effective, especially in treatment of stress incontinence and incontinence due to prostate enlargement.
Lifestyle changes. The physician may recommend cutting down or eliminating caffeine, alcohol and tobacco products. All can increase incontinence by irritating the bladder. 

When treatments don't completely work…       

People who are living with incontinence may feel more secure wearing special absorbent, disposable undergarments which are inconspicuous and quite effective in masking the incontinence. These undergarments are sold in drug stores and supermarkets, and though they don't "solve" the problem, they may bring a sense of peace of mind and dignity to your loved one.

If mobility problems prevent the person from making it to the bathroom in time, consider having a commode chair nearby.

Specially designed clothing makes it easier for people with arthritis, stroke or Alzheimer's to negotiate fasteners in time.

How can family help?

When dealing with an incontinent loved one, tact and sensitivity are always necessary. Try not to overreact if an older family member or friend has an accident around you. Dignity is a fragile thing in all of us, and it is something we all need to maintain. This is one of those occasions in which you need to be particularly careful in your caring.

But it's also important to talk about the problem with your loved one, and encourage him or her to seek treatment. The National Association for Continence estimates that the average senior waits close to seven years to report the problem to the doctor! The sooner treatment begins, the better.


For More Information

The National Association for Continence website offers information and support for older adults and caregivers, including the Bladder and Bowel Diagnostic Tool. 

The National Kidney and Urologic Diseases Information Clearinghouse website includes extensive information and resources on urinary incontinence.

SOURCE: Assisting Hands Home Care in association with IlluminAge, © IlluminAge 2013