How to Deal With Elderly Incontinence

We’ve all managed to delay a trip to the bathroom often in our lives, but there are numerous others, especially the elderly ones who suffer from urinary incontinence.

Urinary incontinence is the loss of an individual’s bladder control, often seen among elderly people, as a result of aging and resultant pelvic floor muscle weakening.

How To Deal With Elderly Incontinence

There are many reasons why incontinence occurs in people, the most common being urinary tract infections, vaginal infections and irritation, and constipation. Also, certain medications can also cause urinary incontinence among people.

Long term incontinence among the elderly is generally a result of:

  • Weak bladder muscles
  • Weak pelvic floor muscles
  • Overactive bladder muscles
  • Damaged nerves

Types of Urinary Incontinence

Stress Incontinence

It is the result of a pelvic floor weakened by factors like childbirth and obesity, and leads to trickles or slight leaks when pressure is placed on the bladder during everyday activities such as coughing, sneezing, laughing, or exercise.

Urge Incontinence

It is associated with having an overactive bladder or OAB, which means that you feel frequent and sudden urges to urinate. You may or may not be able to make it to the restroom on time and even if you, you find that it was actually just a false alarm and you didn’t really need to go.

OAB is mostly a result of muscle or nerve damage in the bladder tissue. If you feel the urge to go more than eight or nine times a day, and frequently get up more than once a night to pee, you may have OAB.

Overflow Incontinence

Commonly found in men than in women, overflow incontinence is when your bladder doesn’t successfully empty fully due to a blockage or muscle weakness. The result is that it leaks when it is full even though you may not feel the urge to urinate.

Causes of Urinary Incontinence in Elderly People

The first step to deal with urinary incontinence is to realize that it is not a part of aging. There are numerous ways to treat elderly incontinence regardless of its cause. Let’s learn more about the common causes of incontinence, types, treatment options, etc in this article.

Health Issues That Cause/Aggravate Incontinence:

  • Multiple sclerosis
  • Obesity
  • Prostate issues
  • Pelvic Floor Atrophy
  • Pre Menopause symptoms
  • Parkinson’s disease
  • Stroke
  • Constipation
  • Alzheimer’s disease

Urinary incontinence may differ in elderly people, with some of them displaying occasional urinary leaks, some who constantly pass urine in trickles, and some who have lost most of their bladder as well as bowel control.

Dealing With Urinary Incontinence Among the Elderly

Urinary incontinence can be easily treated with medical treatment. Your elderly one may be hesitant or reluctant to talk about this issue but discuss the matter with them in a gentle, understanding way and help them receive the treatment they need.

You can visit a trusted primary care doctor who may then refer you to a Urologist or Urogynaecologist as the case may be.

Tests or Diagnosis for Urinary Incontinence:

Generally, a doctors appointment for urinary incontinence looks like this:

  • Urine analysis to rule out infection or blood in the urine
  • Blood tests for checking kidney function and levels of glucose, and calcium
  • A thorough evaluation of the medical history of the patient
  • A complete physical exam, including a rectal and pelvic exam for women, or a urological exam for men

Behavioral Therapy and Exercises for Treating Urinary Incontinence

After the diagnosis, it is common for the doctor to suggest behavioral therapy and physical exercises to treat accidental leakage of urine. Read on to see what are the common exercises/behavioral therapies used for treating incontinence in the elderly:

Pelvic Floor Muscle Strengthening Exercise

You would have heard of Kegels, right? Well, these exercises strengthen the muscles that help regulate urination. There are many resources online to find the step by step Kegel exercise routine. Practice it a few times a day, every day for good results. Learning how to contract the right muscles can be confusing, but these will yield positive results to an embarrassing problem.

Pelvic floor tilt for urinary incontinence

How to do Kegel Exercises:

  1. Before training, ensure that you empty your bladder, then sit or lie down.
  2. Tighten the pelvic floor muscles. Hold tight and count 3 to 5 seconds.
  3. Relax the muscles. Count for 3 to 5 seconds.
  4. Repeat 10 times, 3 times a day (morning, afternoon, and night).

Bladder Training

Bladder training is an important form of behavior therapy that can be effective in treating urinary incontinence, even if it means that you are going to the bathroom even if you feel no urge to pee. The goals are to increase the amount of time between emptying your bladder and the amount of fluids your bladder can hold. Scheduled bathroom visits can gradually help diminish leakage and the sense of urgency to pee many elderly people feel at intervals.

Diet

While it is true that the types of food you eat alone cannot cure urinary incontinence, it can certainly have an effect on improving bladder control. For instance, beverages like carbonated drinks and alcohol can cause your bladder stress. Also, it is found that consuming tea, coffee, or any caffeinated beverage,  while you’re taking prescribed medication can aggravate urinary incontinence. Other commonly found bladder irritants that you may do best to avoid include milk, tea, honey, soda, tomato-based, and spicy foods.

What Procedures Are Used for Diagnosing Urinary Incontinence

  • Bladder ultrasound and post-void residual (PVR)
    This procedure usually takes around five to 10 minutes. Tests are conducted by placing an ultrasound wand, (after the person has passed urine) on the abdomen, creating a bladder scan to show if any urine remains in the bladder. A catheter may also be placed into the bladder to drain and measure any urine left.
  • Cystography
    A catheter is inserted into the bladder, through which a certain dye is injected. The patient is asked to pass urine and an X-ray is then taken while the patient urinates. The dye helps in highlighting the urinary tract. X-rays of the kidney, ureter, and bladder will be taken so the urinary system is completely visible.
  • Urodynamic testing
    A test designed to look 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.  A catheter fills the bladder with water to measure the pressure in the bladder during three phases- when it’s at rest, when it’s filling, and when it empties.
  • Cystoscopy
    The Cystoscopy checks for tumors, stones, or cancer in the patient’s bladder. The doctor uses a bladder scope to examine the lining of the patient’s bladder and the tube that carries urine out of the body (urethra).

Surgeries for Urinary Incontinence

These are the invasive treatments for urinary incontinence and may vary for men and women. Below are commonly recommended procedures:

Sling procedures or Mid Urethral Sling Surgery

For women, this procedure involves supporting the urethra by a sling around it, to lift it back into a normal position and support it.  The sling is placed around the urethra to hold it in a normal position and to exert pressure on the urethra to aid urine retention
For men, it involves making a cut between the scrotum and anus. This surgery is generally seen to have successful results, although sometimes, the patient may face issues with not being able to fully void the bladder

Colposuspension

This is used to treat stress incontinence,  which is basically, the leakage of urine when you do physical exercise, or even due to pressure of sneezing, coughing, etc. A cut is made into the lower stomach, and the bladder is lifted up and stitched. The surgery is performed by making small cuts in the lower region of the stomach, and accessing the bladder with a laparoscopic colposuspension, which is the surgical instrument used for this procedure.

Artificial urinary sphincter

Here, 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. In the case of female patients, it is attached to the labia. The patient can press the valve twice to urinate, and the bladder can be emptied.

Urinary Incontinence In People With Dementia

Urinary incontinence may also occur in older adults because of neurological decline caused by dementia. Mobility can decrease as the disease progresses, making it difficult for a sufferer to reach the toilet on time. The reduced sensations can also prevent the sufferer from knowing when they need to urinate. Older adults with dementia experience mental decline, which can lead to the individual not knowing where the toilet is located, and they often have trouble remembering how to use the toilet even if they do reach there on time.

Many times, patients suffer from urine leakage from time to time even after treatments and therapies. In this case, you many rely on bladder control products and other solutions, like adult diapers, furniture pads, urine deodorizing pills, and special skin cleansers that may make urine leakage and the resultant odors a little less bothersome.

Adult diapers for urinary incontinence

As caretakers or relatives of elderly adults suffering from urinary incontinence, it’d best to understand and accept that it can be painful, embarrassing, and even debilitating to the patient. Whether it is you, a member of your family, or even a close friend, this is an issue many will have to deal with.

About Aswathy Suresh