Incontinence in Seniors. A Touchy Subject

Incontinence in Seniors

Incontinence in seniors is indeed a touchy subject. The first time it occurs, there is a sense of anxiety and confusion as to how “such a thing could have happened”. Many feel bewilderment, shame,  and anxiety, and only discuss the condition with their doctor after many further mishaps.

As much as incontinence sometimes sneaks up on many seniors as they age, the subject should not be a taboo.

Urinary incontinence is not really a disease. It is however, a symptom of other health problems.

Incontinence should not cause a decline in your quality of life. The good news is, most cases can be treated or managed. The first step is getting yourself informed!

This article therefore focuses on discussing bladder control related issues experienced by many seniors and the elderly.

The Urinary System and Normal Operation

Our kidneys play a huge role in filtering blood and helping to remove wastes and extra fluid from the body through the urine. These bean shaped organs in the lower abdomen regulate blood pressure, helping to control the body’s chemical and fluid balance.

The two kidneys, each with a tuble like structure (the ureter) connect to the upper part of the bladder which is a muscular, hollow storage organ for urine. It is about the size of a small grapefruit when empty, but can rapidly expand to a much larger size.

Directly at the base of the bladder is the urethra through which urine is transported on its way out of the body. The kidneys, ureters and the urethra form the urinary system

A Healthy Bladder

Incontinence in Seniors

What do we mean by a healthy bladder?

Our  bladder can comfortably expand to hold slightly above a half liter of liquid for 2 – 5 hours.

If it expands beyond this, it  creates pressure and discomfort on the surrounding structures, and we feel the need to use the bathroom.

This pressure acts as a signal for the bladder muscles to contract, and two valves (sphincters)at the base of the bladder open and allow the urine to move into the urethra which carries it out of the body.

This is the operation of a healthy bladder which we generally take for granted.

Generally,  a healthy bladder needs to be emptied 4-8 times a day, and does not leak urine even if it has to extend the time before visiting the bathroom. Its frequency increases however, depending on the volume of liquid consumed.

Usually, it should only cause you to wake up once at night to empty , or at most twice in older adults. For some seniors, that seems like light years ago. How many times do you wake up during the night to empty?

What is Urinary Incontinence in Seniors?

Incontinence in Seniors

One of the commonest bladder conditions is urinary incontinence. It is caused by a problem with the bladder and the control of the valves (sphincter muscles) at its base, resulting in the uncontrolled and very embarrassing leaking of urine.

Urinary incontinence is more prevalent in older people, especially women. It can often be treated  or controlled. About 1 in 2 women and 1 in 4 men in the United States suffer from urinary incontinence (Urology Care Foundation 2020).

Higher risks exist for females, increasing age, smoking, previous family history, being overweight and the presence of other diseases (Mayo Clinic 2019)

What Causes Urinary Incontinence in Seniors?

Incontinence is a symptom of a wide range of underlying conditions. These can be short term or long term conditions:

Short Term Conditions: These are temporary conditions which can be quickly treated. Treat or remove the condition and in most cases, you will be fine. These include

  • Urinary tract infections
  • Vaginal infection or irritation
  • Constipation
  • Using certain medications such as diuretics, antihistamines and antidepressants

Longer term Conditions – These are as numerous as they are diverse, and some are more gender related. They require tailored treatments as may be recommended by a doctor.

Incontinence in Seniors
  • Weak bladder muscles
  • Overactive bladder muscles
  • Weak pelvic floor muscles
  • Occurrence of a Stroke
  • Damage to nerves controlling the bladder from diseases like diabetes, multiple sclerosis or Parkinson’s
  • Diseases such as arthritis may affect mobility, and result in a slower ability to get to the bathroom on time
  • Pelvic organ prolapse, which is when pelvic organs (such as the bladder, rectum, or uterus) shift out of their normal place into the vagina.

When these organs are out of place, the bladder and urethra are not able to work normally, which may cause urine to leak.

  • Pregnancy
  • Strain of childbirth in some women
  • Menopause in some women
  • The prostrate gland  accounts for most  incontinence in men. A painful inflammation of or, an enlargement of the prostrate gland can put pessure on the bladder causing incontinence.

What are Stress, Urge, Overflow, Mixed Urinary and Functional Incontinence in Seniors?

These are terms used for the five different types of incontinence explained below:

Stress Urinary Incontinence (SUI):

This is the most common type of bladder control problem in younger and middle-aged women, but may also begin around the time of menopause for older women.

In this condition, the pelvic floor muscles (which hold the pelvic organs in place) have become weak and don’t work well enough to hold urine in the body. Accidental leaks will occur when you place any pressure on the bladder such as coughing, sneezing, laughing, lifting heavy objects or even during exercise.

Incontinence in Seniors

Statistics

These stats demonstrate that to show that you are not alone :

About 1 in 3 women have SUI

Urinary incontinence increases with age.

About 33% of women who are 60 years old sometimes leak urine while that number increases to about 50% in women aged 65 and over.

SUI is less common in men and when it does occur, is usually due to prostate cancer surgery or pelvic nerve damage (Urology Care Foundation, 2020)

More than 25 million people in the USA experience bladder leakage every day (National Association for Continence 2020) and approximately 3.5 million Canadians experience some form of incontinence (The Canadian Continence Foundation 2014)

The two commonest types of urinary incontinence in women are stress and urge incontinence.

Urinary incontinence affects more women than men because of pregnancy, childbirth and menopause (U.S. Department of Health & Human Services – Office on Womens Health 2018)

Urge Incontinence or Overactive Bladder (OAB):

This condition happens when you have a sudden strong desire to urinate and cannot hold urine long enough to get to the washroom.

This is the annoying “got to go, got to go, got to go RIGHT NOW” feeling and may cause you to wake up to “go” several times in the night – disturbing your sleep. It is also common for people with diabetes, stroke, multiple sclerosis, Alzheimer’s disease and Parkinson’s disease.

Overflow Incontinence in Seniors:

This condition occurs more frequently in men. The bladder is always full and because it cannot empty, it overflows with small amounts of urine leakage.

A man can have trouble emptying his bladder if an enlarged prostate is blocking the urethra. This condition is characterised by the passing of small amounts of urine each day or ongoing dribbling. Diabetes and spinal cord injuries can also cause this condition

Mixed Urinary Incontinence in Seniors:

This is a condition where more than one type of incontinence occurs such as stress leakage with urge incontinence.

Functional Incontinence in Seniors:

This condition is related to mobility issues. It occurs in many older people who have normal bladder control but are just unable to move quickly enough to get to the washroom because of arthritis or other disorders that make it difficult to move quickly.

Treatment for Urinary Incontinence

Incontinence in Seniors

Today, there are lots of treatments for urinary incontinence as evidenced from my research below. The choice of treatment, recommended and explained by your doctor, will depend on your type of bladder control problem, how serious it is, and what best suits your lifestyle.

Typically, the doctor will recommend the simplest and safest treatments first.

Lifestyle Changes:

Include weight loss, quitting smoking, and dietary changes – avoiding or reducing intake of known foods that irritate the bladder such as spicy foods and caffeine ( in coffee, tea, carbonated drinks).

Fluid control can be helpful -drinking water instead of other drinks,  limiting fluids before bedtime, avoiding alcohol and, avoiding the lifting of heavy objects.

Bladder Training or Re-training:

Timed urination, scheduled voiding, or double voiding. The goal is to re-train your bladder to hold urine in for longer and longer periods of time. In timed voiding, you urinate on a set schedule, for example, every hour. You can slowly extend the time between bathroom trips.

Pelvic Muscle Exercises (also known as Kegel exercises)

work to strengthen the muscles used to stop urinating. Making these muscles stronger helps you hold urine in your bladder longer.

It is better you get your doctor or health care provider to teach you the technique, as many seniors tell me it is difficult to initiate without guidance. Once learned, a helpful video can then be used to guide you when doing the exercises at home (https://youtu.be/3iAkItp6OSE)

  • Drug Treatments  – theseof course can only be recommended by your doctor.
  • Surgical Treatments span a wide range of options and are the treatments many seniors find intimidating. They include slings, bladder neck suspensions, injections, artificial sphincters, bladder pacemakers, bladder enlargements and many others.

Once your doctor explains the procedure to to be done in your case, this should dispel any fears or concerns you may have.

Incontinence in Seniors

Conclusion – What Should I Do?

Now that you understand a bit about what could be causing this condition of inconvenience, its time for you to visit your doctor for more in depth discussions.

Remember, incontinence is NOT an inevitable part of the aging process, though it often occurs as aging progresses.

As a senior, incontinence  need not be a source of anxiety, shame or withdrawal from family and friends.  It can be treated or managed so that you can continue to do the things you love and enjoy your quality of life.

How has incontinence been affecting your quality of life? Provide your comments or questions in the comment box below.

Some References

1. National Association for Continence (2020) https://www.nafc.org/home

2.Incontinence – The Canadian Perspective (2014). The Canadian Continence Foundation http://www.canadiancontinence.ca/pdfs/en-incontinence-a-canadian-perspective-2014.pdf

3. Urinary Incontinence (2019) Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/symptoms-causes/syc-20352808

4. Incontinence Patient Guide (2020) Urology Care Foundation https://www.urologyhealth.org/educational-materials/incontinence

5. Urinary Incontinence in Older Adults (2017) https://www.nia.nih.gov/health/urinary-incontinence-older-adults

6. Understanding the Bladder (2018) https://facty.com/anatomy/urinary-system/understanding-the-bladder/

7. How to Do Kegel Exercises for Bladder Control – Urinary Incontinence Treatment (2014). https://youtu.be/3iAkItp6OSE

8. U.S. Department of Health & Human Services – Office on Womens Health. Fact Sheet. Urinary Incontinence (2018) https://www.womenshealth.gov/a-z-topics/urinary-incontinence

9. MedlinePlus (2018) Aging Changes in the kidneys and bladder.https://medlineplus.gov/ency/article/004010.htm

12 thoughts on “Incontinence in Seniors. A Touchy Subject”

  1. Thank you so much for addressing this subject with such class and grace. My mother will be 60 years old next month, and she’s beginning to experience incontinence issues. She feels ashamed that she’s experiencing these problems, and feels that she’s “too young” to have such problems, but so many factors figure into the condition (she’s definitely under a lot of unnecessary stress). I am going to forward this article to her, as it will definitely help her to put things into perspective and take the necessary steps to treat (or even eradicate) the problem. God bless you!

    Reply
    • C.N
      Thank you for stopping by! I am delighted that I was able to provide you with useful information that may help your Mum.

      This is a condition which those entering into the twilight zone of senior citizenship don’t fully understand as being one of the “negative bonuses” of aging. If we know what to expect, we will embrace and manage it like a pro. I totally agree with your Mum that we are too young to let this affect our quality of life!

      God bless you too!
      Ceci

      Reply
  2. Hi S Cece,

    Well written, informative and yes a delicate matter to be sure. I thank you for being brave and addressing the subject. I hope many seniors will be helped. I’ll be one soon enough myself.

    JN

    Reply
  3. Hi,

    This is indeed a touchy subject, but it is one that needs to be discussed within the senior community and their surroundings. I have parents in their 70’s. At the moment they are fine but I have friends who’s parents are not as lucky. But when talking about it, it gets swept under the carpet.

    We need to address these things with senior people and help wherever we can. The coronavirus has showed that when things are in crisis mode, we can pull out all of the stops and help each other.

    We need to keep up this kindness when the pandemic is over, and address the other issues that people have, just like the incontinence in seniors.

    Thank you for sharing and making us think. Keep up the amazing work on your site.

    All the best,

    Tom

    Reply
    • Thanks for stopping by Tom! Happy that I got you relecting on thissubject…

      I really do hope I can create awareness about this touchy subject in seniors and the elderly. Fortunately, some of my friends are now beginning to take notice and are breathing a sigh of relief that incontinence just sometimes comes with the territory of aging – not necessarily for all, but certainly for many.

      Thank you.

      Ceci

      Reply
  4. Good information on this too often thought taboo subject. I couldn’t believe the statistics “About 1 in 2 women and 1 in 4 men in the United States suffer from urinary incontinence (Urology Care Foundation 2020)”.
    That’s eye opening. I didn’t realize that incontinence was an sypmptom of Parkinson’s Disease. My mother had Parkinson’s and also was later bothered by incontinence. She would of gladly done exercises, Kegel exercises, as she exercised daily until arthritis pain was too intense. I wonder how long bladder slings last. Thanks for your informative article.

    Reply
    • Hi Nancy,
      Thanks for checking out this sensitive information. Too few women understand the causes and suffer with anxiety for so long before seeking for help. Now you know, and can spread the word to others.

      Kegel exercises really do help – if you do them correctly. Bladder slings unfortunately don’t last forever. The symptoms return gradually and the slings can last up to 5 years.
      Ceci

      Reply
  5. Hi Ceci, This is really an informative article, so many of the old are to stubborn to seek help. With this article at least they will be informed and take the necessary action. Also for those leading up to that age that when it comes we don’t freak. Thanks again Barry

    Reply
    • Glad this article was informative for you Barry. Knowledge brings peace of mind – especially when you know what to expect.
      Thanks for stopping by.

      Ceci

      Reply
  6. Thank u for addressing such important issues and doing such a good job of it. Really ceci, you are a terrific expert and I value your opinions so much. Great article for my father.
    Regards,
    Aparna

    Reply

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