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
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?
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
- 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.
- 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.
- 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.
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
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.
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.
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.
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