It’s Not Normal: Urinary Incontinence

Cleveland, MaryJo 4x6Maryjo L. Cleveland, MD
Medical Director, Post Acute & Senior Services
Chief, Division of Geriatric Medicine
Summa Health System
Akron, Ohio

 

This month we are going to talk about one of those problems that no one wants to talk about. Urinary Incontinence. There, I said it. Now you can too.

Urinary incontinence is the involuntary loss of urine and boy, is it common. Probably 50% of older women and 15% of older men suffer from this problem. But most older adults don’t tell their healthcare provider about it. Why? If you have followed this blog at all, you already know the answer. Because people think it’s normal, and that nothing can be done about it. Fortunately, people are wrong!

If you have episodes of involuntary loss of urine, please talk to your healthcare provider. The first thing he or she will do is ask you many questions. Don’t be embarrassed to answer these honestly! Honest answers will help determine the cause and the approach to treatment.

Some of the questions will likely include:

  • How frequently is it happening?
  • Is it affecting your work, social life, or sex life?
  • Do you lose small amounts or do you soak your clothing or pad?
  • Is it worse when you cough or sneeze?
  • Do you have to rush to the bathroom to avoid and accident?

There are basically five kinds of incontinence:

1.  Stress incontinence - this is the loss of small amounts of urine when you exert pressure on your abdomen and bladder-coughing, sneezing, laughing, lifting heavy objects. This happens because the muscle that keeps the bladder closed has weakened over time. In women, this is usually due to pregnancy and childbirth and in men it can happen if the prostate has been removed.

2.  Urge incontinence - this is loss of larger amounts of urine with little or no warning. You have seen commercials for this kind of incontinence.  This is also known as overactive bladder.  This is often caused by infections, bladder irritants, or brain diseases such as Alzheimer’s disease or strokes.

3.  Overflow incontinence - this is a frequent dribble of small amounts of urine and the inability to completely empty the bladder. This is often due to diabetes and is more common in men due to prostate problems.

4.  Mixed incontinence - this is combination of  the above patterns.

5.  Functional incontinence - this is incontinence due to something outside of the bladder. In older adults it is because of physical or mental impairments that prevent them getting to the bathroom in a timely manner.

Once your healthcare provider has some idea of what category your symptoms appear to fall in, a treatment plan can be formed. Usually, simple things are suggested first and are often surprisingly helpful. Some of these ideas include:

  • Reduce your intake of fluid during the day, especially after 6 pm
  • Alcohol and caffeine are bladder stimulants-cut down on both of these
  • Other things act as bladder irritants and should be minimized such as carbonation, artificial sweeteners, foods high in acid or spice
  • Certain medications may worsen incontinence and may be able to be adjusted (don’t do this alone!)

You may also be asked to keep a diary of your bladder symptoms as you make some of these changes to document patterns and look for improvement. And, your healthcare provider may order some basic blood and urine tests to rule out infection, elevated blood sugar or other treatable causes.

At this point, further treatment will depend on your response to the non-drug approaches. While the incontinence may not completely disappear, it is likely that the frequency and intensity of symptoms can be reduced to allow you to go about all your usual activities.

So, if you are having incontinence symptoms, you are not alone. Ask your doctor what you can do about it. And remember, It’s Not Normal!

Related Resources from Healthinaging.org:
Urinary Incontinence
Caregiving How-tos:  Urinary Incontinence

2 thoughts on “It’s Not Normal: Urinary Incontinence

  1. I’ve had a private Geriatric nursing practice for years, and something i’ve discovered about urinary incontinence that really works for both older men and women, especially women who have had a hysterectormy in the past is emptying the bladder completely, especially before bedtime and first thing in the morning – standing over the toilet if necessary. “Old” urine in the bladder can be an irritant and present as a UTI without meeting clinical criteria. Incomplete cleansing after a bowel movement could also be a factor in contributing to UTI Cleansing from “front to back” is good advice to avoid e.coli infections, but some older clients have arthritic hands, short arms and are generally overweight, making such cleansing difficult, if not impossible. I don’t find such advice in any of the literature I read!

  2. That’s a great idea! I also suggest that folks consciously wait a count of 10, then void a second time to see if they can empty out more and give themselves longer between trips to the bathroom.

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