Caregiver Guide: Incontinence

Understanding the Problem

Incontinence is when someone has leakage of urine.  You may also hear it referred to as having accidents or problems with bladder control.
Urinary incontinence, or leaking urine, is a problem for at least 30% of people over age 60. It is more common in women than in men and can range from occasional dribbling to total loss of bladder control. 
You should start by sensitively discussing the problem with the older person. Many people who have incontinence do not tell their healthcare provider because they are embarrassed or they feel it is not a major problem. The first step to help them accept that they have a problem is by discussing it with tact and sensitivity.
Whether the incontinence is mild or severe, everyone with incontinence should be seen by a healthcare professional. A medical condition might be causing the incontinence and, if so, this should be treated. Incontinence is almost always treatable with bladder training, pelvic muscle exercises, medications, and/or surgery. Sometimes it can be cured.

There are 4 types of incontinence

Urge incontinence

Urge incontinence is the sudden urge to go to the bathroom but not having enough time to reach the toilet. People with urge incontinence often have an overactive bladder muscle. Bladder over-activity can also cause frequent urination and awakening at night to urinate (this is known as nocturia.). When urge incontinence occurs, the bladder contracts with little or no warning and urine leaks as a result. This can be caused by stroke, Parkinson's disease, bladder infection, and disorders that affect the spinal cord.

Stress incontinence

Stress incontinence is most common in women. It happens during coughing, laughing, bending, or other activities that apply pressure to the abdomen. Common causes are weak muscles around the urethra and bladder opening as a result of childbirth, surgery, or lack of estrogen after menopause. Stress incontinence has nothing to do with emotional stress. 

Mixed incontinence

Mixed incontinence is a combination of urge and stress incontinence.

Other incontinence

Other incontinence is incontinence that does not fall into the categories of urge, stress, or mixed incontinence. Sometimes this occurs when the bladder and the urethra are functioning normally, but the person either cannot physically get to the toilet, or has impaired mental function that interferes with recognizing the need to urinate and getting to the toilet on time. This latter condition is common in patients with Alzheimer’s and other types of dementia. However, sometimes people with physical or cognitive conditions can have the above types of incontinence or abnormal bladder function as well.  Even if it is assumed that the person is incontinent because of physical or cognitive reasons, they should be evaluated for other types of incontinence and contributing factors that should be addressed.

Your goals are to:

  • Have the older person evaluated by a healthcare provider no matter how small the problem appears.
  • Schedule bathroom trips or, if necessary, provide a urinal or commode to make reaching the toilet easier.
  • Encourage bladder training and Kegel exercises.
  • Encourage changes in diet and fluid intake.
  • Take care of constipation - pressure from hard stool in the rectum can make urinary incontinence worse.
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