Urinary Incontinence in Older Adults

Urinary Incontinence in Older Adults

Urinary incontinence means a person leaks urine by accident. Although this may happen to anyone, urinary incontinence is more common in older people, especially women. The severity ranges from occasionally leaking urine when you cough or sneeze to having an urge to urinate that’s so sudden and strong you don’t get to a toilet in time. While it occurs more often as people get older, urinary incontinence isn’t an inevitable consequence of aging. If urinary incontinence affects your daily activities, don’t hesitate to see your doctor. For more people, simple lifestyle and dietary changes or medical care can treat symptoms of urinary incontinence.

What happens in the body to cause bladder control problems?

The body stores urine in the bladder. During urination muscles in the bladder tighten to move urine into a tube called the urethra. At the same time, the muscles around the urethra relax and let the urine pass out of the body. When the muscles in and around the bladder don’t work the way they should, urine can leak. Incontinence typically occurs if the muscles relax without warning.

Types of urinary incontinence include:

• Stress incontinence. Urine leaks when you exert pressure on your bladder by coughing, sneezing, laughing, exercising, or lifting something heavy. It’s the most common type of bladder control problem in younger and middle-aged women and may begin around the same time of menopause.
• Urge incontinence. This happens when people have a sudden need to urinate and cannot hold their urine long enough to get to the toilet. You may need to urinate often, including during the night. Your urge incontinence may be caused by a minor condition, such as an infection, or a more severe condition such as a neurological disorder or diabetes. It also occurs in people with Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, or stroke.
• Overflow incontinence. This is when you experience frequent or constant dribbling of urine due to a bladder that doesn’t empty completely. A man can have trouble emptying his bladder if an enlarged prostate is blocking the urethra. Diabetes and spinal cord injuries can also cause this type of incontinence.
• Functional incontinence. This occurs in many older people who have normal bladder control. They just have a problem getting to the toilet because of arthritis or other disorders that make it hard to move quickly.

Treatment of urinary incontinence.

Today there are more treatments for urinary incontinence than ever before. The choice of treatment depends on the type of bladder control problem you have, how serious it is, and what best fits your lifestyle. As a rule, the simplest and safest treatments should be tried first. Bladder control training may help you get better control of your bladder. Your doctor may suggest you try the following:

• Pelvic muscle exercises (also known as Kegel exercises) work the muscles that you use to stop urinating. Making these muscles stronger helps you hold urine in your bladder longer.
• Biofeedback uses sensors to make you aware of signals from your body. This may help you regain control over the muscles in your bladder and urethra. Biofeedback can be helpful in learning pelvic muscle exercises.
• Timed voiding may help you control your bladder. In timed voiding, you urinate on a set schedule for example, every hour. You can slowly extend the time between bathroom trips. When timed voiding is combined with biofeedback and pelvic muscle exercises, you may find it easier to control urge and overflow incontinence.

When to see your doctor.

You may feel uncomfortable discussing incontinence with your healthcare provider. But, if incontinence is affecting your quality of life, it would be in your best interest to see your physician.  Urinary incontinence may:

• Cause you to restrict your activities and limit your social interactions.
• Negatively impact your quality of life.
• Increase the risk of falls in older adults as they rush to the toilet.
• Indicate a more serious underlying condition.

Temporary urinary incontinence.

Certain drinks, foods, and medications may act as diuretics. These stimulate your bladder increasing your volume of urine. They include alcohol, caffeine, carbonated drinks and sparkling water, artificial sweeteners, chocolate, chili peppers, foods that are high in spice, sugar or acid, especially citrus fruits, heart and blood pressure medications, sedatives and muscle relaxants, and large doses of vitamin C.

Urinary incontinence may also be caused by easily treatable medical conditions such as: 

• A urinary tract infection. Infections can irritate your bladder causing you to have strong urges to urinate and sometimes incontinence.
• Constipation. The rectum is located near the bladder and shares many of the same nerves. Hard, compacted stool in your rectum causes these nerves to be overactive and increase urinary frequency.

Persistent urinary incontinence.

Urinary incontinence can be a persistent condition caused by underlying physical problems or changes including:

• Pregnancy, hormonal changes, and increased weight of the fetus can lead to stress incontinence
• Childbirth – vaginal delivery can weaken muscles needed for bladder control and damage, bladder nerves and supportive tissue leading to a dropped (prolapsed) pelvic floor. With prolapse the bladder, uterus, rectum, or small intestine can get pushed down from the usual position.
• Changes with age. Aging of the bladder muscle can decrease the bladder’s capacity to store urine. Also, involuntary bladder contractions become more frequent as you get older.
• After menopause women produce less estrogen, a hormone that helps keep the linking of the bladder and urethra healthy. Deterioration of these tissues can aggravate incontinence.
• Enlarged prostate especially in older men. Incontinence often stems from enlargement of the prostate gland, a condition known as benign prostatic hyperplasia. Prostate cancer in men stress incontinence or urgent incontinence can be associated with untreated prostate cancer but more often, incontinence is a side effect of treatments for prostate cancer.
• A tumor anywhere along your urinary tract can block the normal flow of urine leading to overflow incontinence.
• Neurological disorders. Multiple sclerosis, Parkinson’s disease, a stroke, a brain tumor, or spinal injury can interfere with nerve signals involved in bladder control.

A danger of ignoring incontinence.

An AARP poll conducted by the University of Michigan found that 51% of women ages 65 to 80 and 43% of women ages 50 to 64 have had an episode of incontinence in the past year and that nearly half of those who experienced such leakage (48%) worry that their symptoms will get worse as they age.

Despite this only one in three of affected women said they sought advice from their doctors even though 51% described their symptoms as problematic. The survey was administered as part of the national poll on healthy aging sponsored by the AARP and Michigan Medicine the University of Michigan’s academic medical center. Among responses affected by incontinence their coping strategies included limiting their fluid intake (16%) or modifying their wardrobe (15%) to prevent or hide accidents.

A majority (59%) use pads or other protective garments to guard against leakage the daily use of which can cause women upward of hundreds of dollars per year experts say. Just 38% of those affected reported doing pelvic floor exercises called Kegels, which have been proved to help manage symptoms. Women who viewed incontinence as a problem or felt embarrassed about their symptoms were more likely to have sought medical advice. Of those who didn’t reach out, two-thirds said they had not spoken to their doctor because they felt the problem was not that bad. Twenty-three percent said they had other things to discuss and 22% did not see urinary incontinence as a health problem.

Yet 79% of those affected reported that coughing or sneezing was a trigger, followed by 64% who cited trying to get to the bathroom in time. Nearly half (49%) pointed to laughing as a culprit and more than a third (37%) said exercise was to blame.

For women your physician has even more options:

• Medication to help the bladder empty more fully during urination. Other drugs tighten muscles and lessen leakage.
• Some women find that using an estrogen vaginal cream may help relieve stress for urgent continence. A low dose of estrogen cream is applied directly to the vaginal walls and urethral tissue.
• A physician may inject a substance that thickens the area around the urethra to help close the bladder opening. Some women may be able to use a medical device such as a urethral insert, a small disposable device inserted into the urethra.
• Nerve stimulation which sends mild electric current to the nerves around the bladder to help control urination may be another option.
• Surgery can sometimes improve or cure incontinence if it is caused by a change in the position of the bladder.

Bottom line: Discuss this with your health care provider. Steward Medical Group and Sebastian River Medical Center have a world class urologist in your community.  Amr Fergany, MD is known world-wide for his advance’s treatments, surgical and non-surgical, for all urological conditions including surgical treatments for cancer.  To schedule your appointment, call (772) 918-4327.