It is estimated that more than one in eight older adults in Canada experiences some type of bladder control problem, resulting in an involuntary release of urine. This condition is known as urinary incontinence. It is not a disease in itself, rather it's a symptom of some other disorder in the body.
Incontinence can have devastating effects on the lives of the people experiencing it. It can limit social outings due to fear and embarrassment, can negatively affect feelings of well-being and self-esteem, and can also cause mental and emotional stress, leading to other health problems. Fortunately, there are a number of treatment options that can help improve the quality of life for people with bladder control problems.
There are four types of incontinence: stress, urge, overflow and functional. They may occur alone, or in combination, especially in older adults.
Stress incontinence is the involuntary leakage of small amounts of urine in response to increased pressure in the abdomen (e.g., when you sneeze, laugh, cough or lift something heavy). It is present in about 35% of incontinent seniors. It is more common in women, often because childbirth loosens the pelvic floor muscles. It also occurs, usually temporarily, in men who have had prostate surgery.
Urge incontinence is the leakage of large amounts of urine when someone is unable to reach the toilet in time after feeling the urge to urinate. It accounts for 60-70% of incontinence problems in older adults.
Overflow incontinence accounts for 10-15% of urinary incontinence. It occurs when there is an obstruction in the bladder, which causes the bladder to overfill. Often, there is no sensation that the bladder is full. Then, when the bladder contracts, urine is released.
Functional incontinence accounts for 25% of the incontinence seen in institutions. It often happens because a person has mobility issues or disabilities. Poor vision, hearing or speech may delay access to a toilet. This type of incontinence can also occur in the home.
The first step in treating incontinence is to see your doctor. Your doctor will ask about your symptoms and the medicines you use. They will want to know if you have other health issues or have had surgery recently. Your doctor also may also order some tests to confirm the diagnosis.
Once you have been diagnosed with urinary incontinence, your doctor will help you choose a treatment option. The choice of treatment depends on the type of bladder control problem you have, how serious it is, and what best fits your lifestyle along with personal preference. Your doctor may suggest you try the following conservative treatment options:
Pelvic floor muscle exercises (also known as Kegel exercises) strengthen 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.
Timed voiding or bladder retraining may help you control your bladder. In timed voiding, you urinate on a set schedule, for example, every two hours. You can slowly extend the time between bathroom trips. When timed voiding is combined with biofeedback and pelvic muscle exercises, it helps control urge and overflow incontinence.
Lifestyle changes may also help with incontinence. Losing weight, quitting smoking, staying away from alcohol, limiting caffeine intake, preventing constipation and avoiding lifting heavy objects may help control incontinence. Choosing water instead of other drinks and limiting drinks before bedtime may also help. Modifying your surroundings so it is easier to reach the toilet (e.g., installing a higher toilet seat or bathroom grab bars) and making sure your clothing is easy to remove or undo helps too.
Less conservative options include medication and surgical treatments, such as bladder suspension, artificial sphincter and collagen injections. Some women find that using an estrogen vaginal cream may help relieve stress or urge incontinence. A low dose of estrogen cream is applied directly to the vaginal walls and urethral tissue.
Even after treatment, some people still leak urine from time to time. There are bladder control products and other solutions, including adult diapers, furniture pads, urine deodorizing pills, and special skin cleansers that may make leaking urine less bothersome.
I can imagine how challenging it can be for someone to carry on with their life while dealing with urinary incontinence. At in4MED, we can make this difficult time easier by providing you with information about your condition, connecting you to local support systems and being there for you as your trusted health advocates. As always, feel free to connect with me or leave a comment.
Healthcare Consultant, in4MED
Urinary Incontinence in Older Adults - National Institute on Ageing https://www.nia.nih.gov/health/urinary-incontinence-older-adults
Urinary Incontinence in the Elderly - The Ochsner Journal https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116748/
Managing urinary incontinence in older people - The BMJ https://www.bmj.com/content/341/bmj.c3835
Seniors and Aging - Bladder Control Problems (Incontinence) https://www.canada.ca/en/health-canada/services/healthy-living/your-health/medical-information/seniors-aging-bladder-control-problems-incontinence.html
The author of this blog post is a Physician with over 10 years of experience working in the healthcare system as a clinician, researcher and educator. She is passionate about healthcare for older adults and strives to be a resourceful inspiration to caregivers.
*No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified healthcare professional.