Incontinence

Number of people affected:
Up to 30% of people aged 50 and over. Incontinence is particularly common among elderly women.

Who gets it:
At least 1 in 10 people age 65 or older has incontinence problems.

Symptoms:
Mild leaking to uncontrollable wetting

Treatments:
Medications, absorbent underclothing, an implant around the urethra, surgery

Doctors to see:
Urologist; Gynecologist

Loss of bladder control is called urinary incontinence. It can happen to anyone, but is very common in older people.

The body stores urine in the bladder. During urination, muscles in the bladder contract or tighten. This forces urine out of the bladder and into a tube called the urethra that carries urine out of the body. At the same time, muscles surrounding the urethra relax and let the urine pass through. Spinal nerves control how these muscles move. Incontinence occurs if the bladder muscles contract or the muscles surrounding the urethra relax without warning.

Incontinence can occur for many reasons. For example, urinary tract infections, vaginal infection or irritation, constipation, and certain medicines can cause bladder control problems that last a short time. Other problems include weak or overactive bladder muscles, blockage from an enlarged prostate, damage to nerves that control the bladder from diseases such as multiple sclerosis or Parkinson’s disease, or diseases such as arthritis that can make walking painful and slow.

Urinary incontinence is the accidental leakage of urine. It can happen when you cough or sneeze, or have a sudden urge to go to the bathroom but can't get there in time. Symptoms vary depending on the type of incontinence:

• Stress incontinence happens when urine leaks during exercise, coughing, sneezing, laughing, lifting heavy objects, or other body movements that put pressure on the bladder. It is the most common type of bladder control problem in women. It may begin around the time of menopause.
• Urge incontinence happens when people can’t hold their urine long enough to get to the toilet in time. Healthy people can have urge incontinence, but it is often found in people who have diabetes, stroke, Alzheimer’s disease, Parkinson’s disease, or multiple sclerosis. It is also sometimes an early sign of bladder cancer.
• Overflow incontinence happens when small amounts of urine leak from a bladder that is always full. A man can have trouble emptying his bladder if an enlarged prostate is blocking the urethra. Diabetes and spinal cord injury can also cause this type of incontinence.
• Functional incontinence happens in many older people who have normal bladder control. They just have a hard time getting to the toilet in time because of arthritis or other disorders that make moving quickly difficult.

The first step in treating a bladder control problem is to see a doctor. He or she will give your loved one a physical exam and take his or her medical history. The doctor will ask about symptoms and the medicines your loved one uses. He or she will want to know if your loved one has been sick recently or had surgery. Your doctor also may do a number of tests. including urine and blood tests, as well as tests that measure how well your loved one empties the bladder. In addition, your doctor may ask you to keep a daily diary of when your loved one urinates and when he/she leaks urine.

Treatments include:

• Bladder control training. With bladder training, seniors can change how their bladder stores and empties urine.
• A small, throwaway patch. A small, tampon-like urethral plug; or a vaginal insert for women with stress incontinence.
• Medications. Some drugs prevent unwanted bladder contractions. Some relax muscles, helping the bladder to empty more fully during urination. Others tighten muscles in the bladder and urethra to cut down leakage.
• An injectable implant into the area around the urethra. The implant helps close the urethra to reduce stress incontinence. Injections may have to be repeated after a time because the body slowly gets rid of these substances.
• Surgery can improve or cure incontinence if it is caused by a problem such as a change in the position of the bladder or blockage due to an enlarged prostate. Common surgery for stress incontinence involves pulling the bladder up and securing it.

At least 1 in 10 people age 65 or older has incontinence problems. Incontinence is more common in women. Aging alone does not cause incontinence, but it is more common among the elderly. It can occur for many reasons. For example, temporary bladder control problems can be caused by urinary tract infections, constipation, and certain medicines can contribute to bladder control problems. Sometimes incontinence lasts longer. This might be due to problems such as:

• Weak bladder muscles
• Overactive bladder muscles
• Blockage from an enlarged prostate
• Damage to nerves that control the bladder from diseases such as multiple sclerosis or Parkinson’s disease
• Diseases such as arthritis that can make walking painful and slow

There are many ways to make living with urinary incontinence easier.

• Monitor fluid intake. Keeping your loved one’s daily water intake to a quart or so -- may be all you need to do notice improvement. However, talk to your doctor before making any major changes in fluid intake.
• Pay attention to diet. Among foods and drinks that may worsen incontinence are alcoholic beverages, caffeine-containing foods and drinks, spicy foods, high-acid foods such as citrus fruits and juices, and carbonated drinks. If you notice symptoms of urinary incontinence worsen after your loved one has any of these foods or drinks, eliminating them or cutting back on them may make living with urinary incontinence easier.
• Use absorbent underclothing. It is not bulky and can be worn easily under everyday clothing.
• Be aware of the potential emotional toll of urinary incontinence. Incontinence can cause emotional distress and depression, particularly urge incontinence since it is so unpredictable. Monitor your loved one’s mental state, and talk to your doctor right away if you notice signs of depression.