Understanding and Managing an Older Loved One’s Urinary Incontinence

As we age, changes in our body can reduce how much urine our bladder can hold. The stream can become weaker and can cause us to feel the urge to urinate more often. Some people suffer from overactive bladder, which is characterized by urinary urgency and frequency. Others may also suffer from urinary incontinence, which is the loss of bladder control. It can range from leaking a small amount of urine, to having very strong urges to urinate that are difficult to control. Incontinence may be either a chronic or temporary problem.

Millions of adults in the United States experience urinary incontinence. It is most common in people over 50 years of age, especially women. Although the prevalence and incidence of urinary incontinence increases with advancing age in both men and women, it should not be considered part of the normal aging process (Emmons, K, Robinson, J. (2014) The Impact of Urinary Incontinence on Older Adults and Their Caregivers).

If we are caring for an older loved one with urinary incontinence, here are things we should know about the condition:

Types of Incontinence

Urge Incontinence: This is the sudden sensation of needing to urinate, most common in older adults. It is often associated with underlying neurological disorders like Parkinson’s Disease, multiple sclerosis or stroke.

Stress Incontinence: This involves leakage associated with physical activity that increases abdominal pressure, such as sneezing, coughing, laughing and lifting.

Overflow: This is when incomplete bladder emptying causes the bladder to leak.

Functional incontinence: This occurs when one has normal urine control, but has trouble getting to the bathroom in time. They may not be able to get to the bathroom because of arthritis or other diseases that make it hard to move around.

Causes of Urinary Incontinence

If a loved one is experiencing urinary incontinence, they should talk to their doctor and have an exam. The doctor will also need to know about a loved one’s medical history to determine the cause of the urinary incontinence.

Urinary incontinence in women may be caused by the drying and thinning of the skin in the vagina or urethra, especially after menopause. Another potential cause may be weakened and stretched pelvic muscles after childbirth. Urinary incontinence may be caused in men due to an enlarged prostate gland or as an after-effect of prostate surgery. Obesity is another potential cause in both sexes, as it increases pressure on the bladder.

Other factors that may cause urinary incontinence include: 

• Certain medications 
• Constipation
• Urinary tract infections 
• Vascular diseases 
• Diseases such as diabetes, Alzheimer’s and multiple sclerosis

Effects of Urinary Incontinence

Urinary Incontinence can have a negative impact on a loved one’s quality of life. They may become depressed and retreat socially, especially if they are worried about having an accident in a public setting. Many adults with incontinence also refrain from sexual activity or experience painful rashes. Helping our loved one cope with urinary incontinence can also be a stressful situation for us as caregivers. However, there are several methods we can discuss with a loved one’s doctor to help with their treatment:

Non-Surgical Treatments for Urinary Incontinence

Timed voiding: A loved one with urinary incontinence may be able to learn how to lengthen the time between urges to go to the bathroom. They can start by urinating at set intervals, such as every 30 minutes to 2 hours (whether they feel the need to go or not). Then, gradually lengthen the time between urinating (for example, by 30 minutes) until they’re urinating every 3 to 4 hours.

Kegel exercises: These consist of contracting and relaxing the muscles that form part of the pelvic floor. Making these muscles stronger can help a loved one hold the urine in the bladder longer. This is often thought of an exercise for women to do after childbirth, but men can benefit from it as well.

Lifestyle changes: If a loved one struggles with being overweight or obese, they can alleviate the symptoms of urinary incontinence through weight loss and use of a proper diet, especially one that avoids foods that irritate the bladder, like caffeine, alcohol and spicy foods. Before planning a diet, be sure to consult with a loved one’s doctor first.

Biofeedback: This treatment requires a pressure sensor to be placed in the urethra, vagina or rectum under a doctor’s care. The sensors will make a loved one aware of their body signals. Biofeedback can be helpful when learning pelvic muscle exercises and may help a loved one gain control over the muscles in the bladder and urethra.

Absorbent pad products: These products can help manage leakage and make it easier for a loved one to have social interactions and feel more confident. They can also assist with odor control.

However, we should be aware that using these products will not cure a loved one’s problem with incontinence.

Medical Treatments

The doctor may also treat urinary incontinence with medicine or medical devices, depending on the type of urinary incontinence.

Finally, if other treatments haven’t worked or the incontinence is severe, in some situations, the doctor may recommend surgery. This typically is for stress incontinence in women and in overflow incontinence in men due to an enlarged prostate.

Conversations About Urinary Incontinence

Urinary incontinence can be an embarrassing subject to discuss, and many older adults with the condition often do not seek evaluation or treatment because they are embarrassed or think that nothing can be done to help. Many are also afraid that surgery is the only option. However, it is important for us to encourage our loved ones to discuss any issues that are affecting their wellbeing. If we address urinary incontinence with a loved one and their doctor, we can help them find the cause and learn about their options.

A version of this article appeared in the Private Health News