What is urinary incontinence?
If you frequently lose urine by accident, you have some type of urinary incontinence. You also have plenty of company. As many as 35 percent of older people living on their own have some degree of incontinence, and the rate is much higher in nursing homes.
Incontinence isn't just a nuisance. Many older people give up golfing, bridge club, drives to see the grandkids, and other favorite activities for fear of an accident. The condition can harm your self-esteem and lead to loneliness and depression.
Some people are so embarrassed by urinary incontinence that they won't even tell their doctor about the problem. That's unfortunate, because proper medical care can help many older people regain control of their bladders. Incontinence isn't necessarily a sign that you've grown old and feeble -- it's a medical condition that's most often easy to treat.
What are the different types of incontinence?
Urge incontinence. Most older people who have trouble holding their urine suffer from this type of incontinence, also known as overactive bladder. The muscular wall of their bladder contracts many times throughout the day, creating a sudden and urgent need to urinate even though the bladder isn't full. Small amounts of urine often escape before a person can make it to the toilet.
Bladders naturally grow more twitchy with age, but many factors can make urge incontinence worse. The condition is particularly common in stroke survivors and people with Parkinson's disease, some forms of cancer, multiple sclerosis, urinary tract infections, or, in men, an enlarged prostate.
Overflow incontinence. Many seniors are incontinent for the opposite reason: Their bladder doesn't contract completely. The flow of urine slows to a trickle, and the bladder never feels empty. This condition, called overflow incontinence, can also occur when there's an obstruction of the tube that carries urine out of the bladder (the urethra). Many people with this syndrome produce a frequent or even constant dribble of urine.
Anything that deadens the nerves controlling the bladder -- including diabetes, prostate surgery, and medications such as narcotic painkillers and sedatives -- can cause overflow incontinence. The condition can also be a side effect of medications prescribed to control tremors and drugs that manage hypertension (calcium channel blockers such as diltiazem). Over-the-counter drugs such as antihistamines can also contribute to this type of incontinence. In men, overflow incontinence often occurs because an enlarged prostate is blocking the flow of urine.
Stress incontinence. Many women have a bladder control problem called stress incontinence, which means they often lose small amounts of urine when they laugh, sneeze, cough, or exercise. Older women are especially prone to this condition because drops in estrogen can weaken the tissues that hold back urine.
What can I do to overcome incontinence?
If you have any trouble controlling urine, schedule an appointment with your family doctor, urologist, or geriatrician. A doctor can determine your particular type of incontinence (or sometimes more than one type), check to see which conditions or medications might be causing the problem, and, most important, help you find a way to regain control.
In many cases, simple lifestyle changes are enough to overcome incontinence. If you have an overactive bladder, your doctor may suggest establishing a regular schedule for both drinking and urinating to retrain your bladder.
For the ultimate in simple remedies, women with stress incontinence can prevent many accidents by crossing their legs when they laugh, cough, or sneeze. Other quick fixes include cutting back on caffeine and alcohol, urinating before you leave the house or go to bed, and urinating frequently whether you feel the need or not.
Women with stress incontinence often benefit from Kegel exercises, which strengthen the muscles of the pelvic floor. These are the muscles you use to stop your urine in midflow. Squeeze them 10 to 20 times in a row, holding each squeeze for 10 seconds, and repeat the sequence three times each day. Nearly 80 percent of all women who try the exercises say their incontinence is markedly improved or even cured within eight weeks.
Some people also swear by Pilates when it comes to a muscle-strengthening regimen as a prevention measure. While the evidence for Pilates is anecdotal at best, what doctors know for certain is that physical activity in general does reduce your risk of developing incontinence in the first place.
Meanwhile, many seniors can stay mobile and active with the help of absorbent pads that fit into their underwear or even adult diapers; these are available without prescription in drugstores and supermarkets. With the use of these aids, many seniors have resumed their former activities, including traveling and going to dances. Wear dark, loose-fitting clothing to help hide any stains, advises the Cleveland Clinic, which also recommends you use barrier cream.
And if self-help measures aren't enough, your doctor has many ways to help, which may include drug therapy.
National Association for Continence http://www.nafc.org
An organization founded for those who suffer from incontinence.
Simon Foundation http://www.simonfoundation.org
A nonprofit organization that publishes a newsletter on incontinence treatments and research.
National Association for Continence. Can medications I take affect my bladder or bowel control? http://www.nafc.org/bladder-bowel-health/frequently-asked-questions/#Question2
Mayo Clinic. Urinary Incontinence. http://www.mayoclinic.com/health/urinary-incontinence/DS00404
Duong TH, Korn AP. A comparison of urinary incontinence among African American, Asian, Hispanic, and white women. Am J Obstet Gynecol;184(6):1083-6.
Dugan E, Roberts CP, Cohen SJ, Preisser JS, Davis CC, Bland DR, Albertson E. Why older community-dwelling adults do not discuss urinary incontinence with their primary care physicians. J Am Geriatr Soc; 49(4):462-5.
Elliott DS, Lightner DJ, Blute ML. Medical. Management of overactive bladder. Mayo Clin Proc.;76(4):353-5.