Urinary incontinence, or involuntary leaking of urine, is a problem for at least 30% of people over age 60. It is more common in women than in men and can range from occasional dribbling to total loss of bladder control. What can you do?
You should start by sensitively discussing the problem with the older person. Many people who have incontinence do not tell their health care provider because they are embarrassed or they feel it is not a major problem. The first step to help them accept that they have a problem is by discussing it with tact and sensitivity. Whether the incontinence is mild or severe, everyone with incontinence should be seen by a healthcare professional. A medical condition might be causing the incontinence and, if so, this should be treated. Incontinence is almost always treatable with bladder training, pelvic muscle exercises, medications, and surgery. Sometimes it can even be cured .
There are 4 common types of incontinence:
- Stress incontinence is when urine leaks out involuntarily during coughing, laughing, bending, or other activities that apply pressure to the abdomen. It is most common in women but can also occur in men. Common causes are weak muscles around the bladder opening as a result of surgery, childbirth, or lack of estrogen after menopause. “Stress” incontinence has nothing to do with emotional stress.
- Urge incontinence is when urine leaks while having the sudden urge to go to the bathroom, but not being able to reach the toilet, commode or urinal. People with urge incontinence often have an overactive bladder muscle. Bladder overactivity can also cause frequent urination and awakening at night to urinate (nocturia). When urge incontinence occurs, the bladder contracts with little or no warning and urine leaks as a result. It can be caused by illnesses such as stroke, Parkinson’s disease, bladder infection, and disorders that affect the spinal cord.
- Overflow incontinence is when urine leaks from a full bladder that does not fully empty during voiding, leading to chronic retention of urine. This condition can be due to damage to the nerves that control the bladder-from diseases such as diabetes mellitus or injuries to the spinal cord-that make the bladder too weak to empty. It can also result from conditions that block the bladder opening and prevent the bladder from emptying, such as an enlarged prostate in men.
- Functional incontinence occurs when the bladder and the urethra are functioning normally, but the person either cannot physically get to the toilet, or has impaired mental function that interferes with recognizing the need to urinate and getting to the toilet on time. This condition is common in patients with Alzheimer’s and other types of dementias.
Your goals are to:
- Have the older person evaluated by a health care provider no matter how small the problem appears.
- Schedule bathroom trips or, if necessary, provide a urinal or commode to make reaching the toilet easier.
- Encourage bladder training and Kegel exercises.
- Encourage changes in diet and fluid intake.
- Take care of constipation – pressure from hard stool in the rectum can make urinary incontinence worse.
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