Urinary incontinence is a medical term for accidentally leaking urine. It’s a widespread issue that affects people of every age and gender, though it’s more common with elderly women.
It’s safe to say that urinary incontinence is a sensitive issue that nobody really wants to talk about, making it even more challenging to address when the patient is an aging senior who is already dealing with the gradual loss of their independence.
The good news is that urinary incontinence is relatively easy to diagnose and treat thanks to a deep understanding of the underlying issues. With the help of the patient’s doctor, family members have a number of options to better care for their elderly loved ones.
The Four Types of Incontinence
According to the National Institute on Aging, there are four types of urinary incontinence:
- Stress incontinence
- Urge incontinence
- Overflow incontinence
- Functional incontinence
Stress incontinence takes place when pressure on the bladder leads to leaking urine. The pressure may be due to laughing, sneezing, coughing, exercising, or lifting something heavy.
Urge incontinence occurs when someone experiences a sudden need to urinate but cannot hold their urine long enough to reach a toilet. This is particularly an issue with patients who are suffering from multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, diabetes, and stroke.
Overflow incontinence takes place when a person’s bladder is constantly full, leading to small amounts of leaking urine. You’ll often see this type of incontinence with diabetes patients, spinal cord injuries, and men with an enlarged prostate that’s blocking the urethra.
Unlike the other three types of incontinence, functional incontinence is more of an issue of mobility than bladder functionality. Patients may have normal bladder control, but another issue such as arthritis makes it difficult to move quickly and reach the toilet in time.
Common Causes of Urinary Incontinence
There are a variety of issues that may lead to urinary incontinence:
- Enlarged prostate that creates a blockage
- Mobility-related diseases like arthritis that make it difficult to reach a toilet in time
- Nerve damage from diseases like diabetes, multiple sclerosis and Parkinson’s
- Overactive bladder muscles
- Pelvic organ prolapse
- Weak bladder muscles
- Weak pelvic floor muscles
When the patient is male, incontinence is often linked to the prostate gland. In such cases, urinary incontinence is usually due to prostatitis, an enlarged prostate gland, or internal damage from an injury or surgery.
Some medications may temporarily cause urinary incontinence. Common ailments such as constipation and urinary tract infections can also lead to incontinence.
Diagnosing Urinary Incontinence with Elderly Patients
While it seems fairly intuitive to recognize issues with urinary incontinence, you’ll need to visit a doctor to diagnose the issue that’s actually causing the leaking urine. Remember, you want to treat the underlying problem, not just the symptoms.
The doctor will perform a physical examination and take the patient’s medical history. The doctor will ask about the patient’s symptoms, evaluate their medication regimen, and discuss recent illnesses and surgeries.
In anticipation of these questions, it helps tremendously to keep a daily diary of the senior’s urinary incontinence issues and bring the diary with you to the doctor’s appointment. If not, plan on getting this bit of homework from the doctor at the end of the appointment.
In many cases, the doctor will ask for urine and blood tests. There are also medical tests that measure how well the patient can empty their bladder.
Finally, the senior’s family physician may refer the patient to a urologist who specializes in urinary tract problems.
What Can Be Done for Incontinence in the Elderly
Once you’ve taken the appropriate steps to diagnose the issues behind the senior’s urinary incontinence, the doctor will help you to create a care plan based around the following treatment methods:
- Lifestyle changes
- Pelvic muscle exercises
- Timed voiding
Making minor lifestyle changes is often the first step in a urinary incontinence treatment plan. Your doctor may advise you to quit smoking, lose weight, abstain from drinking alcohol and caffeine, and refrain from lifting heavy objects.
Pelvic Muscle Exercises
Often referred to as Kegels, pelvic muscle exercises strive to strengthen the muscles that you use to urinate. Increased muscle control can help you hold the urine in your bladder longer and avoid accidental leaks.
Biofeedback is often used in conjunction with pelvic muscle exercises to help you become aware of the signals from your body. The goal is to help you regain control over the muscles in your bladder and urethra.
Timed voiding is a simple yet effective way to address urinary incontinence. The idea is to urinate on a set schedule, which you can gradually extend as you regain control of your bladder.
When paired with Kegel exercises and biofeedback, timed voiding can make it easier to control overflow and urge incontinence.
Medical Treatments to Manage Urinary Incontinence
In addition to implementing the previously mentioned bladder control training methods, your doctor may recommend one of the following treatments:
- Applying estrogen vaginal cream directly to the vaginal walls and urethral tissue
- Injections that thicken the area around the urethra to help close the bladder opening
- Medical devices like a urethral insert or pessary
- Medication that helps the bladder tighten muscles or empty fully during urination
- Nerve stimulation
Keep in mind that even after a successful treatment, elderly patients may still leak urine from time to time. When this occurs, it helps to apply an over-the-counter option like adult diapers, furniture pads, urinary deodorizing pills, and special skin cleansers.
Is Urinary Incontinence a Sign of Alzheimer’s Disease?
Seniors with late-stage Alzheimer’s disease often suffer from urinary incontinence. Dementia patients may forget to go to the bathroom, not realize they need to urinate, struggle to reach the bathroom on their own, or forget where the toilet is.
To minimize the chance of accidents, caregivers should take the following precautions with dementia patients suffering from urinary incontinence:
- Avoid caffeinated beverages like coffee, soda, and tea
- Maintain a clean, clear and well-lit path to the bathroom
- Plan regular bathroom breaks
- Provide underwear that’s easy to remove
- Utilize absorbent underclothes like adult diapers when traveling
Even if the dementia patient is experiencing severe urinary incontinence, caregivers should not limit water intake. This may seem counter-intuitive, but keeping the aging senior hydrated is far more important than limiting accidents.