What To Do About Urinary Incontinence
In this section, Ill review what you and your healthcare provider can do to prevent, diagnose, and treat incontinence.
Urinary incontinence, like most syndromes affecting older adults, is rarely simple. Dr. Wagg shared that The maintenance of continence in later life isnt just about staying dry. Its about successful toileting, and that requires quite a lot of adequate functioning of many different systems. Some of the management options depend on the type of incontinence, but there are some approaches that are likely to help in any case.
Reasons For Loss Of Bladder Control:
- Vaginal infections
- Damage to nerves that control the bladder from diseases such as multiple sclerosis or Parkinson’s disease
- Diseases such as arthritis that make walking to the bathroom painful or slow
- Confusion regarding the toileting process because of cognitive decline
- Loss of awareness of the need to urinate due to dementia or Alzheimer’s
Surgical Options For Urinary Incontinence
About 285,000 incontinence procedures are performed annually, up 7.5% from 2015. If other treatment methods dont work, surgery may help.
These are common surgical procedures for urinary incontinence:
For women, this supports a womans urethra by placing abdominal tissue or synthetic materials beneath it. For men, it involves making a cut between the scrotum and anus. Complications can include not being able to empty ones bladder fully. However, this surgery is generally preferred because its well-known and has a history of long-term success.
For stress incontinence, a cut is made into the lower stomach, and the bladder is lifted and stitched. The surgery can also be performed through one or more small cuts using surgical instruments, which is called a laparoscopic colposuspension. Both procedural types can help prevent long-term incontinence.
Artificial urinary sphincter
This is generally used for men with stress incontinence. A device is placed around the neck of the bladder. This fluid-filled, doughnut-shaped device holds the sphincter closed and is attached to a valve implanted in the testicles or, when used in women, the labia. To urinate, one presses the valve twice and the bladder empties.
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Treatment Of Urge Incontinence
The anticholinergic agents oxybutynin and tolterodine are used widely to treat urge incontinence. These medications are not, however, the most effective therapies. Behavior therapies are more effective, and theynot medicationsshould be first-line treatment.
Behavior therapies for urge incontinence include bladder training and pelvic floor muscle exercises. Bladder training is more effective than oxybutynin and improves incontinence in more than 50 percent of patients.6 Kegel exercises are even more effective. In a randomized controlled trial 7 comparing Kegel exercises with oxybutynin in patients with urge incontinence, patients performing Kegel exercises had an 81 percent reduction in incontinence episodes compared with a 69 percent decrease in oxybutynin-treated patients, a statistically significant difference.
Although biofeedback commonly is used to help patients learn effective Kegel technique, evidence suggests that biofeedback training does not result in decreased frequency of incontinence episodes compared with Kegel exercises alone.8 Physicians should keep in mind that successful use of Kegel exercises is dependent on a patients motivation and ability to cooperate with the exercise routine.
One patch twice weekly
86 to 95
Incontinence In Older Adults: The Role Of The Geriatric Multidisciplinary Team
Urinary and fecal incontinence are very common in the geriatric population, yet many patients and health care practitioners wrongly consider incontinence a normal part of aging.
Older adults require an incontinence assessment that includes a review of physical, psychological, and social health. Functional status, quality of life, and goals of care must also be considered. Quality of life for older patients can be improved with the help of a nurse continence advisor , a pelvic floor physiotherapist, a geriatrician, and other health professionals skilled in the assessment, diagnosis, and management of urinary and fecal incontinence.
The nurse continence advisorThe nurse continence advisor is a registered nurse who has recognized education, training, and certification in continence management. The NCA focuses on conservative and holistic strategies for managing incontinence and related symptoms, including urinary urgency, frequency, and nocturia, and fecal incontinence and constipation. This nursing specialty was developed in Great Britain in the 1970s in response to long wait lists to see urological specialists, and was introduced in Canada in 1995 by the Ontario Ministry of Health.
This article has been peer reviewed.
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How Do Procedures Pinpoint A Diagnosis
If the previous tests and exams dont point to a diagnosis, the patient could undergo one of these procedures:
Bladder ultrasound and post-void residual
After urination, an ultrasound wand is placed on the abdomen, creating a bladder scan to show if any urine remains in the bladder. This procedure usually takes around five to 10 minutes, and a catheter may also be placed into the bladder to drain and measure any urine left.
A catheter is inserted, through which dye is injected into the bladder. An X-ray is then taken while the patient urinates, highlighting the urinary tract system. X-rays of the kidney, ureter, and bladder will be taken so the urinary system is completely visible.
A catheter fills the bladder with water to measure the pressure in the bladder when its at rest, when its filling, and when it empties. This test looks at the anatomy of the urinary tract, the bladders functioning ability, and capacity of the bladder, as well as what sensation the patient feels.
The doctor views the patients bladder through a bladder scope, which acts like a telescope. It is used to check for capacity, tumors, stones, or cancer.
Addressing Urinary And Bladder Control Issues
Treating incontinence in older dogs isn’t a one-size-fits-all solution. It depends on the underlying cause of the problem. Some of the most common treatments for old dog bladder control issues include:
- Hormone therapy: Since hormonal imbalances are often at the root of bladder control issues, hormone therapy is a common method to manage the condition. Pets undergoing hormone therapy will usually need blood work performed on a regular basis to make sure the hormones aren’t causing any negative side effects.
- Phenylpropanolamine: Also known as PPA, phenylpropanolamine is a medication widely used in veterinary medicine to manage bladder issues . It’s well-tolerated by most pets and helps combat poor muscle tone in the urethral sphincter.
- Surgery: In some cases, surgical treatments can treat incontinence. A procedure known as colposuspension involves injecting a bulking agent like collagen into the urethra to help urine flow more smoothly. In the case of spinal injury or a bulging disc, surgical intervention can solve the problem.
- Diet adjustments or supplementation: Some dogs can benefit from dietary modifications that make things like bladder stones and UTIs less likely.
Most dogs respond well to therapy and medication. These steps, coupled with proper management at home and a great senior diet, can help your dog continue to enjoy a good quality of life as they age.
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Is Incontinence More Common In Women
Incontinence is much more commonly seen in women than in men. A large part of this is because of pregnancy, childbirth and menopause. Each of these events in a womans life can lead to bladder control issues. Pregnancy can be a short-term cause of incontinence and the bladder control issues typically get better after the baby is born. Some women experience incontinence after delivery because of the strain childbirth takes on the pelvic floor muscles. When these muscles are weakened, youre more likely to experience leakage issues. Menopause causes your body to go through a lot of change. Your hormones change during menopause and this can alter your bladder control.
Men can also experience incontinence, but it isnt as common as it is in women.
Treatment Of Oab In Older Patients
Conventional treatment for OAB with conservative and lifestyle measures in combination with antimuscarinic pharmacotherapy is effective in older people. In direct contradiction to the usual geriatric paradigms of prescribing, older people: are more likely than young to require, and ask for, medication for their bladder problem appear to require higher doses of medication , and, despite higher reported rates of adverse events, are more adherent to their medication than younger users.
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Causes Of Urinary Incontinence
Incontinence can happen for many reasons. For example, urinary tract infections, vaginal infection or irritation, constipation. Some medicines can cause bladder control problems that last a short time. When incontinence lasts longer, it may be due to:
- Weak bladder muscles
- Overactive bladder muscles
- Weak pelvic floor muscles
- Damage to nerves that control the bladder from diseases such as multiple sclerosis, diabetes, or Parkinsons disease
- Blockage from an enlarged prostate in men
- Diseases such as arthritis that may make it difficult to get to the bathroom in time
- Pelvic organ prolapse, which is when pelvic organs shift out of their normal place into the vagina. When pelvic organs are out of place, the bladder and urethra are not able to work normally, which may cause urine to leak.
Most incontinence in men is related to the prostate gland. Male incontinence may be caused by:
- Prostatitisa painful inflammation of the prostate gland
- Injury, or damage to nerves or muscles from surgery
- An enlarged prostate gland, which can lead to Benign Prostate Hyperplasia , a condition where the prostate grows as men age.
Overactive Bladder In The Vulnerable Elderly
Accepted for publication 26 June 2014
3 October 2014Volume 2014:6 Pages 131138
Urinary symptoms such as urgency/frequency and incontinence become increasingly prevalent with aging.1,2 A large multinational population-based survey estimated the prevalence of overactive bladder in Europe and Canada to be 12.8% in women and 10.8% in men.2 The NOBLE study showed similar trends in the USA, with OAB being twice as prevalent in individuals over 65 years of age than in those aged 45 years or younger.3 Urinary symptoms have a considerable negative impact on quality of life and health in the elderly,4,5 and have been shown to be associated with increased risk of falls and fractures.6,7 Costs associated with urinary symptoms in the aged are significant.8,9 With the aging of the population, it is estimated that by 2025 there will be 52 million adults in the USA with lower urinary tract symptoms.10 Thus, the burden of these symptoms on society is increasing.
Vulnerable or frail elderly
Evaluating OAB in the vulnerable elderly
Figure 1 Conceptual relationship of clinical factors.Notes: Symptoms, measurable function, and morbidity related pathophysiology, their evaluation and any treatments are related concerns which must be identified, clarified, and prioritized. While this sometimes-subtle distinction is always important, it assumes greater importance in the vulnerable elderly.
Who is the patient?
What are feasible treatment options?
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Timed Voiding And Bladder Training
This technique can help your aging parent control their bladder by charting urination and leaking to determine the pattern. Once you see a pattern, help your parent to the bathroom at those times to empty the bladder before they might leak. When combined with biofeedback and pelvic muscle exercises, these methods may help your parent control urge and overflow incontinence.
Elderly Incontinence: What You Need To Know Treatment Options And Tips For Care
For many people, a trip to the bathroom is something that can easily be delayed. But for 33 million Americans who experience bladder leakage daily, its not that simple.
Urinary incontinence isnt something your loved one should simply accept or live with, according to the NAFC. In fact, there are many effective ways to treat elderly incontinence regardless of its cause. Learn more about the causes, types, treatment options, and more.
Talk With A Senior Living Advisor
Our advisors help 300,000 families each year find the right senior care for their loved ones.
Pelvic floor muscle exercises
Called Kegels, these exercises strengthen the muscles that help regulate urination. Usually one needs to practice these a few times a day, every day. Learning how to contract the right muscles can be confusing, but your medical provider or this step-by-step guide to performing Kegel exercises can help.
Fluid and diet management
Although diet alone cant cure urinary incontinence, it can improve bladder control. Certain beverages like carbonated drinks and alcohol can cause your bladder stress. Even drinking coffee or tea while taking prescribed medication can aggravate it. Additional bladder irritants to avoid include milk, tea, honey, soda, and very spicy foods.
Spinal Cord Issues Or Damage
It’s possible for spinal cord damage physical trauma or a protruding disc, for instance to cause bladder control issues in older dogs. Since the nerves that control most of your dog’s muscle movements run through the spine, spinal injuries can result in reduced muscle control, including the muscles of the urinary system.
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Pelvic Muscle Exercises: Kegels
This exercise works the muscles that you use to stop urinating. These muscles are the ones used to stop the flow of urine or to keep from passing gas. Making these muscles stronger helps your parent hold urine in their bladder longer. These exercises are easy to do. They can lessen or get rid of stress and urge incontinence.
Often doctors suggest that your parent squeeze and hold these muscles for a certain count, and then relax them. Then repeat this a number of times. Your parent will probably do this several times a day. Your doctor will give you exact directions.
What Are Common Bladder Irritants
Before you find out what products to buy, it is important to learn more about the bladder itself. After all, most of us dont know enough about organs and their functions. The bladder is a muscular sac in the pelvis located right above and behind the pubic bone.
When its empty, the bladder resembles a pear in shape and size. On the other hand, when its full your bladder expands. The inner lining of the bladder tucks into the folds and it expands to accumulate the fluid i.e. urine.
Kidneys make urine which then travels to the bladder via tubes called ureters. The urine is stored in your bladder. During urination, muscles in the bladder squeeze, and two sphincters open to allow urine out. On its way out of the bladder, the urine goes through the urethra, a tube that carries it out of your body. Men have a larger urethra than women because it passes through their penis.
Weak bladder control is a frequent problem that happens due to a wide array of causes. Some of the most common causes of weak bladder control include:
- Stay hydrated drink enough fluids, particularly water
- Take enough time to empty your bladder completely
- Urinate after sex
- Wear loose-fitting clothes and cotton underwear
Bladder control requires some lifestyle adjustments, but sometimes you need more than that. This is where bladder control products step in. They help you get rid of the unpleasant symptoms and urgent urination in an entirely natural manner.
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Overactive Bladder Treatment For Seniors
Overactive Bladder Treatment for Seniors
Overactive bladder is a huge inconvenience to seniors because it gets in the way of everyday life. There are about 33 million Americans suffering from the condition. You search for the restroom whenever you get somewhere, or you might not even go because your symptoms may get in the way. You may start to realize that many of your relationships are strained. The problem is that many do not talk to their doctor about it because they are either embarrassed, or they do not think there are treatments available for them. OAB is not just a part of getting older it is a group of urinary symptoms that affect millions of Americans.
Aging Changes In The Kidneys And Bladder
The kidneys filter the blood and help remove wastes and extra fluid from the body. The kidneys also help control the body’s chemical balance.
The kidneys are part of the urinary system, which includes the ureters, bladder, and urethra.
Muscle changes and changes in the reproductive system can affect bladder control.
AGING CHANGES AND THEIR EFFECTS ON THE KIDNEYS AND BLADDER
As you age, your kidneys and bladder change. This can affect their function.
Changes in the kidneys that occur with age:
- Amount of kidney tissue decreases and kidney function diminishes.
- Number of filtering units decreases. Nephrons filter waste material from the blood.
- Blood vessels supplying the kidneys can become hardened. This causes the kidneys to filter blood more slowly.
Changes in the bladder:
- The bladder wall changes. The elastic tissue becomes stiffer and the bladder becomes less stretchy. The bladder cannot hold as much urine as before.
- The bladder muscles weaken.
- The urethra can become partially or totally blocked. In women, this can be due to weakened muscles that cause the bladder or vagina to fall out of position . In men, the urethra can become blocked by an enlarged prostate gland.
In a healthy aging person, kidney function declines very slowly. Illness, medicines, and other conditions can significantly degrade kidney function.
Aging increases the risk of kidney and bladder problems such as:
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How To Deal With Elderly Incontinence: A Practical 5
Lets be honestdiscussing private physical issues can be embarrassing at times. As a society, we often feel squeamish at the prospect of having open discussions about incontinence. So lets talk about how to deal with elderly incontinence.
But weve got to do our best to work through any awkward feelings, and the reason why is clear
Over 50% of people aged 65+ report bladder and/or bowel incontinence.
With this in mind, weve put together a five-step guide on how to deal with elderly incontinence. This will be an ideal read if youre:
a) an older adult who wants advice on managing bladder/bowel issues
b) a family member caring for someone with incontinence
Heres a quick summary of what well be covering
What causes elderly incontinence?
The 3 types of urinary incontinence
The 2 types of bowel incontinence
What is incontinence care & management?
Where can I find elderly incontinence products?
If youre a visual learner, the top tips graphic below may be a helpful place to start:
What Causes Elderly Incontinence?
A range of factors can lead to bowel and bladder problems, but a common challenge that older adults face is functional incontinence. What exactly does functional mean in this context, you may be wondering?
Cognitive, mobility, and sensory limitations can stop elderly people from accessing a toilet when they need it. This could be due to poor eyesight, arthritis, or other health issues. Environmental factors can also play a role.