Loss Of Bladder Control In Elderly

What Is Urinary Incontinence Symptoms Causes Diagnosis Treatment And Prevention

Urinary incontinence , the involuntary loss of urine, is a very common condition that no one wants to talk about. Because of the stigma that surrounds it, many people are too humiliated to seek help. But most conditions that cause UI can be corrected with medical or alternative interventions.

Occurring much more often in women than men, UI happens when the muscles in the bladder that control the flow of urine contract or relax involuntarily, resulting in leaks or uncontrolled urination. UI itself is not a disease, but it can be a symptom of an underlying medical issue.

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Temporary Loss Of Bladder Control

Some food items, beverages and even medication may act as diuretics and increase the urine output.

They could be caffeine, alcohol, soda, chocolate, chilli peppers, spicy food, sweet or acidic food items like citrus fruits, high doses of vitamin C, heart and BP medications, sedatives and muscle relaxants.

Other reasons that can cause temporary urinary continence include

Urinary Tract Infection- An infection in your bladder can cause sudden urges to urinate and lead to urinary incontinence.

Constipation The formation of hard stool in your rectum can put pressure on the bladder nerves and increase the frequency of urination.

Persistent Loss of Bladder Control

Loss of bladder control can also be caused by physical problems or changes caused by

Pregnancy The hormonal changes in the womans body and the growing weight of the foetus can cause stress incontinence which creates an urge to urinate.

Childbirth A normal delivery can weaken the muscles needed for bladder control. It can damage the pelvic floor and can cause dislodgement in the position of the urethra leading to urinary incontinence.

Menopause -After the onset of menopause, women produce lower quantities of estrogen that keeps the lining of the bladder and urethra healthy. Deterioration of these tissues can increase incontinence.

Old age With old age, the bladder muscle can weaken, reducing the capacity to retain urine. Involuntary bladder contractions can increase with age and cause loss of bladder control.

Treating The Presumptive Diagnosis

If the basic evaluation identifies transient causes of incontinence, these causes should be treated . Similarly, if the basic evaluation reveals reasons for referral or specialized testing , these measures should be undertaken.

If neither of the above situations occurs and the physician can make a presumptive diagnosis of stress or urge incontinence , appropriate treatments can be instituted. While a detailed discussion of treatments for urinary incontinence is beyond the scope of this article, the basic treatments are outlined in Table 5.19,20 In general, behavioral therapies are first-choice treatments. For urge incontinence in particular, behavioral therapies are the most effective treatments available.1,19 Medication is used secondarily, often as an adjunct to behavioral treatments. Surgical interventions are an option in properly selected patients, especially those with stress incontinence.

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How A Health Professional Can Help

The first health professional that youre likely to talk to about incontinence is your primary care provider, but they may refer you to another physician or professional who can better help. Urologists and gynecologists are surgeons who see men and women for incontinence, and nurse continence advisors can run specialized interprofessional clinics.

Diagnosing the cause of incontinence

What your doctor will ask about: The treatment of incontinence depends on the cause of the symptoms, which your doctor will evaluate by asking questions, doing a physical examination, and probably order a few preliminary investigations.

Your doctor will review your personal medical history, especially any history of prostate surgery for men, and for women, the history of any pregnancies and number and types of births. Lifestyle issues like smoking, alcohol intake, caffeine consumption, exercise , and body weight are likely to come up.

A careful review of the patterns of incontinence will help to determine the cause of urine loss.

To review, three common patterns of urinary incontinence are:

• Stress: if you lose urine when doing certain activities,
• Overflow: you lose urine all the time in a dribble,
• Urge: feeling an urgent need to get to the toilet that you sometimes cant meet,

In older adults, its common for there to be a mixture of more than one pattern .

Your doctor will want to know:

The physical examination

Tests

Urinary Incontinence In Women: What You Need To Know

• Urinary incontinence is the accidental loss of urine.

• Over 25 million adult Americans experience temporary or chronic urinary incontinence.

• This condition can occur at any age, but it is more common in women over the age of 50.

• There are four types of urinary incontinence: urgency, stress, functional and overflow incontinence.

• Behavioral therapies, medications, nerve stimulation and surgery are some of the treatments available for managing urinary incontinence.

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What Can We Do About It

First off, go see a urologist. Ill do a physical exam, talk to you about your symptoms and how long theyve been going on, and run a test on your urine. If these dont give us a solid diagnosis of the problem, we may do other tests.

How we treat male incontinence is based on what we find out as the cause, and also on how much the control problems are affecting your life. At Urology Associates, we generally like to start with what you can do on your own and go from there.

If lifestyle changes dont solve your problems, we may move to medications. Some cases may require surgery, but not that many do.

• Nerve stimulation for OAB. Also called neuromodulation therapy, this involves implanting a small device under the skin near the tailbone that sends electrical impulses to the nerves going to the bladder. It acts like a heart pacemaker by controlling bladder contractions. Other neuromodulation therapies may also help.
• Sling surgery for severe urinary incontinence. A bulbourethal sling goes under the bulb part of the urethra and is secured to bone or muscle. This lifts up and compresses the urethra, helping it resist pressure from the abdomen.
• Urethral bulking. To prevent urine leakage, we close a hole in the urethra or thicken its wall by adding material to it.
• Adding an artificial sphincter. This is an inflatable silicone device we place around the urethra that acts like the sphincter muscle.

Common Causes Of Urinary Incontinence In Older Adults:

Heres a list of issues that a geriatrician would consider when sorting out incontinence in an older person. It makes a little mnemonic DIAPPERS:

Delirium a sudden change in thinking and alertness, caused by an underlying acute medical illness. When this condition is present, a person could be too drowsy or too confused to get to the toilet on time. For more on delirium, see here.

Infection When theres a urinary tract infection in an older adult, it can cause burning, pain, confusion, and also urinary frequency and urgency, and often incontinence.

Atrophic urethritis and vaginitis in women, shrinkage of the urinary and genital tissues leads to urinary incontinence, and can get better with topical hormone therapy .

Pharmaceuticals its not just diuretics, or water pills that can cause incontinence., but they do top the list .

Psychologic disorders especially depression, and delirium as mentioned above. Dementia can worsen incontinence, especially in the later stages when overall function is more severely impaired.

Excessive urine output this may be obvious if there are other symptoms like shortness of breath and swelling in the legs, but it may require lab tests or x-rays to diagnose these conditions.

Restricted mobility not getting to the bathroom on time because of arthritis or Parkinsons disease, for example, leads to more accidents

Mediations that can worsen urinary incontinence include:

• Some antidepressants
• Allergy medications

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Will I Have Incontinence For My Entire Life

Sometimes incontinence is a short-term issue that will go away once the cause ends. This is often the case when you have a condition like a urinary tract infection . Once treated, frequent urination and leakage problems caused by a UTI typically end. This is also true for some women who experience bladder control issues during pregnancy. For many, the issues end in the weeks after delivery. However, other causes of incontinence are long-term and related to conditions that are managed throughout your life. If you have a chronic condition like diabetes or multiple sclerosis, you may have incontinence for a long period of time. In those cases, its important to talk to your provider about the best ways to manage your incontinence so that it doesnt interfere with your life.

A note from Cleveland Clinic

It can be embarrassing to talk about bathroom habits with your healthcare provider. This embarrassment shouldnt stop you from treating incontinence, though. Often, your healthcare provider can help figure out the cause of your bladder control issue and help make it better. You dont need to deal with it alone. Talk to your healthcare provider about the best ways to treat incontinence so that you can lead a full and active life without worrying about leakage.

What To Expect At A Doctors Appointment For Urinary Incontinence

At your medical appointment, youll likely have:

• A urinalysis to rule out infection or blood in the urine
• Blood tests to check on kidney function, calcium, and glucose levels
• A thorough discussion of your medical history
• A complete physical exam, including a rectal and pelvic exam for women, or a urological exam for men

A patient may also be asked to bring a bladder diary to the first visit, or to create one before the second appointment.

In this journal, they will likely record:

• Types of drinks they consume
• Times they urinate throughout the day
• How much they urinate, which is measured by placing a special measuring cup over the toilet to record volume
• A description and frequency of their accidents

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How Is Loss Of Bladder Control Treated

Non-surgical treatments are often recommended to help treat bladder control issues. These include:

• Physical therapy and exercise
• Reducing intake of alcohol and caffeine
• Electrical stimulation of the nerves that control the bladder
• Bladder retraining by going to the bathroom at set times
• Kegel exercises to strengthen pelvic muscles
• Biofeedback to help patients learn to control the bladder muscles

Depending on the type of leakage and how bothersome it isand if patients do not respond to the non-surgical treatmentssurgery and other interventions can be very successful. In most cases, they can be done as an outpatient procedure.

Last reviewed by a Cleveland Clinic medical professional on 08/26/2015.

References

Incontinence In Older People

In some cases, older people have a higher risk of incontinence because of a medical condition, which may be treatable. Medical causes of incontinence in older people include:

• urinary tract infection this is where bacteria get into the tube that empties pee from the bladder out of the body. This can lead to infection of the bladder or kidneys. Symptoms can include a sudden urge to pee, pain or a burning feeling when peeing, a fever and urinary incontinence. A urinary tract infection can usually be treated with antibiotics
• constipation this is uncomfortable and makes both emptying and controlling the bladder more difficult. Constipation is also a very common cause of faecal incontinence. When the bowel gets full of very hard poo which cannot be passed, liquid poo can leak out from around the edges of the blockage. It is easy to confuse this with diarrhoea
• prostate gland problems these affect men, and may be treatable
• side effects of medication the GP may be able to address these by changing the persons prescription or altering the dose
• other gut conditions such as irritable bowel syndrome .

Many people find it embarrassing to talk about these problems, and this can stop them from seeking help from health professionals. GPs and specialists deal with issues like these frequently and its important to get advice and support from them. Medical causes can often be treated or managed.

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Helping With Personal Care And Elderly Incontinence

Incontinence is something which many elderly people experience, and yet it is a subject which is rarely discussed.

The fact that incontinence is considered to be a taboo subject means that large numbers of elderly people are left feeling ashamed, embarrassed and reluctant to ask for help. Yet the problem is a common one, with around a quarter of elderly people experiencing bladder issues and one-tenth facing bowel problems.

Bladder Control Problems In Elderly Men

Many men develop bladder control problems as they get older. Urine leakage, frequent urination and an urgent need to urinate are embarrassing symptoms to deal with, but they dont have to be unavoidable parts of aging. There are many successful treatment options available for bladder control problems in males.

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Tests And Diagnosis Of Male Urinary Incontinence

A urologist will begin the diagnosis by asking a series of questions about the symptoms. To help make a definitive diagnosis, a doctor will likely recommend:

• A urinalysis to check for signs of an infection or other abnormalities.
• Keeping a bladder diary to record the times and amounts of urination, along with any incontinence episodes.
• Performing post-void residual measurements, or urinating in a container that measures urine output and checking the amount of leftover urine in the bladder.
• Performing urodynamics a study of the coordination between the nerves, the bladder and the ability to sense.

What Is Diabetes

Our bodies turn a lot of the food we eat into sugar, called glucose, which gives us energy. To use glucose as energy, our body needs insulin, a hormone that helps glucose get into our cells. If you have diabetes, your body may not make enough insulin, may not use insulin in the right way, or both. That can cause too much glucose to stay in the blood, which can cause health problems over time. Your family doctor may refer you to a doctor who specializes in taking care of people with diabetes, called an endocrinologist. Often, your family doctor will work directly with you to manage your diabetes.

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How Can A Live

If your loved one is experiencing prolonged issues with incontinence, it may be worth considering private live-in care at home. A dedicated caregiver moves into your relatives home and offers a variety of elderly care services, encompassing everything from companion care to dementia care.

Caregivers are highly trained and empathetic, making it easier for families who are struggling to cope with incontinence issues on their own.

When choosing a carer for your loved one, its important to make sure that they will be compatible with your loved one, to ensure the best possible outcome for both parties.

Maintaining dignity in old age, and in the face of incontinence, can be extremely challenging, and it is important that your loved one feels happy and comfortable with their caregiver, as this ensures the most positive outcomes.

Related articles

Incontinence In The Elderly

Incontinence is the involuntary excretion of urine or feces. While incontinence can happen to anyone, its far more common in older adults. The Mayo Clinic Health System reports that up to 75% of women over age 65 report urine leakage. Additionally, 60-70% of people with Alzheimer’s eventually become incontinent. Although a multitude of older adults deal with incontinence issues, it is not a normal part of the aging process.

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Causes Of Lack Of Bladder Control In Dogs

Urethral disorders are the most common cause of loss of bladder control for dogs. The muscles that involuntarily close the urethra are weakened and unable to contract properly, leading to urine leakage. This occurs as a result of urinary tract infection, inflammation, hormone responsive urinary incontinence, a prostatic disease for male dogs and a vestibulovaginal anomaly in female dogs. Hormone-responsive urinary incontinence occurs in neutered and spayed female dogs and is seen most commonly in spayed females.

Other causes include:

What Causes Urinary Incontinence

Urinary incontinence is not an inevitable result of aging, but it is particularly common in older people. It is often caused by specific changes in body function that may result from diseases, use of medications and/or the onset of an illness. Sometimes it is the first and only symptom of a urinary tract infection. Women are most likely to develop urinary incontinence during pregnancy and after childbirth, or after the hormonal changes of menopause.

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Physiological Changes Associated With The Ageing Lower Urinary Tract

Urinary incontinence increases with rising age. Ageing is associated with changes in the lower urinary tract which predispose an elderly to UI. As we age, bladder capacity and contractility reduce, with reduced ability to defer voiding once the urge to do so arises. The post-void residual urine volume increases with age. During the storage phase, detrusor shows increased uninhibited contractility .

Among the elderly postmenopausal women, the pelvic muscles show loss of volume and tone. The ligamentous and connective tissue support for the pelvic organs gradually fail because of ageing. The weakened pelvic floor increases the risk of pelvic organ prolapse causing cystocele, rectocele and uterine prolapse. Stage 3-4 prolapse of pelvic organs can cause UI. A weakened pelvic floor also allows a hypermobile urethra to slide downwards during sudden increase in intraabdominal pressure .

Why Uti Is The Most Common Bladder Problem In Seniors

UTIs are one of the most common bladder problems among seniors. It is caused due to bacteria and there are several other reasons too for developing the risk of UTIs in older ones, such as:

• Having or had an UTI before
• Changes in the immune system
• Being exposed to various bacteria in the care facility or in hospital
• Presence of a urinary catheter
• Experiencing changes in the functionality of the urinary system
• Having health conditions such as Parkinsons disease, Alzheimers disease, diabetes, etc.

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