HEALTH TOPICS

The issue of urinary incontinence is present in approximately 30 percent of people over the age of 60 and it is often more common in women.Many seniors feel embarrassed or awkward when they have this condition because they will occasionally urinate without even realizing it. The best course of action is to discuss this issue with the person very sensitively: assuring them that incontinence is almost always treatable especially with a behavioral technique like bladder training.

Causes

Urinary incontinence occurs when there is loss of urinary bladder control, and urine leaks, drips, or rushes out of the body, depending on the type of incontinence. In elderly people, this condition arises due to aging of the bladder muscle combined with a reduction in the bladder’s capacity to store the urine and an increase in overactive bladder symptoms.

Once women attain menopause, lower levels of the hormone estrogen may also lead to urinary incontinence. Other factors that cause long-term incontinence include:

• Nerve damage due to multiple sclerosis, Parkinson’s disease, or diabetes

• Weak bladder muscles

• Overactive bladder muscles

• Diseases or conditions such as arthritis, brain and spinal cord disorders, or stroke that make it difficult to get to the bathroom in time

• Enlarged prostate (in men)

With aging, typically the ability to postpone urination after feeling the need to urinate decreases, and the amount of residual urine, or urine left in the bladder after urinating, increases. In men, the rate of urine flow through the bladder and urethra decreases, especially when there is an enlarged prostate gland, which is a commonly occurrence as men age.

 Types

There are a few different types of urinary incontinence.

• Stress Incontinence – urine leaks when some type of pressure pushes on the bladder; for example, during exercise, when laughing or sneezing; or when lifting heavy objects. This is common in menopausal women.

• Urge Incontinence – there is a sudden need to urinate, but the person cannot hold the urine long enough to get to the toilet in time. This is common in people with diabetes, multiple sclerosis, stroke, Alzheimer’s, or Parkinson’s disease.

• Overflow Incontinence – small amounts of urine leak from a bladder that is always full. This may happen when conditions like enlarged prostate, diabetes, or spinal cord injury are also present, pushing on the bladder and creating pressure.

• Functional Incontinence – when seniors have normal bladder control but cannot get to the toilet in time, due to unwillingness or inability, for example, in cases of arthritis or dementia.

• Mixed Incontinence – involves more than one type of incontinence, commonly seen in older women and often a mixture of stress and urge incontinence. A mixture of urge and functional incontinence is also common for some elderly people.

If any of the above types of incontinence are present, it is best for the person to consult a doctor

 Diagnosis

The doctor will conduct a complete physical examination while taking a detailed history and list of current symptoms. The doctor may also ask the patient to keep a bladder diary: recording fluid intake, time of urination, quantity of urine produced, and the number of incontinence episodes for at least three days.

A urinalysis may be conducted where a sample of urine is taken to analyze and detect any possible infections or abnormalities, and a blood test might be performed to determine other factors that can contribute to the incontinence. Other specialized tests for diagnosis include the following:

• Postvoid Residual, or PVR, Measurement to measure the amount of residual urine left in the bladder after urination 

• Pelvic Ultrasound to view urinary tract and genitals to check for abnormalities 

• Stress Test where the patient coughs vigorously or bears down while the doctor looks for loss of urine 

• Urodynamic Testing to measure pressure in the bladder, as well as bladder and sphincter strength 

• Cystogram, an X-ray of the bladder, to examine any problems in urinary tract 

• Cystoscopy, a test to examine and potentially remove abnormalities in the urinary tract.

Bladder Training

Urinary incontinence cannot really be “cured”, but it can be managed. Incontinence is often best treated by using behavioral methods, which are safe, easy, effective, and inexpensive. These include:

· Bladder Training (bladder retraining) – mainly used to treat urge incontinence, this training attempts to increase how long the patient can wait before having to urinate.

· Timed Voiding (habit training) – mainly used to treat functional incontinence, this training sets a schedule for urinating, determined by personal habits.

· Prompted Voiding – mainly used to treat functional incontinence; this training is usually done with the help of a caregiver by reminding the incontinent person to urinate periodically.

 Bladder training is one behavioral technique that restores the normal functioning of an otherwise overactive bladder. The goal here is to reduce the frequency of visits to the toilet; increase the quantity of urine passed each time; and postpone emptying the bladder or hold on for longer than in the past.

In order to accomplish the above, a patient must practice the following basic steps:

· Find out the pattern of urination with the help of a bladder diary

· Extend the intervals between each bathroom visit by 15 minutes; if a bathroom visit is required every hour, extend the subsequent visit to one hour and 15 minutes.

· Once a schedule has been made, stick to it for the best results.

·  Try to lengthen the intervals between every bathroom visit slowly, until the desired goal is reached.

 A typical schedule for a day of bladder training starts when the patient empties the bladder first thing in the morning, and then visits the bathroom only at the next scheduled time. The bladder must be voided even if there is no urge to urinate and it is critical that this pattern be followed throughout the day. At night, the patient should simply visit the bathroom if awake and a trip is necessary. If there is any urge to urinate before the stipulated time, then employing the following ‘urge suppression’ or ‘relaxation’ techniques is recommended until the next scheduled time:

· Breathe slowly and evenly

· Do not rush to the toilet

·  Apply perineal or vaginal pressure, for example cross the legs or sit on a rolled towel

·  Curl the toes and hold them firmly

·  Stretch the calf muscles and hold the stretch

·  If walking, slow down and try heel-toe walking

·  Press or rub the trigger point on the inside of the leg, above the ankle

·  Press or rub the trigger point at the base of the nose

·  Exercise the pelvic floor muscles by squeezing and lifting, hold tight for ten seconds; then release and repeat

· Distract oneself by not thinking about the toilet or incontinence; try a mental task like counting backwards or thinking of all the state capitols

Once a particular urge suppression technique has been applied, visit the toilet in a slow and controlled manner.

A person’s bladder cannot see or sense how far away the toilet is, and it is a person’s own anxiety that may cause a leak. So, the patient should stay as calm and relaxed as possible, and with practice, it will become apparent which bladder-training techniques are most suitable. There will be good days and bad days and it takes approximately six to 12 weeks to see results.

 In most cases, a behavioral method or methods, along with a few lifestyle changes are successful in treating or, at the very least, minimizing, urinary incontinence.Along with behavioral therapy, the patient should implement the following changes on a daily basis:

• Manage fluid and diet intake by drinking per the body’s thirst requirements, avoiding drinking large amounts of fluid at one time, and cutting down on acidic food

• Reduce the intake of caffeine, artificial sweeteners, and citrus juices because they all contain chemicals that act as bladder irritants

• Lose weight to help relieve some pressure off the bladder

• Strengthen pelvic floor muscles that weaken with increasing age by doing Kegel exercises, improving bladder control, and preventing urine leakage.

These small changes can provide significant improvement for those suffering from urinary incontinence.

More than medication, surgery, or using certain devices to contain incontinence, bladder training and other behavioral methods are more successful with fewer risks. Incontinence is a commonly seen problem that can be treated and greatly improved with proper guidance, efforts, and support.