It's Time to Talk About Incontinence

Senior women sharing a conversation and coffee

Jacinta and Jan both volunteer at their grandchildren's school. But for several months, Jan had cancelled. "What's up?" asked Jacinta. Jan blushed and confessed that she had been experiencing "leaking" and felt like she should stay near the bathroom at home. “What does your healthcare provider say?" asked Jacinta. Jan blushed all the more. "Oh, I would be too embarrassed to mention it to my doctor!"

June 17–23 is World Continence Week. This health campaign is sponsored by the International Continence Society to highlight the impact of urinary incontinence on 200 million people around the world. According to The Urology Foundation, half of all adults will experience incontinence at some time in their life—making it a topic you'd think plenty of people would discuss!

And yet, many don't. A March 2018 University of Michigan poll of senior women aged 50 – 80 who are dealing with incontinence revealed that fewer than one-third had talked to their doctor about the problem. Why? Many of the women polled said the problem was "not too bad"; some didn't see it as a health issue to be discussed with the doctor; others were too embarrassed to bring up the topic; and many assumed nothing could be done about the problem.

Women aren't the only ones to suffer in silence. A few months after the University of Michigan study, a poll conducted by the University of Texas Southwestern Medical Center revealed that many men who are dealing with incontinence wait several years to talk to their doctor about it. One-third of them wait five years or longer!

This silence can have a big impact on a senior's health and overall well-being. Incontinence can cause skin irritation and infections, and may interfere with sleep. Worst of all, it can be the first step in a senior's withdrawal from social interactions, intellectual stimulation and exercise.

Seniors shouldn't allow embarrassment to stand in the way of seeking help, because incontinence is treatable! It is not, as some believe, "just a part of growing older." The first step is a thorough evaluation of the problem by the doctor. Treatment depends on the type of incontinence a senior has:

  • Urge incontinence happens when the bladder begins to empty itself before a person realizes it—sometimes too late for them to reach the bathroom. This type of incontinence occurs often in older adults and can be the result of damage to the nerves, or irritation from infection or certain foods.
  • Overflow incontinence occurs when small amounts of urine leak from a bladder that is always full due to an obstruction, constipation, nerve damage, or in men, an enlarged prostate.
  • Stress incontinence happens when urine leaks from the bladder as a person coughs, sneezes, laughs or lifts heavy objects. It is often seen in women who have weak muscles in the pelvic floor, usually due to childbirth. In men, it might occur after prostate surgery.
  • Functional incontinence occurs when a person has normal bladder control, but is unable to get to the toilet on time because of vision loss, stroke, arthritis, osteoporosis, other mobility problems, or confusion due to Alzheimer's disease or a related condition.

Treatment for incontinence can be very effective, and might include:

  • Bladder training. The patient keeps a chart of urination and leaking, and then works out a bathroom schedule, planning trips to the toilet at certain set times (for example, once an hour). The goal is to increase the interval gradually.
  • Pelvic muscle exercises. Just as we can strengthen other muscles in the body, simple moves such as the commonly recommended "Kegels" can strengthen the bladder muscles and the muscles of the pelvic floor. This helps hold urine in the bladder longer.
  • Medications. Some commonly prescribed drugs stop bladder contractions; others relax the muscles to prevent urgent or frequent urination. In post-menopausal women, estrogen pills, creams or patches may be prescribed.
  • Surgery and medical devices. A number of procedures can be effective, especially in treatment of stress incontinence and incontinence due to prostate enlargement.
  • Lifestyle changes. The physician may recommend cutting down or eliminating caffeine, alcohol and tobacco products. All can increase incontinence by irritating the bladder. Increased exercise and weight loss can also make a big difference.

When treatments don't completely work

People who are living with incontinence may feel more secure wearing special absorbent, disposable undergarments which are inconspicuous and quite effective in masking the incontinence. These undergarments are sold in drug stores and supermarkets, and though they don't solve the problem, they can enhance dignity and peace of mind.

If mobility problems prevent the person from making it to the bathroom in time, consider having a commode chair nearby. Clean up clutter that could slow trips to the bathroom. Specially designed clothing makes it easier for people with arthritis, stroke or Alzheimer's to negotiate fasteners in time.

Senior man talking to his doctor

Raising awareness

The University of Michigan researchers urge doctors to ask all patients about incontinence during routine appointments. They noted, "There are few medical conditions as common as urinary incontinence for which routine screening does not already exist."

A word to family caregivers

Family members and friends can help, too. If you suspect a senior loved one is experiencing incontinence, encourage them to seek help. Use tact and sensitivity when discussing this issue with your loved one. Try not to overreact if an older family member or friend has an accident around you. This is one of those occasions in which you need to be particularly careful in your caring!

The first step might be to share with your loved one that they are in good company with millions of other people who are taking charge of incontinence. Offer to come along to a healthcare appointment and talk to the doctor about ways you can help. Yes, this can be an embarrassing problem, but consider how much better it is if your loved one doesn't have to face it alone.

Source: IlluminAge Communication Partners; copyright 2019 IlluminAge