Incontinence issues

Elderly urinary incontinence symptoms can vary, as certain people trickle urine sporadically while others may continuously dribble. Still others experience an absolute deficit of both bladder and bowel control.

The most widespread diagnosis is “urge incontinence,” an urgent need to urinate resulting in the loss of urine before one arrives at the bathroom. This is believed to originate from involuntary contractions of the bladder so that the patient can simply not discontinue the urine flow. Urge incontinence — also called “overactive bladder” — can be caused by strokes, dementia, Alzheimer’s disease, multiple sclerosis, Parkinson’s or injuries. Conditions such as pelvic floor atrophy in women, prostate enlargement in men or constipation in either sex can also lead to urge incontinence.

Stress incontinence occurs when an increase in abdominal pressure overwhelms the closing pressure of the bladder sphincter. This can happen when you cough, sneeze, laugh or exert yourself physically. In many cases, elderly people leak urine simply getting up from a chair because there bladder muscles are so weakened. A lack of estrogen in post-menopausal women has also been linked to stress incontinence.

Because urinary incontinence is common among the elderly, people assume it goes with the territory, but it is not a normal part of aging and in most cases it can be alleviated. There is an estimated 25 million Americans who suffer from urinary incontinence. And generally they are reluctant to talk about the problem and just as reluctant to talk about their need for incontinence products. Not only should people who have incontinence issues seek treatment — as up to 90 percent will likely no longer need to wear protective products — they also should let it be known that they need protective undergarments.  

Women might see an urogynecologist for diagnosis and men might see a urologist, although either gender may be more comfortable talking with a geriatrician or a nurse practitioner who specializes in incontinence issues. Most of the time a non-surgical treatment, which may include bladder training, scheduled bathroom trips, pelvic floor muscle exercises and fluid and diet management, will bring about a “cure.” This is not a topic that has any stigma or shame and it should be talked about.

It is important to get this issue under control because it can impact the rest of a senior’s life immensely. Falls happen frequently when a senior feels the sudden uncontrollable urge to use the bathroom and then they rush and fall while trying to make it in time. Falling and breaking bones is one of the worst things that can happen to a senior person, as it limits their independence and their entire health status. Everything from eating, bathing and socializing — or simply getting around and looking after oneself — is impacted when you break an arm, leg or hip. The other issue for many is the insecurity they feel at social events or even just going grocery shopping. People begin limiting their activities, their social lives, their errands and outings simply because they are not sure if they can make it to a bathroom. Senior people literally plan their outings around restroom accessibility. When physical activities are limited because people are afraid they might leak urine, or social activities are curtailed for the same reason, the quality of life has begun a downward spiral. 

It is important to drink water to keep hydrated. It is important to exercise and be active to stay strong and independent. It is important to go out and socialize for emotional and psychological health.

For many, the cost of protective underwear is prohibitive. Most cases of urinary incontinence can be helped by seeing a specialist, but wearing protective briefs also gives another measure of security.

One of my classmates in the Masters of Gerontology program has addressed the issue of providing for those who need and yet cannot afford protective underwear. Marlene Ceragno of Bergen County has begun “adult absorbent products” drives — much like food drives. This was her capstone project at school and gained positive attention, not only by all of our classmates but also state wide. She has begun petitioning federal lawmakers for Medicare coverage for these products. Medicaid recipients already receive coverage for these vital products, which can cost around $1 apiece. For many seniors on fixed income this is a hefty price tag and truly a limiting factor that impacts their lifestyle. If you or one of your loved ones has incontinence issues it is well worth it to go and see an expert about it, and certainly speak up. It is not normal to be limited in your life or be worried about making it to the toilet on time.  

• Jane Riley, M.S., B.A., C.P.T., C.N.A., can be reached at janerileyfitness@gmail.com, 808-212-1451 or www.janerileyfitness.com.