Living Well with Urinary Incontinence

Urinary incontinence, or involuntary release of urine, is common among Canadian seniors – it’s estimated that one in five experiences difficulties with bladder control. This condition can be extremely distressing, and people often think nothing can be done. However, incontinence is not a normal part of aging. It can often be cured or controlled, so it’s important to seek medical advice.

Types of incontinence

There are four types of urinary incontinence. An individual can have one or more types.

• Stress incontinence: This is caused by abdominal pressure on weakened pelvic muscles. A small amount of urine may leak out when a person sneezes, coughs, laughs, lifts objects, climbs stairs, rises from a chair or has sexual intercourse, for example. Stress incontinence is common in senior women, pregnant women and new mothers, and men who have enlarged prostates or who have received treatment for prostate cancer.
• Urge incontinence: This is the most common type among seniors. Bladder contractions and the need to urinate happen suddenly, giving the person only seconds or minutes to reach a washroom. Also called “overactive bladder,” this problem is caused by involuntary bladder contractions due to different medical conditions – such as dementia, multiple sclerosis, Parkinson’s disease, or an infection in the bladder or kidneys. Other causes are weakened pelvic muscles in women and enlarged prostates in men.
• Overflow incontinence: Less common than other types, this condition causes people to feel like their bladder is overfull and/or won’t completely empty. They often leak small amounts of urine (sometimes described as “dribbling”). They may frequently feel the urge to go, and may strain to start or stop urinating. Overflow incontinence occurs when an obstruction in or near the bladder, such as an enlarged prostate, blocks the flow of urine, or if the bladder itself has weak or no contractions. Constipation, nerve damage and some medications can also cause overflow incontinence.
  
• Functional incontinence: With this type of incontinence, people still have urinary control, but they have difficulty using a washroom in time. This could happen because of arthritis, dementia, stroke complications or other health issues, or because poor eyesight or other factors prevent them from asking for assistance (from a caregiver, for example) in time.

Causes of incontinence

Urinary incontinence has many causes. Often, it improves when the underlying problem or problems are treated or better managed. Causes may include:

• Weak or poorly functioning pelvic muscles
• Some medications (such as diuretics, hypertension medications, heart medications)
• Constipation
• Lower bladder capacity due to aging
• Urinary tract infection or bladder infection
• In men, enlarged prostate gland or prostate surgery
• In women, thinning and drying of skin in the vagina or of the urethra (the tube that carries urine from the bladder) after menopause
• Diabetes
• Multiple sclerosis
• Alzheimer’s disease and other types of dementia
• Parkinson’s disease
• Stroke
• Surgery side effects
• Injuries
• Certain types of food and drink (caffeine, sugar, alcohol, spicy or acidic foods)

It is difficult to determine the reasons on your own, so be sure to consult a health professional. Don’t ignore or try to hide incontinence – people who have this stressful condition are vulnerable to skin problems and bladder infections. They may also feel ashamed, embarrassed, isolated and reluctant to socialize, and this can affect wellness and quality of life.

Treatments for incontinence

Treatment will depend on the cause or causes of incontinence. Your physician will review your medical history, conduct a physical exam, and ask questions to help identify potential causes. They may also test your urine to check for blood or an infection.

Physicians often ask patients to keep a journal for several days, noting when they use the washroom, any leakage and accidents, fluid intake and types of drinks. This can help determine patterns and causes.

These are common treatments for incontinence:

• Dietary changes, such as limiting alcohol, caffeine and sugar, or eating more fibre to relieve constipation
• Kegel exercises (squeezing and relaxing muscles that control urine flow, to improve their strength); ask your physician for instructions
• Bladder retraining using scheduled times for urination, with gradually longer wait times between bathroom visits – eventually, as long as three to four hours; this can take up to three months. Your physician may recommend additional treatments:
• Biofeedback, to help women identify and contract pelvic muscles
• Electrical stimulation
• For women, vaginal weight training, vaginal cones or pessaries
• Medication that calms bladder muscles or reduces contractions
• Surgery

Other things you can do

If you or a loved one has urinary incontinence, try these ideas to make things easier:

• Use absorbent pads or briefs (available at drugstores or online)
• Drink less liquid before bedtime
• Improve bathroom safety by installing grab bars and higher toilet seats
• Keep routes to the bathroom clear and well-lit
• Choose clothing that is easy to undo or remove
• Schedule regular bathroom breaks

Finding a solution for incontinence may take time, so try to be patient. It’s worth persisting, so that you or your loved one can continue to enjoy a comfortable and active life.