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Matters of the bladder: dealing with urinary incontinence

by Sue Lanza

A troublesome symptom that may spring up as we age is urinary incontinence. Defined as the involuntary leakage of urine, urinary incontinence can seriously impact your quality of life if left unmanaged. The good news is that many forms of urinary incontinence are treatable. Let's sort out this common condition together.

When we are younger, a trip to the bathroom is a routine affair. For the growing elderly population, these bathroom excursions can cause anxiety due to the presence of one of the forms of urinary incontinence. In fact, urinary incontinence can cause embarrassment and self-esteem issues that can diminish your quality of life.

The Basics of Incontinence

The leaking of urine called urinary incontinence is not a disease but rather a symptom that needs to be explored to determine the cause and then the treatment. For a person to remain continent, their central nervous system and entire urinary structure must be in working order and communicating to each other properly. You may ask why the central nervous system even involved in this process. A full bladder triggers the brain to alert us to get moving towards the bathroom.

When disconnections occur between these systems, researchers see more women than men being affected. In addition, as people age, incontinence becomes more of a possibility. Studies report that over 50% of all elderly patients in hospitals and nursing homes have urinary incontinence issues. In fact, many persons may have been admitted to long term care facilities as a partial result of incontinence problems that proved too great for caregivers to manage.

Symptoms of Incontinence

You may find yourself of a loved one with a combination of many symptoms or just one or two. Having existing medical conditions such as obesity, diabetes, Alzheimer's disease, stroke or multiple sclerosis can worsen the degree of these signs. These are a number of commonly seen indicators:

  • Decrease in overall bladder control
  • Voiding too frequently
  • Urinating more than twice during the night called nocturia
  • Difficulty initiating urine flow called hesitancy
  • Feeling of the urgency to urinate
  • Reduced urine stream
  • Feeling that bladder is not completely emptied
  • Decreased bladder capacity

Diagnosis/Types of Incontinence

Despite awkwardness about your symptoms, a visit to your doctor is the next step. Your physician will conduct a full physical examination including questions about your specific signs. The doctor will most likely do a urinalysis test or other lab work to check for infection or abnormalities. She may also search for clues to the type of your incontinence by asking you to complete a voiding diary over the next few days. I know it sounds unpleasant to write it all down but surprisingly this record of the volume and time of your toilet use as well as any incontinent episodes is thought to be one of the most reliable pieces of information for your physician about your case.

The type of incontinence will usually fall into one of four typical categories. Your doctor may have determined that your incontinence signs fall into one of these areas:

  1. Stress incontinence. Very common in "younger" elderly women, urinary leakage in this type occurs during mundane events such as coughing, laughing, exercising and sneezing.
  2. Urge incontinence. This is the most common type of incontinence seen in the elderly with up to 70% have symptoms. Urge incontinence occurs when a person has the need to go to the toilet but has seepage before they arrive. Some researchers feel this syndrome is related to involuntary bladder contractions or an overactive bladder that could be associated with certain diseases or injuries.
  3. Functional incontinence. In this form of incontinence, which is seen in many elderly nursing home patients, the delay in getting to the bathroom (that results in the accident) is a consequence of having a plan that can't be functionally executed. An example might be a person with some confusion who has difficulty finding the bathroom or someone whose lack of hand dexterity causes trouble in opening their belt or pants.
  4. Overflow incontinence. A condition that is seen in a small percentage of the elderly; thought to occur when the bladder never fully empties, causing a continued feeling of urgency and occasional leaking.

Incontinence Treatment Options

Once your physician has completed her full evaluation including a review of your voiding diary, you may have a name for your type of incontinence. You may even have discovered that you have "mixed" incontinence; named for those who show signs of more than one type. Two categories of incontinence that are often seen together are stress and urge incontinence.

The good news for you is that most incontinent cases can be helped. Non-invasive treatment is always the first choice and here are some options:

  • Bladder retraining which that involves a behavioral conditioning of the bladder to teach it to expect emptying at regular intervals such as every 2 hours.
  • Pelvic muscle strengthening such as easy-to-learn Kegel exercises can frequently help fortify weakened muscles.

If further treatment is required, the physician has medication options to offer for urge or overactive bladders. In severe cases, surgery is another alternative but not usually seen.

By now you realize that you are not alone if you have been coping with urinary incontinence and it certainly doesn't have to dramatically alter your life. Take the time to find out how you can make your next trip to the bathroom just another simple task in your busy day.