Incontinence is one of the least talked about, most feared, and also commonest concern among older people. If you go into a nursing home, a huge percentage of people are wearing some kind of incontinence product. We need to develop different attitudes towards incontinence; one of which should include the idea of treatment and prevention. From what I can see, it is another one of those problems for which the attitude is ” Oh, well, what do you expect, it s part of old age.. .” Marcy Dayan, in her article below, tells us that is not so.
URINE LEAKAGE IS NOT A NECESSARY PART OF AGING
By Marcy Dayan, BSR, MHA
A Registered Physiotherapist with expertise in the treatment and management of urinary and fecal incontinence.
If you leak urine you might have a condition called urinary incontinence. Although the chance of becoming incontinent increases with age, it happens to people of all ages and is not a natural part of aging. It is estimated that up to 25% of adults have urinary incontinence and that women are affected twice as often as men. It is known that problems with bladder and bowel control increase with age, loss of mobility, and declining mental function. It is important to know that both urinary and fecal incontinence can be effectively managed, and if the individual is able to follow instructions and do simple exercises (even while sitting), incontinence can be significantly reduced and sometimes eliminated.
The bladder is a hollow muscular organ that collects urine. Urine leaves the bladder through the urethra, a narrow tube-like structure extending from the bladder to the outside of the body. The bladder has two functions. It either stores urine or empties urine. During the storage phase the bladder muscle remains relaxed, while the sphincters and muscles that block off the urethra and bladder stay contracted, thus preventing any urine from escaping. If urine escapes during the storage phase, it is called a leak.
In the emptying phase, the sphincters and muscles around the urethra relax, opening the tube through which urine exits the bladder. The bladder muscle contracts and squeezes the urine out of the bladder and through the now open urethra. Immediately upon emptying the bladder relaxes, the sphincters contract and the cycle starts all over again.
Urine leakage, or incontinence, can have many causes. Functional, stress and urge are three common types of urinary incontinence. Many people have more than one type of incontinence at the same time.
Helpful Tip:
- If you are using pads for incontinence, try using pads made to absorb urine. These products help keep urine away from the skin and so are less irritating and result in less skin problems.
- If the skin is becoming itchy, red or irritated, check with your nurse of physician. . Skin cleansers are better than soap as they are less drying to the skin. Sometimes all that is needed is a simple barrier cream to help the skin heal and improve comfort. If using a barrier cream, make sure to cleanse the skin daily, including wherever there is a fold. Ask your pharmacist about skin care products.
- When providing assistance to someone who has a cognitive impairment, regular trips to the toilet at times intervals can be helpful in maintaining continence.
FUNCTIONAL INCONTINENCE
Functional incontinence occurs when the individual has physical difficulty getting to the toilet in time. The distance might be too far, the walker may be out of reach, or the joints in their hands may be too sore to remove clothing in time. The problem is with the individual’s physical ability to access the toilet in time. The bladder and its control mechanisms are functioning. In this situation, continence can be maintained by addressing the physical mobility issues.
Helpful Tip:
- Address your mobility needs. Walkers and canes should be within easy reach. Raised toilet seats and grab bars might be helpful. A physiotherapist or occupational therapist can assist you with this.
- Clothing that is easier to manage might be helpful as well.
- Sometimes a bedside commode or urinal might be the solution during the night.
STRESS INCONTINENCE
Many people leak urine when they cough, sneeze, walk, or otherwise exert themselves. This is called stress urinary incontinence. These actions increase the pressure within the abdomen. This increased pressure is then passed on to the bladder, causing it to be compressed. If the pressure on the bladder is greater than the closure pressure of the sphincters sealing the urethra, urine is forced out during the storage phase and a leak occurs. Correctly performed pelvic floor muscle (Kegel) exercises help to strengthen the closure mechanism of the urethra and bladder. Many people find it difficult to do these exercises correctly. One study demonstrated that following verbal instruction on how to perform Kegel exercises, 49% of the study group was unable to correctly do the exercise1.
Helpful Tip: How to contract your pelvic floor (Kegels).
- The pelvic floor is a muscle just like any muscle in your body and it can get stronger through exercise. The muscle stretches like a hammock at the inside bottom of your pelvic bones and is attached at the front, back and sides. The urethra and anus (and vagina in the female) pass through this muscle. Correctly done, contacting this muscle can help stop urine or bowel accidents.
To contract this muscle, imagine trying to stop passing urine, gas or stool. Even if the problem is urine leakage, most people contract this muscle best by trying to stop gas or stool. Be careful not to squeeze other muscles at the same time and make sure you aren’t holding your breath! Once you’ve found the muscle, hold the contraction for 3-5 seconds and repeat 10 times. Do this a couple of times a day. Tightening the muscle before you cough, sneeze or lift will also help control leakage. Remember, 49% of people have a hard time figuring out how to do this correctly. If you are not finding improvement in 3-4 weeks, contact a physiotherapist or other health professional who has specific training in the treatment and management of incontinence. In some situations, internal assistive devices (pessaries) or surgery may be options.
URGE INCONTINENCE
A strong, sudden need to empty the bladder that is associated with involuntary urine loss is called urge incontinence. The strong urge is caused by an overactive contraction of the bladder muscle. When the bladder contracts, urine is forced out during the storage phase and a leak occurs. The problem is compounded if the pelvic floor muscles that close the urethra and bladder are weak. Several things can cause your bladder to become overactive. Small bladder capacity, nerve damage, caffeine, and anxiety are a few of the contributors to an overactive bladder. It is not uncommon for someone to have both stress and urge incontinence. The individual can learn to suppress the urges, increase their bladder capacity and the amount of time between emptying their bladder, and strengthen their pelvic floor muscles. There are also medications that can help the bladder to be less active.
Helpful Tip: Suggestions for managing urgency.
- Check with your doctor to rule out a bladder infection and to find out if your medications are impacting your bladder function.
- Try eliminating caffeine, alcohol, carbonated beverages, spicy foods and citrus from your diet for a couple of weeks and see if it helps. If the urgency has decreased, add back the eliminated items one at a time until you find the guilty ones!
- Stay CALM when the urge hits. Talk to your bladder and tell it that you are in control and it is not the appropriate time to empty! Once the intense urge has passed, wait 10 seconds and then calmly proceed to the toilet.
- Constipation can contribute to urgency. If you are constipated increase fluids, fibre and exercise. If you are still constipated, speak to your doctor.
It is important to know that incontinence is not a necessary part of aging and need not interfere with your ability to have a full and active life. Remember, incontinence can be treated, managed and sometimes eliminated.
Marcy Dayan, BSR, MHA is a Registered Physiotherapist with expertise in the treatment and management of urinary and fecal incontinence. She is also a very warm person whose caring comes through from the minute you meet her. She can be reached at 604-739-3133
1 Bump RC et al. Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. American Journal of Obstetrics and Gynecology, 1991 Aug;165(2): 322-7.
