Everyone knows that it is only natural when babies wet themselves. Nobody considers it a social or hygienic problem. However, believing that it is also an unavoidable part of growing old is incorrect. While incontinence is more common among the elderly, it can also happen to younger people, especially young women. In the community, about 1 out of every 10 elderly individuals is estimated to have incontinence, and up to 50% of those in institutions face this issue. Importantly, ageing itself does not cause incontinence.
Left untreated, urinary incontinence can contribute to pressure sores, urinary infections, and depression.
Types of Urinary Incontinence
There are several types of urinary incontinence: urge incontinence, overflow incontinence, stress incontinence, functional incontinence, and total incontinence.
Urge Incontinence
Urge incontinence occurs when the urge to pass urine becomes so intense that control is lost and urine is passed involuntarily. This type commonly happens with urine infections in females and enlarged prostate in males, and can also result from an irritable bladder or neurological conditions such as stroke or Parkinson’s disease.
Management depends on the cause and may involve medication to relax the bladder, antibiotics for infection, bladder retraining, or surgery for cases like enlarged prostate. Bladder retraining involves suppressing the urge by postponing urination or distracting oneself, helping regain control over time.
Overflow Incontinence
Overflow incontinence indicates that the bladder is overly full, and any additional urine produced causes overflow. The bladder is typically distended, sometimes causing a visible bulge in the lower abdomen. This may not be painful due to gradual onset or damaged nerves that eliminate the sensation of fullness. Physical exertion or coughing can increase abdominal pressure and cause leakage, resulting in constant dribbling of urine. Causes include nerve damage from spinal cord lesions or diabetes, chronic distension from enlarged prostate, or severe constipation.
Management may involve decompressing the bladder with a catheter to prevent further damage. Treatment of the underlying cause might include prostate surgery or evacuation of stool. Long-term catheterization may be needed if nerve damage is present.
Stress Incontinence
Stress incontinence means there is weakness in the bladder outlet despite normal bladder function. When coughing or straining increases abdominal pressure, urine leaks from the bladder. Individuals can often identify activities that trigger leakage.
Management includes pelvic floor exercises, surgery to tighten the pelvic floor, the use of a vaginal pessary if a prolapsed uterus is involved, and use of leak pads or diapers for severe cases.
Functional Incontinence
In functional incontinence, bladder function is normal but physical or cognitive barriers prevent timely toileting. For example, severe arthritis can make unbuttoning pants difficult, or mobility issues from stroke or Parkinson’s disease can delay getting to the toilet.
Management includes optimizing physical function, physiotherapy, occupational therapy, and using easier clothing fastenings like Velcro. Toileting can be made more accessible with urinals or commodes, and going to the toilet earlier can help prevent accidents.
Functional incontinence can also be caused by dementia, where individuals are unaware of the need to urinate or do not recognize the toilet. In these cases, diapers may be the only solution.
Multiple Causes and the Role of Healthcare Professionals
Often, several types of incontinence may occur together, such as urinary infection, overflow, and functional incontinence. It is best to have healthcare professionals assess and manage the condition appropriately.
Prevention
What can be done to avoid these issues in old age? Here are some tips:
- Drink enough fluids to promote regular urination and reduce bladder infections, which can cause lasting damage.
- Avoid delaying urination for long periods, as this can weaken the bladder. Also, don’t rush to the toilet at the first urge, which may worsen urgency.
- If you have diabetes, maintain good blood sugar control to prevent nerve damage affecting bladder function.
- Reduce stroke risk by managing blood pressure and cholesterol, avoiding smoking, moderating alcohol, exercising regularly, and maintaining a healthy lifestyle.
- Maintain regular bowel movements, as constipation can also affect urinary continence.