Urine Incontinence: How To Deal With It

Do you know that most cases of Urine Incontinence in elderly are not reported? Due to ignorance and stigmas attached to it, they are not getting proper treatment too.

By Dr Sanjeev Bafna and Dr Ananthakrishnan Sivaraman

Urine Incontinence: How To Deal With It

Anuja Nalvade makes it a point to visit her mother in Pune every other weekend. After her father’s death, Anuja’s mother Rukmini lives alone. During one of her visits, Anuja notices that her mother is withdrawn and refuses to go out. When she asks, her mother replies that she is having old-age issues. When probed further, Anuja comes to know that her mother Rukmini is suffering from urine incontinence and hesitate to discuss it even with her daughter.

What is urine incontinence?

Loss of control over the bladder is a common problem among elderly. The problem is more prevalent in women. It becomes a matter of embarrassment for elderly.

For some the problem of Urine Incontinence (UI) arise less frequently and severity is less, while for some elderly people, this problem is life-changing.

UI is in mild form when you occasionally leak urine as you cough or sneeze. When it is severe, the urge to pass urine is so strong that you may not make it to the toilet.

As this issue is sensitive, most of the people do not report this and remain untreated. The problem of UI increases with age, it affects around 50-84 per cent of elderly people. It is more common in females than in males.

More than a health problem, incontinence is a social issue. Most of the time, those who are suffering from it do not think that the problem could be treated. They just accept it as part of growing old.

According to a survey, 50-70 per cent of women with UI never report. Sometimes, patients wait for six to nine years before reporting and getting treatment. Some don’t even get proper treatment.

Social Stigmas

Stigmas attached with UI make people uncomfortable about the subject. They live in constant fear of losing control in public. Family members also ridicule the sufferers.

Some people go to the extent of avoiding social functions and refuse to leave their homes. They face difficulties in travelling as rest room facilities are not there or these are difficult to access.

This could cause anxiety and hopelessness in persons suffering from UI. This also leads to depression and reduced self-esteem and hampers the quality of life for the elderly.

Different types of incontinence:

There are different types of incontinence.

Stress incontinence: When you strain the muscles in lower abdomen around bladder from coughing, sneezing, laughing, exercising or lifting something heavy, you may have incontinence caused by stress.

Stress incontinence happens due to weakness or injury to the muscles around the opening of bladder.

Mostly, women suffer from this type of inconsistence. Pregnancy, childbirth or menopause are some of the reasons for stress incontinence.

Urge incontinence: Some people suffer from the sudden urge to urinate and it is immediately followed by an involuntary passing of urine.

It becomes worse when the urge comes at night. Triggers like sound of running water or putting key in front door, could also prompt leaking. This happens when signals from the brain does not reach the bladder.

Overflow incontinence: When the bladder does not empty completely, the person suffers from constant or frequent dribbling of urine. This type of incontinence is more prevalent among men.

Functional incontinence: Sometimes, a physical or mental impairment keeps a person from making it to the toilet in time. Generally, person with severe arthritis suffer from this type of incontinence.

There are other factors too which can cause UI.

Pregnancy: Pregnancy could also lead to UI as the body undergo many hormonal changes and the weight of the foetus on the pelvic floor muscles could lead to stress incontinence.

Childbirth: Sometimes, after childbirth, women complain about incontinence as they have weaker or damaged bladder muscles which lead to a dropped pelvic floor.

Ageing: Sometimes, the aging bladder muscles decrease the bladder's capacity to store urine. Also, as you get older, involuntary bladder contractions become more frequent.

Menopause: Some women suffer from UI after menopause. Once menopause sets in, women produce less estrogen which is responsible for keeping the lining of the bladder and urethra healthy. Weak or damaged tissues can aggravate incontinence.

Hysterectomy: Women could suffer from UI after reproductive organ surgeries like removal of uterus as it may damage the supporting pelvic floor muscles.

Neurological disorders: Disorders like multiple sclerosis, Parkinson's disease, stroke, brain tumor, spinal injury, diabetes and spinal disc problem could interfere with nerve signals which controls the bladder.

Diuretics: Alcohol, carbonated drinks and sparkling water, and certain foods and medications could stimulate your bladder and increase your volume of urine. Some of the diuretics foods are, artificial sweeteners, chocolate, chilli peppers, citrus fruits and foods which are high in spice and sugar.

Heart and blood pressure medications, sedatives, and muscle relaxants could also stimulate bladder.

Diagnosis:

Consult a doctor, preferably a urologist, if anyone in your family, parents, grandparents are suffering from UI. Patients undergo a basic evaluation that includes questions on the history and a physical examination. A urine analysis is also done to check for signs of infection or traces of blood or other abnormalities.

Treatment:

To treat sudden episodes of UI, absorbent products like pads could be used temporarily.

In early stages, pelvic floor or Kegel exercises are also highly recommended to treat UI. These exercises mostly help women. It is a good option for reducing stress and urge type of incontinence.

Yoga too helps tighten the muscles that control the bladder and provides benefits for UI patients.

Acupuncture can help increase your ability to hold urine and reduce urinary urgency.

Go through the below ClipBook to know about different ways of treating incontinence problem. 

Lifestyle changes:

Some lifestyle changes could also improve the condition of UI.

  1. Add more fibre to your diet. Lack of fibre leads to constipation that puts pressure on the bladder.
  2. Heavy smokers are at greater risk of developing an overactive bladder.
  3. Restrict your intake of alcohol and caffeinated beverages including tea, coffee and some sodas. They can worsen an overactive bladder.
  4. Avoid citrus fruits, tomatoes, hot peppers and spicy dishes as they may irritate your bladder.
  5. Avoid artificial sweeteners. They tend to aggravate urinary urges and frequency.

Behavioral Approaches:

Bladder training, that is, to delay urination for 10 to 15 minutes once you get the urge, could help in containing UI. 

Double voiding which means urinating, then waiting a few minutes and trying again, could help us learn to empty our bladder more completely to avoid overflow incontinence.

Scheduled toilet trips and fluid and diet management, also help you regain control of your bladder. Reducing liquid consumption, losing weight or increasing physical activity also can ease the problem.

Medications:

There are many medicines available in the market for treating incontinence. Some commonly used medications are, Anticholinergics, Mirabegron and topical estrogen.

There is a need to sensitise the people and the society at large that there is no embarrassment in UI, it is a medical condition and completely curable. Dignity of the patients need to be preserved at all cost. Family members need to be more sensitive. 

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