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Urinary Incontinence

• Urinary incontinence is a common problem in older adults.
• There are three major types of incontinence: urge, stress, and overflow.
• The health care provider will conduct a physical examination and tests, and discuss strategies for management.
• Management may involve conservative treatment, medications, surgery, and/or incontinence supplies.
• Incontinence can usually be successfully treated.

• Urinary incontinence – the involuntary loss of urine – is a common problem among older adults.
• One in three women and one in six men, over the age of 65, living in the community suffer from this problem.
• Urinary incontinence is not a normal part of aging. Many seniors are embarrassed to talk about it, and some believe that nothing can be done.
• However, urinary incontinence can be assessed and managed successfully.

• The body absorbs liquids you drink into the bloodstream through the stomach and gut. Any extra liquids and other waste products are cleared from the blood by the kidneys in the form of urine.
• The urine flows from the kidneys through tubes called ureters, and is stored in a sac called the urinary bladder.
• When you are ready to pass urine, the sphincter at the bottom of the bladder relaxes and allows the urine to pass down a tube called the urethra so it can be expelled from the body.

There are three main types of incontinence.

1. Urge Incontinence: This is the most common type of incontinence. Older people with urge incontinence may:
• leak urine when they cannot get to the bathroom quickly enough
• urinate very often, both day and night
• leak large amounts of urine and wet their clothes

2. Stress Incontinence: This is the loss of urine with certain activities. People with stress incontinence may leak urine when they sneeze, cough, laugh, or exercise. Leakage usually happens in small amounts and occurs during the day.

3. Overflow Incontinence: People with overflow incontinence cannot empty their bladders completely. They may:
• lose small amounts of urine day or night
• often feel they have to empty the bladder, but cannot
• pass only small amounts of urine despite straining

Incontinence may be temporarily caused by:

• urinary tract and vaginal infections
• some medications
• constipation
• high blood glucose (sugar) levels
• stones in the bladder
• immobility (not being able to move around)

Management of urinary incontinence requires a step-wise approach.

• The first step is to tell the health care provider (e.g., family doctor, public health nurse, homecare nurse) about the problem with incontinence.
• The second step is to find out the cause of the incontinence. This usually requires a history and a physical examination. Even though the older person may be embarrassed to describe the pattern of the incontinence, these details can help to pinpoint the cause. Also make sure the doctor or nurse know of all the medications taken. A vaginal or a rectal examination may be part of the physical examination. Also, certain tests may be done (e.g., blood and urine tests, bladder scans, cystoscopy).
• The third step is to treat the type and cause of the incontinence. This may be done by conservative treatment, medications, surgery, and/or the use of incontinence products.

Conservative Treatment – older people can do these techniques themselves:

• Empty the bladder regularly, every two to three hours.
• Drink 6 to 8 cups of liquids daily. Decrease intake of liquids after supper.
• Avoid alcohol. Reduce the total amount of coffee and tea. Do not drink these after supper or close to bedtime.
• Exercise pelvic floor muscles regularly by squeezing them

Medications – the most common types of medicine are those to:

• Treat infection.
• Replace hormones.
• Stop abnormal bladder contractions.
• Tighten the sphincter muscle.

Surgery is sometimes needed to help treat certain causes of incontinence:

• Removal of tissue that is causing a blockage (e.g. Prostate).
• Return of bladder to its proper position for women with stress incontinence.
• Dilate (expand) the urethra if it is narrowed.

Incontinence products: Many types of incontinence products are available. These include different types of diapers, soaker pads, special underwear, male and female urinals, and different types of catheters.
Health Canada

• Seniors and Aging - Bladder Control Problems (Incontinence) provides lots of information about the topic.

The Canadian Continence Foundation

• Main Website: The Foundation was formed in 1986 to address the needs of consumers experiencing urinary incontinence.
• Information about Incontinence: This comprehensive site provides information, downloadable documents and videos for purchase.

American Geriatrics Society

• Eldercare at Home is a resource for families and friends who are caring for older people at home. Chapter 10 – Incontinence provides detailed information.

Mayo Clinic

• The Mayo Clinic's Diseases and Conditions – Urinary Incontinence also provides a comprehensive article about incontinence.

Urology Channel

• Urology Channel provides a featured video, Overactive Bladder: How To Take Back Control.

Merck Source

• The Merck Source website provides links to more detailed information about urinary incontinence.