Urinary incontinence is the involuntary or uncontrollable loss of urine, and it is a common and difficult problem for aging adults. It is a problem that affects up to 30% of older persons living outside of hospitals or nursing homes, and is particularly common among elderly women. Incontinence can range from minor, occasional dribbling, to occasional unwanted loss of bladder control, to the complete inability to hold one's urine. Despite its high prevalence, however, urinary incontinence is not a 'normal' part of aging. There are multiple kinds of incontinence and their treatment varies depending on the cause.

Stress Incontinence is a very common form of incontinence in older women. It is defined as the involuntary loss of small amounts of urine when a person coughs, laughs, exercises or is startled. Stress Incontinence results from a natural muscle weakening in the floor of the pelvis which accompanies aging. Women who have had multiple vaginal deliveries are at increased risk. In less severe cases, stress incontinence can be treated with Kegel exercises, or exercises that strengthen the muscles of the pelvic floor. The exercises involve contracting the pubococcygeal muscle, or the muscle used to hold back the flow of urine. This muscle can be identified by trying to stop the flow of urine halfway through urination, while seated on the toilet. Once a person appreciates what it feels like to contract this muscle, he or she can exercise by tightening to a count of three, relaxing, and then tightening again. A typical regimen involves repeating this exercise 10 times, 5 times a day.

35% of older persons with incontinence have what is called Urge Incontinence. 'Urgency' is the sudden feeling of having to urinate. For this population, the bladder tends to contract spontaneously when filled with only small amounts of urine, and some refer to it as 'overactive bladder'. Persons with urge incontinence will complain of frequent urination, frequent urination at night, bed-wetting, and sudden loss of urine. Since the bladder is contracting at smaller volumes than it should, some people are able to avoid leakage by urinating frequently, preventing the bladder from filling to the point where it overacts. Toileting every hour is sometimes necessary, but many are able to 're-train' their bladder to tolerate larger amounts, by gradually increasing the intervals between urination. Detrol and Ditropan are two commonly prescribed medications for urge incontinence. The use of these medications should be discussed with your physician.

Overflow incontinence is a common cause of incontinence in men. Persons with overflow incontinence will often describe a sensation that their bladder still contains urine after they've urinated. The most common cause of urethral obstruction leading to overflow is an enlarged prostate. Less commonly, overflow incontinence can result from a diminished nerve supply to the bladder. This can occur in people with longstanding diabetes, multiple sclerosis, stroke, or spinal cord injury. It also occurs as a side effect of some medications. Treatment of overflow depends on its cause. If it is a result of an enlarged prostate, surgery may be necessary to clear the obstruction. In those who have damage to the nerve supply of the bladder, intermittent catheterization may be necessary.

The most important thing to keep in mind is that incontinence does not have to be a part of the normal aging process. Most causes of incontinence can be treated effectively.

Based upon an article by Ardina Schneider, MD, Columbia Presbyterian Medical Center

Submitted by: Janet Tuttle, RN, RAC-C
Executive Quality Assurance Nurse
ABCM Corporation