Senior living: Aging and urinary incontinence — what you need to know

By Dr. K. Lauren de Winter,

Contributing Writer

Urinary incontinence, meaning when a person leaks urine by accident, is especially common in older adults. The severity can range from occasional drops of urine to regular leakage that soaks your clothing.

A recent AARP poll found that 51% of women aged 65 to 80 and 43% of women ages 50 to 64 have had an episode of incontinence within the past year. Many people think that urinary incontinence is a normal part of aging that can’t improve; however, there are treatments available to help you manage this condition.

Luckily, this doesn’t have to keep disrupting your life.

There are different types of urinary incontinence, as well as signs and symptoms for each. They are:

• Stress incontinence: Leakage when you put pressure (stress) on your bladder by coughing, sneezing, lifting heavy objects, laughing or exercising. This most often occurs in men and women in all stages of life and may begin for women during menopause.
• Urgency incontinence: Sudden, intense urge to urinate followed by accidental loss of urine. This can include getting up more than once at night to urinate. This may be an issue for people who have multiple sclerosis, diabetes, Alzheimer’s disease, Parkinson’s disease, or have had  a stroke.
• Overflow incontinence: Frequent dribbling of urine from a bladder that doesn’t completely empty. For instance, men often have trouble emptying their bladder if an enlarged prostate is blocking the urethra. Also, diabetes and spinal cord injuries can contribute to this type of incontinence.
• Functional incontinence: Leakage from a physical or mental impairment, such as Alzheimer’s disease, that can occur in many older people who have normal bladder control. They can experience problems getting to the toilet because of arthritis or other disorders that make it hard to move quickly.

You can have temporary urinary incontinence from certain foods, medications or a bladder infection. Urinary incontinence can also be caused by other changes in the body, such as aging, weight gain, menopause or chronic constipation.

As women age, the effects of menopause on the vaginal tissues may contribute to bladder control problems, so keeping your pelvic floor muscles strong during and after menopause is vital. Some women experience pelvic organ prolapse as they age (where one or more of the pelvic organs drop down into the vagina). Pelvic floor muscle exercises may help to support these organs and stop the prolapse from getting worse.

As men age, it is common for urinary incontinence to stem from prostate issues. If your prostate becomes enlarged, it can block your urethra, causing your bladder to work harder to release urine. Other causes include neurologic diseases, such as multiple sclerosis, prior surgeries, urinary tract infections and constipation.

Pelvic floor muscles can become weakened in various ways, including years of lifting heavy objects, straining on the toilet to empty your bladder or bowels, chronic coughing, or hormonal changes. The pelvic floor muscles play a key role in bladder and bowel control, so it is key to know where they are to retrain them.

Reversing or remedying urinary incontinence

Pelvic floor physical therapy is a specialty that exists to help you get back to enjoying your everyday activities.

Along with the option of seeing a pelvic floor physical therapist, there are ways to maintain physical and muscle strength in your legs, core and pelvis at home. Low-impact exercises such as stretching, walking, cycling on a stationary bike, yoga, Pilates and swimming several times a week are all helpful options.

Kegel exercises, which are for both men and women, can strengthen the muscles that support the bladder. Kegel exercises involve repeatedly contracting and relaxing the muscles that form part of the pelvic floor. It’s important to make sure you seek help from your doctor to determine the best course of action for your condition.

Bulking agents (like fillers used in the face) can also be used to help with bladder issues and stress-related urinary incontinence. Doctors can inject a bulking gel or paste that thickens the area around the urethra. This can help reduce stress incontinence but may need to be repeated over time by the doctor.

Bulkamid is a urethral bulking agent for women with stress and urinary incontinence. It is a water-based gel that consists of four injections directly into the wall of the urethra. Injectable Botox can also be used for overactive bladder and can be used in combination with the Bulkamid. Botox is injected into the bladder muscle to treat bladder problems, such as overactive bladder, urge incontinence and leakage of urine; it works by blocking nerve signals that can cause the bladder muscle to spasm involuntarily.

Lifestyle and behavioral changes may also help with bladder problems.

Maintaining a healthy weight, not smoking, avoiding alcohol and caffeine, and limiting liquids before bed may assist in preventing urine incontinence. Medications are also an option, but there are some that have been associated with a higher risk of mental decline in adults over age 65. It’s always best to talk with your doctor about what options and medications, if any, would work best.

Dr. K Lauren de Winter is a board-certified, fellowship-trained urogynecologist who specializes in female pelvic medicine and reconstructive surgery with Praxis Urogynecology at MemorialCare Long Beach Medical Center. She is focused on treating urinary incontinence, pelvic organ prolapse, fecal incontinence, recurrent urinary tract infections, chronic pelvic pain, urogenital fistula and interstitial cystitis/bladder pain syndrome. She also performs minimally invasive procedures for prolapse and incontinence.

Source: Orange County Register