It’s a common condition that’s very treatable and it is also one that can cause a lot of emotional pain. I am talking about urinary incontinence, something that many people choose to keep to themselves because they feel humiliated and embarrassed. In fact, according to the National Association for Continence, of the more than 25 million Americans affected by bladder or bowel control issues, only one out of every 12 seeks help. I find that frustrating as a healthcare provider because so much can be done to address it.
Although some habits can cause incontinence, such as having a poor diet, it can also be a sign of an underlying physical problem or medical condition. Sometimes a urinary tract infection or constipation is the culprit, both of which can be easily treated. At other times, medications can lead to incontinence. Disorders like multiple sclerosis, Parkinson's disease, stroke, brain tumor or spinal injury can also interfere with nerve signals involved in bladder control.
Whatever the case, a physician will probably perform a urinalysis to rule out infections; blood tests to check on kidney function, calcium and glucose levels, and a complete physical including a rectal exam, with a pelvic exam for women, and a urological exam for men. Patients may also be asked to keep a bladder diary, recording what they drink and when and how much they urinate.
The most common type of incontinence is urge incontinence (a.k.a. overactive bladder) which, as the name implies, involves an urgent need to urinate. The treatment approach is usually limiting fluid, especially alcoholic, caffeinated and carbonated beverages, along with pelvic-floor exercises (Kegels) and behavioral modification. The latter includes bladder training and scheduled bathroom trips in which the patient increases the intervals between bathroom trips, gradually training the brain and the body to delay urination. Other treatments include medication, electrical stimulation of the pelvic floor muscles and surgery.
Stress incontinence, which is much more common in women, occurs when physical movement or activity, such as coughing, laughing or climbing stairs, puts pressure on the bladder. The usual treatment is pelvic floor muscles exercises and/or using devices like pessaries, a stiff ring that is inserted into a woman’s vagina, and urethral inserts, a tampon-like disposable device. The U.S. Food & Drug Administration has not approved any medications for the treatment of stress incontinence, but surgery is always a last resort.
Lifestyle changes can also make a big difference in the management of incontinence. Overweight patients may be encouraged to go on a diet as excess weight can put pressure on the bladder. Likewise, smokers are encouraged to give up the habit, especially if they have developed a chronic cough, which can increase pressure on their bladder.
Patients are often advised to add fiber to their diet if chronic constipation plays a role in their urinary incontinence. Those who can't completely get rid of the problem through medical treatments or lifestyle changes may need to wear pads and protective garments. The good news is that today’s designs emphasize comfort and dignity, without interfering with appearance or lifestyle.
It is vital to note the importance of staying hydrated for seniors, especially when dealing with incontinence. When many seniors start having bladder issues, they often stop drinking fluids in order to avoid an embarrassing accident. However, abstaining from liquids can have serious side effects that lead to bigger health issues or dangerous falls.
Signs to watch out for include:
- Difficulty walking
- Dizziness or headaches
- Dry mouth
- Rapid heart rate
- Low blood pressure
- Inability to sweat or produce tears
Although urinary incontinence is no one’s favorite diagnosis, I’m convinced that it doesn’t have to interfere with your enjoyment of life if it is well-managed. So, if you or a loved one is one of the 25 million affected, I urge you to seek help from a doctor. Despite the fact that incontinence is a common condition, it doesn’t have to be a normal part of aging.