How can I stop incontinence in old age?: A comprehensive guide

It's a common misconception that incontinence is an inevitable part of aging, with reports indicating it affects at least 30% of people over 60, yet it is almost always treatable. Discover how can I stop incontinence in old age by exploring the range of effective strategies available, from behavioral changes to advanced medical options.

Quick Summary

Manage urinary incontinence in older age by combining lifestyle adjustments, like regulating fluid intake and managing weight, with targeted bladder training and pelvic floor exercises. Medical treatments, devices, and surgery are also options that can be explored with a healthcare professional to significantly reduce or eliminate symptoms and improve quality of life.

Key Points

• Incontinence is Treatable: Contrary to popular belief, incontinence is not an inevitable part of aging and can often be significantly improved or cured with the right strategies.

• Start with Behavioral Changes: Simple lifestyle adjustments like regulating fluid intake, avoiding bladder irritants, and managing diet are often the first and most effective steps.

• Practice Pelvic Floor Exercises: Kegels are a critical and proven method for strengthening the muscles that support the bladder, helping to reduce leaks associated with stress and urgency.

• Utilize Bladder Training: Scheduling trips to the toilet and learning to delay urination can help retrain your bladder for better control over time.

• Consider Medical Options: For persistent issues, a doctor can recommend medications, minimally invasive devices, or surgery, depending on the specific cause and type of incontinence.

• Talk to a Healthcare Provider: Seeking a proper diagnosis from a professional is crucial, as underlying medical conditions may be contributing to the problem.

Understanding the Causes of Incontinence in Older Adults

Incontinence, or the involuntary leakage of urine, has various potential causes in older adults. It is not an unavoidable consequence of getting older, but rather a condition that can often be managed or cured. Some common factors that contribute to incontinence include:

• Weakened pelvic floor muscles: These muscles support the bladder and urethra. Aging, childbirth, and a lack of exercise can weaken them, making it harder to hold urine, especially during physical strain like coughing or sneezing.
• Overactive bladder muscles: Uncontrolled contractions of the bladder muscles can cause a sudden, strong urge to urinate, a condition known as urge incontinence.
• Changes in the urinary tract: For women, a decrease in estrogen after menopause can affect the lining of the urethra and bladder. For men, an enlarged prostate can block the urethra, leading to overflow incontinence.
• Medical conditions: Neurological disorders (Parkinson's, MS), diabetes, and arthritis can all impact bladder control.
• Other factors: Chronic conditions, certain medications, constipation, and UTIs can all exacerbate or cause temporary incontinence.

Lifestyle and Behavioral Modifications

Many people find significant improvement in their incontinence symptoms by first focusing on simple lifestyle and behavioral changes. These non-invasive methods are often the first step in a treatment plan.

Diet and Fluid Management

What you eat and drink can have a direct impact on your bladder.

• Limit bladder irritants: Reduce or eliminate consumption of alcohol, caffeine (found in coffee, tea, and soda), artificial sweeteners, and highly acidic foods like citrus fruits and tomatoes.
• Stay hydrated strategically: While it's important to drink enough water to prevent concentrated urine from irritating the bladder, it's wise to limit fluid intake a few hours before bedtime to reduce nighttime trips to the bathroom.
• Prevent constipation: A high-fiber diet, along with adequate fluids, can help prevent constipation. Pressure from hard stool in the rectum can push on the bladder, worsening incontinence.

Pelvic Floor Exercises (Kegels)

Kegel exercises are a cornerstone of incontinence management for both men and women and are proven to strengthen the muscles that control urine flow.

1. Identify the muscles: To find your pelvic floor muscles, imagine you are trying to stop the flow of urine mid-stream. The muscles you tighten are the right ones. (Do not perform Kegels while urinating as a regular practice).
2. Practice holding: Squeeze these muscles and hold the contraction for 3 to 5 seconds. Start small and work your way up to 10 seconds as you get stronger.
3. Perform repetitions: Relax for the same amount of time you held the contraction. Do 10 repetitions, 3 times a day.

Bladder Training

Retraining your bladder can help restore its capacity and reduce urgency.

• Timed voiding: Start by urinating at set intervals, for example, every two hours. Gradually increase the time between trips to train your bladder to hold more urine.
• Double voiding: If you have overflow incontinence, urinate and then wait a few minutes before trying to go again. This helps empty your bladder more completely.
• Urgency suppression: When you feel a strong urge to urinate, try distracting yourself, taking long breaths, or squeezing your pelvic floor muscles until the urge subsides and you can get to the toilet calmly.

Comparison of Incontinence Management Options

Method	Effectiveness	Best For	Considerations
Lifestyle Changes	Significant for many, especially mild cases.	Anyone experiencing incontinence.	Low-cost, safe, requires consistent effort.
Pelvic Floor Exercises	Highly effective for stress incontinence and improving urge control.	Stress and urge incontinence.	Requires proper technique and consistency for results.
Bladder Training	Effective for urge incontinence.	Urge incontinence, overactive bladder.	Requires discipline and tracking progress.
Medications	Can be very effective for urge incontinence.	Overactive bladder (urge incontinence).	Can have side effects in older adults; require doctor's supervision.
Medical Devices	Good for specific types, like pessaries for prolapse.	Women with stress incontinence or prolapse.	Invasive but non-surgical; require fitting and maintenance.
Surgery	Can cure or significantly improve stress or overflow incontinence.	Severe cases, specific anatomical issues.	Invasive, last resort, carries typical surgical risks.

Medical and Clinical Treatments

When behavioral changes and exercises are not enough, or for more severe cases, a healthcare provider can recommend further medical intervention.

Medications

• Anticholinergics: These drugs can calm an overactive bladder. However, they can cause side effects like dry mouth, blurred vision, and cognitive issues in older adults.
• Mirabegron: This medication relaxes the bladder muscle and increases the amount of urine it can hold. It has fewer side effects than anticholinergics but can raise blood pressure.
• Topical Estrogen: For postmenopausal women, low-dose vaginal estrogen cream can help relieve urge or stress incontinence by rejuvenating tissues around the urethra.
• Alpha-blockers: Prescribed for men with incontinence caused by an enlarged prostate, these help relax bladder muscles.

Minimally Invasive Procedures and Devices

• Bulking agents: A doctor can inject a substance into the tissue around the urethra to help close the bladder opening and reduce stress incontinence.
• Nerve stimulators: These devices send mild electrical pulses to the nerves that control the bladder to regulate reflexes.
• Pessaries: For women with stress incontinence or a prolapsed bladder, a pessary is a small, rigid ring inserted into the vagina to help support the bladder.

Practical Tips for Daily Management

• Use absorbent products: Pads, protective underwear, and bed pads can provide peace of mind and protection, especially during treatment or for managing ongoing symptoms.
• Adjust your environment: Ensure a clear path to the bathroom, use nightlights, and consider a bedside commode for nighttime convenience.
• Dress strategically: Wear clothing that is easy to remove quickly, such as elastic-waist pants instead of buttons or zippers.
• Manage other health conditions: Keeping chronic conditions like diabetes in check can improve bladder function.
• Seek professional help: Always consult a healthcare provider for a proper diagnosis and treatment plan, as incontinence can sometimes be a sign of a more serious underlying issue. The National Institute on Aging offers excellent resources for seniors on this and other health topics.

Conclusion

Understanding how can I stop incontinence in old age involves recognizing that it is a treatable condition, not a certainty of aging. By adopting a multi-pronged approach that includes lifestyle modifications, targeted exercises, and—if necessary—medical interventions, older adults can regain significant bladder control and greatly improve their quality of life. The key is to address the issue openly and proactively with healthcare professionals who can provide tailored guidance and support. With the right strategies, you can manage and often overcome the challenges of incontinence.

Visit the National Institute on Aging for more information about urinary incontinence in older adults.

Frequently Asked Questions

What foods and drinks should I avoid to help stop incontinence?

To help manage incontinence, try reducing or avoiding bladder irritants such as caffeine (coffee, tea, soda), alcohol, carbonated beverages, acidic foods (citrus, tomatoes), and spicy foods. Keeping a bladder diary can help identify specific triggers.

Are Kegel exercises really effective for stopping incontinence in old age?

Yes, Kegel exercises are highly effective and are often the first line of treatment recommended by doctors for both stress and urge incontinence. Consistent, proper practice can strengthen the pelvic floor muscles, improving bladder control.

When should I see a doctor for incontinence?

You should see a doctor if incontinence is affecting your daily life, and simple lifestyle changes haven't helped. It's especially important to get a medical evaluation if you have sudden onset, severe symptoms, or notice other related issues, as it could indicate an underlying condition.

Can weight loss help reduce incontinence?

Yes, maintaining a healthy weight is beneficial for incontinence. Excess body weight, particularly around the abdomen, puts extra pressure on the bladder and pelvic floor muscles, which can worsen symptoms. Losing weight can significantly reduce this pressure and improve control.

Is it okay to drink less water to prevent leakage?

No, it's not recommended to drastically reduce your fluid intake. While it seems logical, drinking too little water makes urine highly concentrated, which can irritate the bladder and worsen symptoms. It's better to manage when you drink fluids, such as limiting them before bed.

What are some practical tips for managing incontinence at night?

To manage nighttime incontinence, try limiting fluid intake a few hours before bedtime. You can also make sure the path to the bathroom is clear, use nightlights, or keep a commode nearby. A healthcare provider might also suggest timed voiding.

What medical treatments are available for incontinence in older adults?

Medical treatments include medications to calm the bladder (for urge incontinence), devices like pessaries, nerve stimulation, and botox injections. For some specific causes, such as an enlarged prostate in men or a prolapsed bladder in women, surgery may be a viable option.