Understanding the different types of incontinence
Incontinence is not a single condition but rather a symptom with several root causes, each leading to a different type of leakage. Identifying the specific type is crucial for determining the most effective treatment plan. Here are the most common types found in older adults:
- Urge incontinence: Characterized by a sudden, intense urge to urinate that is difficult to hold back, often leading to involuntary urine loss before reaching a toilet. It is associated with an overactive bladder (OAB) and is more prevalent in seniors.
- Stress incontinence: Occurs when pressure is exerted on the bladder, such as from coughing, sneezing, laughing, exercising, or lifting heavy objects. It's more common in women due to changes from childbirth and menopause, but can also affect men.
- Overflow incontinence: Defined by the frequent or constant dribbling of urine because the bladder does not empty completely. The bladder becomes overly full and leaks, often without the person feeling the urge to urinate.
- Functional incontinence: This type occurs when a physical or mental impairment prevents a person from reaching the toilet in time. This is not a problem with the urinary tract itself but with the body's ability to act on the signal to urinate.
- Mixed incontinence: The presence of more than one type of incontinence, most often a combination of urge and stress incontinence.
Age-related changes affecting bladder control
As the body ages, several natural physiological changes can affect bladder and nerve function, making seniors more susceptible to incontinence.
Weakened pelvic floor muscles
Over time, the muscles that support the bladder, uterus, and bowels can weaken. This is particularly common in women after childbirth or menopause, as hormonal shifts (reduced estrogen) can affect the health of bladder and urethral tissues. In men, the pelvic floor can also weaken, though often less directly connected to major life events like childbirth.
Changes to bladder elasticity
The bladder muscle itself undergoes changes with age, losing some of its elasticity and capacity to store urine. This means it cannot hold as much urine as it once did, leading to more frequent urination and an increased chance of involuntary contractions. These contractions can cause the strong, sudden urge associated with urge incontinence.
Prostate issues in men
An enlarged prostate gland, known as benign prostatic hyperplasia (BPH), is a common cause of incontinence in older men. The enlarged gland can press against the urethra, blocking urine flow and causing the bladder to not empty completely. This can lead to overflow incontinence.
Medical conditions that cause incontinence
Incontinence is frequently a symptom or side effect of an underlying medical issue, not an isolated problem. Many chronic diseases common in older adults can disrupt bladder function.
- Neurological disorders: Diseases that affect the nervous system, such as Alzheimer’s disease, Parkinson’s disease, stroke, or multiple sclerosis, can interfere with nerve signals that control the bladder. This can lead to impaired bladder emptying or the inability to recognize the need to urinate. For example, individuals with advanced Alzheimer’s may simply forget to go to the bathroom.
- Diabetes: This condition, particularly type 2, can cause nerve damage (neuropathy) that affects bladder control. It can also increase urine production, overwhelming the bladder's capacity.
- Urinary tract infections (UTIs): UTIs are a common and treatable cause of temporary incontinence. The infection irritates the bladder, causing strong urges and, sometimes, involuntary leakage.
- Chronic constipation: The rectum is located near the bladder and shares some nerves. When hard, impacted stool accumulates in the rectum, it can press on the bladder and overstimulate the nerves, leading to increased urinary frequency and urge incontinence.
- Pelvic organ prolapse (in women): After childbirth or due to age, the pelvic organs (bladder, uterus, or rectum) can shift out of their normal position and press against the bladder and urethra. This can prevent the bladder from working normally and cause leakage.
Medication side effects and incontinence
Many common medications can affect bladder function and contribute to incontinence, especially in older adults who may be taking multiple prescriptions. A detailed review of current medications is a critical step in diagnosing the cause of incontinence.
How medications impact the bladder
| Medication Class | Mechanism of Effect | Type of Incontinence | Example |
|---|---|---|---|
| Diuretics | Increase urine production, overwhelming bladder capacity. | Urge | Furosemide |
| Alpha-blockers | Relax muscle tissue in the bladder neck and prostate, decreasing urethral tone. | Stress | Prazosin |
| Calcium Channel Blockers | Decrease smooth muscle contractility in the bladder. | Overflow | Amlodipine |
| Anticholinergics | Inhibit bladder muscle contractions. | Overflow | Oxybutynin |
| Sedatives and Hypnotics | Impair cognition and mobility, preventing a timely bathroom visit. | Functional | Diazepam |
| ACE Inhibitors | Can cause a chronic cough, increasing abdominal pressure. | Stress | Lisinopril |
| Antidepressants | Interfere with nerve signals controlling the bladder, often causing urinary retention. | Overflow | Imipramine |
Managing and preventing senior incontinence
While incontinence can be distressing, it is often manageable and sometimes even reversible. A healthcare provider can recommend a tailored treatment plan, which may include a combination of strategies.
Lifestyle and behavioral changes
- Timed voiding: Creating a scheduled bathroom routine can help retrain the bladder. This is particularly helpful for those with functional incontinence.
- Bladder training: Gradually increasing the time between trips to the bathroom can build bladder capacity and endurance.
- Pelvic floor (Kegel) exercises: Strengthening the pelvic muscles that support the bladder can improve control, especially for stress incontinence.
- Dietary adjustments: Limiting caffeine, alcohol, and acidic foods can reduce bladder irritation. Maintaining a healthy weight also decreases pressure on the bladder.
- Manage constipation: Increasing fiber intake can prevent constipation, which puts pressure on the bladder and can worsen incontinence symptoms.
Medical and supportive treatments
- Medication: Drugs are available to manage certain types of incontinence, such as overactive bladder. However, seniors should discuss side effects with their doctor.
- Medical devices: Options for women include urethral inserts or a pessary to support the urethra and bladder. These are used to manage stress incontinence.
- Surgery: For severe cases, surgery may be an option, especially if there is a structural problem like an enlarged prostate or significant pelvic organ prolapse.
- Assistive products: Incontinence pads, briefs, and protective bedding can help manage leaks and maintain dignity.
When to see a doctor
It's important not to be embarrassed about incontinence. Many people do not discuss it, but it is a medical condition that can often be improved with the right care. If incontinence is affecting daily activities, causing social isolation, or accompanied by other new symptoms, seeking a medical opinion is highly recommended. For individuals experiencing cognitive decline, establishing a bathroom routine with the help of a caregiver is beneficial.
For more in-depth information on managing specific types of incontinence, consider visiting the National Institute on Aging.
Conclusion
While incontinence is more common in older adults, it is not an inevitable or untreatable consequence of aging. The reasons why elderly people get incontinence are varied, from natural physical changes and chronic conditions to medication side effects. By understanding these causes, seniors and their caregivers can work with healthcare providers to develop a personalized plan, restore bladder control, and significantly improve their quality of life. Open communication and a proactive approach are key to managing this common condition effectively.
