Many older adults live with the ageism that loss of bladder control is a normal part of aging thereby living more restrictive lives and becoming socially isolated.This leads to a higher risk of depression and falling. With evidence-based knowledge, and some action on your part, you can improve the quality of your life and perhaps manage this condition without medications.
FIRST THINGS FIRST
I’ll be bold and say that most practitioners don’t do a thorough examination and thoughtful interview when someone complains of incontinence. It’s usually a brief conversation and then the prescription is written for Detrol, Ditropan or Flomax. However, if there’s one thing I’ve learned in order to get this right it’s to have a thorough pelvic examination by someone who is experienced in bladder health along with a thoughtful interview. Anatomical changes seen with aging, especially in women, can cause incontinence and knowing specifically what changes have occurred then leads to accurate decisions for effective management. Is it exercises, or is it a topical estrogen cream or a pessary? If the diagnosis is correct, then the least invasive and most effective therapy can be prescribed.
TYPES OF INCONTINENCE
There are several types of incontinence but it should be understood that people can frequently have more than one. The approach to managing each type can differ so it’s important to understand the differences.
This form is most common in women and is associated with the post-menopausal decline in the body’s estrogen which leads to atrophy of supportive tissue around the urethra. It usually results in a small amount of urine leakage when coughing, laughing, exercising, sneezing or lifting heavy objects. Stress incontinence should first be managed with exercises that help control the muscles that surround the urethra. These exercises are called Kegel exercises. If you can change your daily routine and add these simple and short exercises into your routine you can take control of urine leakage caused by stress incontinence. In some instances the use of topical estrogen creams helps enhance the integrity of the tissue that surrounds the urethra thereby giving more support so urine doesn’t leak out. This low-dose estrogen can also be delivered by having a bladder health specialist or your physician insert an estrogen-ring that stays in for 3 months. Every 3 months it is replaced thereby delivering the medication constantly over three months and eliminating the need to administer medication routinely. Medication should always be combined with bladder health exercises since medication alone is not as beneficial.
This form can be described by a sudden urge to go to the bathroom. If you do not make it in time then a larger loss of urine usually occurs. Urge incontinence is more common in co-morbid conditions like diabetes, Parkinson’s disease, MS, Alzheimer’s disease and others. In addition to pelvic floor exercises, timed or prompted-voiding is known to greatly reduce the number of incontinence episodes in those with urge incontinence. The idea is to develop the bladder muscles by trying to hold in urine longer each time you have the urge. The urge can frequently dissipate and each time you hold urine in longer you extend the time between episodes. Literature states that you can reduce the number of episodes by up to 50%. Medications added to that, like Detrol, Ditropan, and others only enhance the reduction to 60 or 70%. Our recommendation is to ALWAYS try to manage this condition without medication first because these medications are known to cause memory health problems in older adults and are expensive. If a bladder health medication is needed we suggest you consider those that have the lowest likelihood of causing side-effects such as Oxytrol patch which is placed on the skin twice a week. Go to www.rxlist.com to learn more about Oxytrol.
Other factors that contribute to urge incontinence which you can alter are caffeine intake, nicotine, alcohol, and managing constipation. Don’t always assume there is one approach to managing incontinence. Success is usually based on several factors. Seeing a bladder health specialist can help tremendously. You can also get very useful information at the National Institutes of Aging web site. This Age Page publication is an unbiased brochure on how to manage incontinence and gives specifics on the exercises and other approaches mentioned above.
This form of incontinence is more common in men with prostate enlargement. Treatment can involve medications that are usually well tolerated such as Flomax, which relaxes the urethra so urine can flow more easily. If the prostate is enlarged then other medications such as finasteride can shrink the prostate over several months. This medication is most useful in managing the condition when combined with a drug like Flomax. Another contributing factor to this form of incontinence is constipation. Managing constipation will help with improving urine flow. Again, it’s a multi-factorial approach that usually works best.
This form of incontinence is associated with the inability to get to the bathroom in time due to slow mobility or severe disability. Consulting a bladder health specialist will help with useful coping mechanisms to assist with reducing the number of episodes.
These come in all sizes and are usually packaged by the amount of absorbent product in each pad which correlates with the amount of urine loss that usually occurs. Stress incontinence usually requires a small pad or panty liner whereas urge incontinence usually requires a brief or “pull-up”. These products are useful in preventing unexpected loss of urine but we encourage people to seek out the cause of incontinence and manage it as suggested above so these products are kept to a minimum. Over-reliance upon these products can lead to skin breakdown, rash and fungal infections.
We hope this information at least directs you to more options to successfully manage your bladder health. Please keep in mind that if you can incorporate some small changes in daily routine you can better manage this condition and do so without medications.