Monday, April 3, 2017

Don’t Be Embarrassed About Incontinence

Incontinence in Older Adults

Many simple and effective solutions are available for an issue common among older adults.

Do you recognize this sign? Whenever you’re in a public place, you’re scouting out where the closest bathroom might be—just in case. If so, you’re not alone. More than 25 million Americans are affected by either bladder or bowel incontinence, according to the National Association for Continence. One in 3 older women is unable to control their bladder. Although such problems can happen at any age, it's more common in older adults.

But incontinence is a hidden issue. Most people are too embarrassed to talk about it, even to their doctor, and feel some personal shame. Despite high success rates in treating incontinence, only 1 out of every 12 people affected seeks help. For the majority of those who suffer, incontinence is 100 percent treatable.

Causes of Incontinence

Although there are short-term reasons for incontinence, such as a urinary tract infection, if it becomes a normal part of your life, other issues may be causing loss of bladder control:

  • Weak bladder muscles

  • Overactive bladder muscles

  • Damage to nerves that control the bladder from diseases such as multiple sclerosis or Parkinson’s disease

  • Blockage from an enlarged prostate in men

  • Diseases such as arthritis that may make it difficult to get to the bathroom in time

  • Medication and side effects

Fecal incontinence is commonly the result of muscle or nerve injuries. For women, obstetrical injuries (such as when episiotomy or forceps are used during childbirth) are the number one cause and produce about 60 percent of cases. Women may suffer nerve damage in childbirth that can cause loss of bowel control later in life.

It is important to note that fecal incontinence is not an inevitable consequence of aging. It may indicate a more serious condition, including (from A Place for Mom)

  • Diseases that affect the nervous system, such as Alzheimer's or diabetes.

  • Long-term, frequent reliance on laxatives.

  • Constipation: When stools become hardened in the rectum, the looser, watery stool must move around the drier mass and often leaks from the anus.

  • Diarrhea: Especially in cases of sphincter muscle and nerve damage, the loose stools of diarrhea are more challenging to retain in the rectum.

  • Scarring from radiation or surgery, which can harden rectal walls, diminishing their ability to hold stool.

  • Virtually any operation involving the rectum and anus, including hemorrhoid removals, which risks damaging the sphincter muscles.

  • Medication and side effects.

Start with Exercises

Treatments range from exercises and dietary changes to surgery. Experts advise that you start with the least invasive, which involves retraining your body.

How to Do Kegel Exercises

The National Institute on Aging provides a brief description of Kegel exercises that help tighten your pelvic floor muscles.

Locate your pelvic muscles by stopping the flow of urine midstream. Empty your bladder, lie down, squeeze and hold these muscles for a count of three, then relax them for a count of three. Work up to doing 10 of these exercises three times a day.

The muscles in your pelvic area need to be strengthened, both for bladder and bowel control. Experts highly recommend Kegel exercises, also known as pelvic muscle exercises (see sidebar for how to do them). Making these muscles stronger helps you hold urine in your bladder longer and strengthens your anal sphincter.

Because it can be difficult to find those muscles precisely, you can use biofeedback. Some biofeedback tools have small exposed sensors that are placed inside the vagina and capture electrical activity. Others can be placed externally outside the anal opening, while others can detect contractions of the pelvic floor. For example, a probe inserted in the rectum measures sphincter contraction and muscle pressure, and you can use that information to determine if you are doing the exercises correctly.

Another recommended tip is to “train” your bladder to urinate on a set schedule, which may help you control your bladder. For example, set a time to urinate every hour and then slowly extend the time between bathroom trips. A similar schedule for your bowels can also be helpful.

Watch Your Fluid / Food Intake

To avoid leakage, many people suffering from bladder control problems may limit how much they drink, but this approach actually worsens the problem. Less liquid concentrates urine, which irritates the bladder, causing you to go to the bathroom more often. Reducing fluid intake can also encourage bacteria growth, which can lead to loss of bladder control. For both bladder and bowel issues, drinking the right amount of fluids is necessary. Medical experts recommend six to eight glasses a day.

It’s also necessary to drink the right kind of fluids. Carbonated beverages and drinks with artificial sweeteners can irritate your bladder and make leakage more likely. Similarly, cutting back on caffeine—from coffee, tea, chocolate and sodas—can make your bladder more comfortable. And alcohol signals your body to get rid of more fluid than you take in, so you end up with more urine in your bladder, which can cause leaking.

For bowel issues, add high-fiber foods to your diet, including whole wheat grains, fresh vegetables and beans. The fiber softens stools and prevents diarrhea and constipation that may lead to incontinence. Psyllium-containing products, such as Metamucil, add bulk to the stools.

Medicines Can Help

Medications can calm bladder muscles and nerves to prevent urinary leakage. Other drugs can help the bladder empty more fully during urination and tighten muscles to lessen leakage. These treatments come as pills, liquids, creams (such as estrogen vaginal cream) or patches.

For bowel control, medications include anti-diarrheal drugs that prevent watery stools. Check out over-the-counter options like Imodium, and prescription medications such as Lomotil, Nulev and Lotronex.

It’s important to never stop or start medications without first consulting with your health care provider. This includes over-the-counter medicines, which are designed to be solutions for short-term episodes and not long-term management.

Medical Treatments

If dietary changes and bladder and bowel training don’t help, your healthcare provider may suggest medical treatments. These include the following:

Medical devices. For women, a urethral insert blocks the urethra temporarily to prevent leaking when it is most likely to happen, such as during physical activity. These can be uncomfortable and can cause urinary tract infections. Another device, a pessary, holds up a prolapsed bladder or vagina.

Nerve stimulation. Mild electric currents are sent to the nerves around the bladder that help control urination. You can do this at home by placing an electrode in the vagina or anus, or you can undergo minor surgery to place an electrode under the skin on the leg or lower back.

When All Else Fails: Surgery

Only consider surgery after other treatments have failed. There are more than 150 procedures available. In a more common procedure for women, a doctor injects a substance that thickens the area around the urethra to help close the bladder opening. This is a temporary fix and must be repeated every three months. For men, surgeons can implant a device that holds the urinary sphincter closed. To urinate, one presses the implanted valve.

For loss of bowel control, the most common surgery is sphincteroplasty, which surgically reconstructs the anal sphincter muscle that controls bowel movements.

Although experts agree that incontinence is common, it is not a normal part of aging. Because there are multiple causes, there may be no single treatment that is totally effective. An accurate diagnosis is crucial, so it’s important to speak to your health care provider about incontinence.



Sources

Urinary Incontinence,” NIH Senior Health.

Elderly Urinary Incontinence: Causes & Care,” April 29, 2015, A Place for Mom.

Elderly Fecal Incontinence: Symptoms & Care,” April 30, 2015, A Place for Mom.

Conditions,” NAFC.

Urinary Incontinence,” National Institute on Aging.

Blog posting provided by Society of Certified Senior Advisors
www.csa.us