Urinary incontinence refers to the accidental or uncontrolled leaking of urine from the bladder. It is something an estimated two thirds of all elder Americans struggle with, and it not only affects the individual medically, but also has social, emotional and psychological consequences. Many people with incontinence are afraid to be too far from the toilet, and retreat from normal activities and enjoying life. It is often assumed that urinary incontinence is a normal part of aging, but it is not. Incontinence can be managed or treated.
The Scottsdale home care team at Nightingale Homecare are here to help you better understand the facts about incontinence and how to best help a loved one (or yourself) to manage it.
- Pregnancy in past, especially multiple pregnancies
- Weak bladder or pelvic muscles
- Overactive bladder muscles
- Prostate problems
- Certain medications
- Damage to nerves that control the bladder
- Parkinson’s disease
- Multiple sclerosis
- Pelvic organ prolapse
- High blood pressure
- Urinary tract infections
- Vaginal infections
Types of Urinary Incontinence
There are four types of urinary incontinence:
- Stress Urinary Incontinence (SUI): This is the most common cause of urinary incontinence and is much more common in women than in men. SUI occurs when the muscles in the pelvic floor have stretched. With physical activities such as exercise, walking, bending, lifting and even sneezing and coughing, leaking may occur. This is especially common in women around the time of menopause.
- Overactive Bladder or Urgency Incontinence: This occurs when the patient has a sudden urge to urinate and cannot hold the urine.
- Mixed Incontinence: This is a combination of stress incontinence and overactive bladder.
- Overflow Incontinence: This occurs when small amounts of urine leak from a full bladder. This can occur with an enlarged prostate, diabetes, or spinal cord injuries.
The first step in identifying and treating incontinence is seeing a doctor for an exam. Come ready with your questions, a diary of your (or your loved one’s) incontinence, list of symptoms, past medical history and any medications currently being taken. The doctor will take some blood and urine tests in addition to tests that measure urine output and how well the bladder is emptying. The doctor may also suggest seeing a urologist, a doctor who specializes in urinary problems.
The doctor will choose a treatment based on the type of bladder control issue and how serious it is. There are multiple treatments available, and the doctor will begin with the simplest and safest treatment first. Treatment options include:
- Kegel or pelvic muscle exercises: These exercises work the muscles used to stop urinating and help make them stronger.
- Biofeedback: This treatment uses sensors to make the patient aware of the body’s signals. Biofeedback can be helpful when learning Kegel exercises.
- Timed voiding: A schedule is set up for urination; for example every hour or two. The goal is to slowly extend the time between voidings to help control urge and overflow incontinence.
- Lifestyle changes: Losing weight, preventing constipation, avoiding heavy lifting, stopping smoking, avoiding alcohol and caffeine can all make a difference. Choosing water instead of other drinks and limiting fluids before bedtime can also help.
- Medications: There are medications that can help empty the bladder, and some medications are used to help tighten muscles.
- Injections: The doctor may use a substance injected around the urethra to help thicken and close the area around the urethra to prevent leaking.
- Urethral and vaginal insert: A small disposable device may be used for women, inserted in either the urethra or the vagina.
- Surgery: Surgery may be used to change the position of the bladder or to reduce the blockage due to an enlarged prostate.
- External catheters: There are external catheter products for both men and women. External catheters work well for men and are applied much like a condom, with tubing attached to collect the urine in a drainage bag. External catheters don’t work well for all women as these funnel-like pouches don’t always adhere perfectly to the labia, and leaking can occur.
- Straight catheters: These catheters are inserted intermittently to drain the bladder 3-5 times a day on a set schedule.
- Indwelling catheters: This type of catheter is inserted into the bladder, either through the urethra or through a surgical opening above the pubic bone. These catheters are for long-term use and are kept in 24/7. A home care nurse can assist with the maintenance and changes every month.
- Absorbent products: There are numerous products that can help protect clothing and bedding from urine leakage, ranging from pads to adult diapers. These products absorb urine leakage and offer some protection to the skin. When choosing a product, consider the ease of use and whether the patient will need to fully remove outer clothing to change the product. Also, consider absorbency and the materials they are made of. Some products have plastic components and can irritate the skin.
Even after treatment, some patients continue to leak urine or have episodes of incontinence. Over time, urine leakage can cause skin breakdown, rashes and redness. Urine on the skin can also lead to bacteria growth and infection. Soaps, skin products and cleansers can help if used properly. Overuse of soap and water, however, can dry out the skin and lead to breakdown. There are special rinses and cleansers made specifically for incontinence, and barrier creams are effective in keeping urine away from the skin and preventing breakdown. If the patient uses adult diapers and incontinent pads, it is important to check and change them frequently to avoid a UTI, skin breakdown and skin infections.
Incontinence and Alzheimer’s Disease
In the later stages of Alzheimer’s disease, patients often experience urinary incontinence. This can be an issue of not realizing the need to urinate, forgetting to use the bathroom, or not being able to locate a toilet.
There are things you can do to avoid incontinence in someone with Alzheimer’s disease. They include:
- Avoid coffee, teas and sodas and other drinks containing caffeine; but don’t limit water
- Keep pathways clear and the bathroom clutter-free
- Post signage that directs the person to the toilet
- Keep a light on in the bathroom
- Provide a consistent bathroom schedule
- Make certain underwear is easy to remove
Nightingale Homecare’s team of fully trained and experienced Scottsdale home care professionals are available to help reduce the discomfort of urinary incontinence with a full range of nursing and non-medical in-home care. Contact us at (602) 504-1555 to learn more!