Tuesday, October 4, 2022

What Causes Urinary Incontinence In Older Adults

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Question: As Ive Gotten Older Ive Noticed That I More Frequently Have Trouble With Bladder Leaks And Find Myself Having More Accidents Than I Used To How Can I Stop Or Prevent Incontinence As I Grow Older

Transient Urinary Incontinence Assessment for Older Adults

Answer: Leaky bladders are common, but not normal.

Experiencing a leaky bladder as you age is a common occurrence. Many people find that they are either running to the bathroom much more often , or unable to hold it like they used to. This can result in embarrassing leaks and extra piles of laundry.

As you age, a number of forces can work against you to cause bladder leaks. A weakened pelvic floor , leaks due to an overactive bladder, or prostate problems can all contribute to incontinence. And while these may all be common occurrences, it doesnt make them normal, and they shouldnt be ignored.

What Is Urinary Incontinence

Urinary incontinence is not a disease, it is a symptom. Incontinence is the involuntary loss of urine due to an inability to control the bladder. It can range from a few drops of urine leaking out when a patient laughs, sneezes, or coughs, to losing a full bladder at any time.

While it does occur more often with senior citizens, it is not an inherent characteristic of aging.

Prevalence And Type Of Urinary Incontinence

The prevalence of UI according to age is shown in . The overall prevalence of UI was 14.8%, increasing from 12.0% for the men aged 7074 years old to 26.3% among men 8589 years old but reduced to 16.3% for those aged 90 years old .

Urgency incontinence was the most frequent type of urinary incontinence, with 20% of men reporting leaking urine before getting to the toilet . About 10% of men experienced post-micturition dribbling and 5% of men reported leaking urine for no obvious reason. Three percent of men reported using pads or other incontinence aids.

Analysis of the data from the ICIQ showed that the frequency of urine leakage was strongly correlated with the quantity of urine leaked . Both frequency and quantity of urine leakage were strongly correlated with the self-perceived impact on daily life rating in the ICIQ. Among those defined with UI, 12.6% reported a score over 5 on the self-perceived impact on life scale . The overall ICIQ summed score in all men in CHAMP ranged from 0 to 18 , with a median score of zero, the first quantile was zero and the third quantile was three.

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Should I Drink Less Water Or Other Fluids If I Have Urinary Incontinence

No. Many people with urinary incontinence think they need to drink less to reduce how much urine leaks out. But you need fluids, especially water, for good health.

Women need 91 ounces of fluids a day from food and drinks.11 Getting enough fluids helps keep your kidneys and bladder healthy, prevents urinary tract infections, and prevents constipation, which may make urinary incontinence worse.

After age 60, people are less likely to get enough water, putting them at risk for dehydration and conditions that make urinary incontinence worse.12

Diagnosing A Urinary Tract Infection In Older Adults

Incontinence Products for the elderly and active Seniors

Vague, uncommon symptoms such as confusion make UTIs challenging to diagnose in many older adults. Once your doctor suspects a UTI, its easily confirmed with a simple urinalysis.

Your doctor may perform a urine culture to determine the type of bacteria causing the infection and the best antibiotic to treat it.

There are home UTI tests that check urine for nitrates and leukocytes. Both are often present in UTIs. Because bacteria are often in the urine of older adults to some degree, these tests arent always accurate. Call your doctor if you take a home test and get a positive result.

Antibiotics are the treatment of choice for UTIs in older adults and younger people. Your doctor may prescribe amoxicillin and nitrofurantoin .

More severe infections may require a broad-spectrum antibiotic such as ciprofloxacin and levofloxacin .

You should start antibiotics as soon as possible and take them for the entire duration of treatment as prescribed by your doctor. Stopping treatment early, even if symptoms resolve, increases the risks of recurrence and antibiotic resistance.

Antibiotic overuse also increases your risk for antibiotic resistance. For this reason, your doctor will likely prescribe the shortest treatment course possible. Treatment typically lasts no more than 7 days, and your infection should clear up in a few days.

Its important to drink plenty of water during treatment to help flush out the remaining bacteria.

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What Is The Treatment For Urinary Incontinence

Specific treatment for urinary incontinence will be determined by your doctor based on:

  • Your age, overall health and medical history

  • Type of incontinence and extent of the disease

  • Your tolerance for specific medications, procedures or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

Treatment may include:

  • Behavioral therapies:

  • Bladder training: Teaches people to resist the urge to void and gradually expand the intervals between voiding.

  • Toileting assistance: Uses routine or scheduled toileting, habit training schedules and prompted voiding to empty the bladder regularly to prevent leaking.

  • Diet modifications: Eliminating bladder irritants, such as caffeine, alcohol and citrus fruits.

  • Pelvic muscle rehabilitation :

  • Kegel exercises: Regular, daily exercising of pelvic muscles can improve, and even prevent, urinary incontinence.

  • Biofeedback: Used with Kegel exercises, biofeedback helps people gain awareness and control of their pelvic muscles.

  • Vaginal weight training: Small weights are held within the vagina by tightening the vaginal muscles.

  • Pelvic floor electrical stimulation: Mild electrical pulses stimulate muscle contractions.

  • Medication :

  • Pessary

  • Office procedure

  • Slings

  • Bladder suspension

  • Consult your doctor with questions regarding the management and treatment of urinary incontinence.

    Sling Surgery Restores A Patient to Active Life | Stephanie’s Story

    Types And Causes Of Incontinence In Aging Adults

    Simply put, the bladder does two things: it stores urine and empties of urine.

    When storage goes wrong, this can result in symptoms of urgency, frequency, and stress incontinence. When these symptoms are severe, like having to void more than 13 times a day, or more than twice at night, quality of life can be significantly impaired.

    There can also be problems with getting the bladder to empty at the right time and place. Two types of issues that often come up for older adults are:

  • Blockage of the bladder outlet, which can happen with a large prostate gland, a constipated bowel, or some other cause, and leads to constant minor dribbling of urine all the time
  • Functional incontinence , where the incontinence is related to difficulty getting to the toilet in time and using it effectively.
  • Heres a chart reviewing the different types of incontinence:

    Symptom
    A mixture of the above symptoms

    So far, Ive talked mostly about chronic incontinence, but there can be a few reasons why an older person would suddenly start losing bladder control. As a geriatrician, I always want to rule out these potentially treatable issues before embarking on a long-term continence management plan.

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    A Pharmacist Can Help With Utis

    You can ask a pharmacist about treatments for a UTI. A pharmacist can:

    • offer advice on things that can help you get better
    • suggest the best painkiller to take
    • tell you if you need to see a GP about your symptoms

    Some pharmacies offer a UTI management service and can prescribe antibiotics if theyre needed.

    Related Conditions And Causes Of Urinary Incontinence

    Urinary Incontinence (Stress, Urge, Overflow & Functional) | Causes, Symptoms, Diagnosis, Treatment

    Fecal incontinence is light to moderate bowel leakage due to diarrhea, constipation, or muscle or nerve damage.

    As described in the section above on causes of urinary incontinence, common conditions may contribute to chronic urinary incontinence, including: urinary tract infection , constipation, interstitial cystitis or other bladder conditions, nerve damage that affects bladder control, side effects from a prior surgery, and neurological disorders.

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    Effects Of Incontinence On Young People

    University of Bristol research on continence problems in young people aged 11-20 years showed that embarrassment, fear of bullying and stigmatisation, and lack of understanding meant that some went to great lengths to conceal bladder and bowel issues, thereby risking:

    • Serious distress
    • Social isolation
    • Underlying conditions going untreated .

    The social assumption that continence problems only affected very young children, women or older adults caused participants to feel abnormal and misunderstood. A small number told friends, but all hid it at some level, and many did not want anyone to know. This led to worry about being discovered, at a time of development when fitting in with peers and society felt particularly important . However, many found effective ways of coping and those who told friends reported positive experiences and a sense of relief .

    In terms of the healthcare experience, participants wanted to be supported to self-manage, reporting positive treatment experiences when there was good rapport with clinicians and they felt fully involved in decision-making . However, many felt frustrated about a lack of continuity of care and poor understanding of the wider impacts of continence problems on their lives.

    Box 1. Case study: a young mans story

    *The patients real name has been used, with his permission.

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    What Can Happen If A Uti Is Not Treated

    If treated right away, a UTI is not likely to damage your urinary tract. But if your UTI is not treated, the infection can spread to the kidneys and other parts of your body. The most common symptoms of kidney infection are fever and pain in the back where the kidneys are located. Antibiotics can also treat kidney infections.

    Sometimes the infection can get in the bloodstream. This is rare but life-threatening.

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    Surgical Options For Urinary Incontinence

    About 285,000 incontinence procedures are performed annually, up 7.5% from 2015. If other treatment methods dont work, surgery may help.

    These are common surgical procedures for urinary incontinence:

    Sling procedures

    For women, this supports a womans urethra by placing abdominal tissue or synthetic materials beneath it. For men, it involves making a cut between the scrotum and anus. Complications can include not being able to empty ones bladder fully. However, this surgery is generally preferred because its well-known and has a history of long-term success.

    Colposuspension

    For stress incontinence, a cut is made into the lower stomach, and the bladder is lifted and stitched. The surgery can also be performed through one or more small cuts using surgical instruments, which is called a laparoscopic colposuspension. Both procedural types can help prevent long-term incontinence.

    Artificial urinary sphincter

    This is generally used for men with stress incontinence. A device is placed around the neck of the bladder. This fluid-filled, doughnut-shaped device holds the sphincter closed and is attached to a valve implanted in the testicles or, when used in women, the labia. To urinate, one presses the valve twice and the bladder empties.

    Selection Criteria And Entry And Exit Criteria

    Causes of Incontinence

    Articles in Persian and English are taken from cross-sectional studies as well as case-control articles, all in the group to select the factors affecting urinary incontinence in older adults women had the selection criteria to enter the study. And review articles, articles that do not have access to full text despite the relationship with the author of the article and lack of proper response, as well as articles that are of low quality in the evaluation of quality evaluation were removed from the review list.

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    If You Or A Loved One Has Been Diagnosed With Incontinence Contact Us For Assistance

    If you or a loved one has been diagnosed with incontinence, let us help you. At Sonas Home Health Care, we have an entire team of experienced caregivers to ensure the wellbeing of our patients.

    If you or an aging loved one are considering home health care services in Florida, contact the caring staff at Sonas Home Health Care. Call today .

    Is Urinary Incontinence A Normal Part Of Aging

    What exactly is urinary incontinence? Its the involuntary loss of urine, according to the National Association for Continence . Although incontinence can happen at any age, its generally more common in seniors.

    As you age, changes in the body can make elderly urinary incontinence more likely. One out of two women older than 65 experience bladder leakage sometimes, according to the Urology Care Foundation. It can be caused by typical aging, lifestyle choices, or a range of health conditions.

    Elderly urinary incontinence can take on a few forms:

    • Some people may only leak urine occasionally
    • Others may constantly dribble urine
    • Some experience a complete lack of both bladder and bowel control

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    What Are The Symptoms Of Fecal Incontinence

    The symptoms of fecal incontinence depend on the type.

    • If you have urge fecal incontinence, you will know when you need to pass stool but not be able to control passing stool before reaching a toilet.
    • If you have passive fecal incontinence, you will pass stool or mucus from your anus without knowing it.

    Some medical experts include streaks or stains of stool or mucus on your underwearcalled soilingas a symptom of fecal incontinence.

    How Are Utis Treated In Older Adults

    An Animation on Urinary Incontinence

    Antibiotics are the first choice of treatment for UTIs. Mild UTIs often clear up in only a few days with the right antibiotic.

    However, depending on the persons age and health plus the severity of the infection, treatment for a UTI may take several weeks and a longer course of antibiotics. In more severe cases, older adults may need to be hospitalized to receive IV antibiotics.

    If your loved one has symptoms of a UTI, its important to make an appointment with their doctor right away. If symptoms are severe, call the doctor immediately to determine whether a trip to the emergency room is necessary.

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    How Is Incontinence Treated

    There are many different factors that your healthcare provider will consider when creating a treatment plan for your incontinence. The type of incontinence and the ways it affects your life are both big considerations. Your provider will also talk to you about the type of treatment you are most comfortable with. There are three main types of treatment you can explore for incontinence medications, lifestyle changes and surgery. Each option has pros and cons that your provider will discuss with you.

    Medications to treat incontinence

    There are quite a few medications that can reduce leakage. Some of these drugs stabilize the muscle contractions that cause problems with an overactive bladder. Other medications actually do the opposite thing relaxing muscles to allow your bladder to empty completely. Hormone replacement therapies can often involving replacing estrogen thats decreased during menopause may also help restore normal bladder function.

    In many cases, medications can work very well to return normal function to the bladder. Your provider will carefully select a medication that matches your specific needs. Often, your provider will start you on a low dose of the medication and then increase it slowly. This is done to try and reduce your risks of side effects and to keep track of how well the medication is working to treat your incontinence.

    Common medications that can be used to treat incontinence include:

    Lifestyle changes to manage incontinence

    Enuresis Or Bedwetting Urinary Incontinence In Adults Young And Old

    Enuresis, or bed-wetting, is commonly associated with children but night time incontinence also affects adults, both young and old.

    Night time incontinence or bedwetting requires medical attention starting with primary care providers. When asking about urinary history, providers may consider inquiring about any recent incontinent episodes along with any history during childhood. This would help uncover a problem and save the patient the embarrassment of bringing it up. Simply asking if there is any problem with bowel or bladder may not uncover an issue a patient is uncomfortable talking about. In young adults, bedwetting is uncommon and can be indicative of something more serious. In the elderly it is not as unusual, but is not considered a normal part of aging. Incontinence can be managed in a variety of ways.

    Causes of bedwetting in younger adults might be:

    • Diabetes new or undiagnosed

    Here are some other ideas, but patients should speak to their doctor before trying:

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    Incontinence And Alzheimers Disease

    People in the later stages of Alzheimers disease often have problems with urinary incontinence. This can be a result of not realizing they need to urinate, forgetting to go to the bathroom, or not being able to find the toilet. To minimize the chance of accidents, the caregiver can:

    • Avoid giving drinks like caffeinated coffee, tea, and sodas, which may increase urination. But dont limit water.
    • Keep pathways clear and the bathroom clutter-free, with a light on at all times.
    • Make sure you provide regular bathroom breaks.
    • Supply underwear that is easy to get on and off.
    • Use absorbent underclothes for trips away from home.

    For more ways to deal with incontinence and other common medical problems in someone with Alzheimers, visit Alzheimers Disease: Common Medical Problems.

    Treatment Considerations In Older Adults

    urinary

    Dr N: She told me that her incontinence had definitely gotten worse in the last couple of weeks. I had noticed that another physician had sent a urine culture that had grown more than 105 CFU/mL of E coli that was sensitive to all antibiotics. Assuming that this was asymptomatic bacteriuria, it was not treated with antibiotics. A repeat urine culture again showed more than 105 CFU/mL of E coli, again it was pan sensitive. Given her symptoms, I treated her with a 7-day course of an antibiotic. However the antibiotics didnt really make a difference.

    Studies have shown that treatment of asymptomatic bacteriuria does eradicate bacteriuria. However, reinfection rates , adverse antimicrobial drug effects, and isolation of increasingly resistant organisms occur more commonly in the therapy vs nontherapy groups. No differences in genitourinary morbidity or mortality were observed between the 2 groups.

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