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 | Urine Incontinence
By Michael Spilane, MD
As a person ages, the distance to the bathroom often assumes increasing importance. For more than a few elderly the trip is too far--the adult diaper business rings up $4 billion in annual sales. Fifteen percent of independent-living elderly suffer from leakage of urine. Many others avoid the problem only by careful plotting of social forays according to the availability of bathrooms.
A hyperactive bladder is the most common cause of urine incontinence (loss of control) in the elderly. It leads to urinary frequency and urgency. Warning of the need to urinate is present, but there is a decrease in the ability to postpone the act. Leakage occurs when the warning is too brief or the distance to the toilet too far. For most older persons the problem is a manageable nuisance. For others the urgency and leakage is severe, necessitates the use of pads or diapers, and brings expense as well as misery.
Most things slow down with advancing age. So why does the bladder become overeager and overactive? The trouble actually is caused by a slowing--- not of the bladder but of the brain and the nervous system. The brain normally sends inhibiting messages to the bladder, telling it to relax and allow urine storage. Degenerative processes of aging in the brain and the spinal tract blunt this claming influence and leave the bladder uninhibited and too ready to contract in response to rising volumes of urine. Voiding becomes more frequent and more urgent. Brain ailments such as Alzheimer's disease, stroke, and Parkinson's disease cause a major loss of nervous system control, and victims often have a bladder that involuntarily contracts within seconds of the first urge to pass urine.
Problems with the bladder itself also can lead to urine incontinence. Irritation of the bladder muscle by urine infection, stones, or tumor can result in uncontrolled and unwanted bladder contractions. In older men, urine urgency is often caused by enlargement of the prostate gland. These conditions are usually more amenable to treatment and cure than the problem of central nervous system aging or disease.
Older persons with incontinence of urine too often fail to discuss the matter with their family or their doctor, believing it is just another irremediable burden of aging. They treat themselves with pads and diapers and stay at home where the bathroom is quickly accessible. A ride on a bus, a lunch at a restaurant, or even a visit to family is avoided because of fear of an accident. The self-imposed social isolation can lead to depression and further deterioration of health.
Proper treatment of urine incontinence begins with an evaluation by a physician. There are many causes of hyperactive bladder symptoms, and there are many causes of urine incontinence other than a hyperactive bladder. A correct diagnosis is essential. While cures are the exception, treatment of a hyperactive bladder usually will provide significant relief.
For those who find that the toilet is never close enough, some advice will prove helpful:
- Discuss the problem with your physician. Ask for a special appointment and make this the only topic on the agenda. If your physician is not helpful, ask for a referral to a physician who has a special interest in urine incontinence.
- Regulate fluid intake. Drink when a bathroom is handy but restrict fluid in anticipation of an outing.
- Avoid fluids and foods that have a caffeine effect--coffee, colas, and chocolate.
- Purchase and use some of the new highly absorbent adult protection pads and pants. They are widely available and are very effective.
- Use the toilet on a regular schedule, before you sense the need to urinate.
- Consider a bedside commode or urinal if your bladder frequently interrupts your sleep.
- Let strategy win over chance--know where the bathrooms are before you go out.
- Don't let your bladder control your life. Maintain a social life despite your bladder.
- Let friends and family know about your problem. Tell them why you are choosy about your social outings.
- Write letters to department stores, grocery stores, and shopping malls. Tell them you are not pleased with the number and location of their bathrooms.
Quickening of bladder function is a tolerable symptom of aging for most. But when quick is not quick enough, the problem demands medical attention. A cure is the exception, but medical advice and treatment offers more hope than pads and isolation.
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