My Grandmother turns 90 years old in just a few months. Ninety is quite a big deal. When discussing with the family what kind of party to throw her and where, it was brought to my attention how difficult it might be to drive her eight hours back to her home town because of her incontinence issues. I had no idea this was a problem for her. I started asking questions like, "How can we work around it?" and "Has she talked to her doctor about it?" and "Is it her bladder or her dementia that is causing the problem?" The answers I received were basically that she refuses to wear garments like Depends because she is too embarrassed and plays down the issue. Frustrated, I decided to do a little research of my own.

Apparently urinary incontinence is a common syndrome affecting at least 1 in 3 older women. Incontinence is often associated with self-imposed social isolation, fractures, falls, a lowered self-esteem, anxiety, depression and even admission to long-term care facilities. Incontinence is more prevalent in women due to a shorter urethra and vaginal delivery that weakens or injures the pelvic floor. However, men and women both can become incontinent from neurologic injury, birth defects, stroke, multiple sclerosis and physical problems associated with aging.

Types of Incontinence

Stress Incontinence - Often caused while laughing, sneezing, coughing or performing other movements that put pressure on the bladder. Childbirth, surgery or hysterectomies can often injure the pelvic floor muscles causing the bladder to move downward. This prevents the urethra from closing as tightly as it should causing leakage.

Urge Incontinence - Losing urine for no apparent reason after feeling the urge to urinate is caused by inappropriate bladder contractions due to nerve signals firing. Urge incontinence can happen while sleeping, when hearing water running, when touching water or after drinking a small amount of water. Damage to the nerves of the bladder, the nervous system or to the muscles from Multiple sclerosis, Parkinson's and/or Alzheimer's disease, stroke or injury is most often the culprit of urge incontinence.

Overactive Bladder - Abnormal nerves send signals to the bladder at the wrong time and the muscles squeeze without warning. This can cause urination eight or more times a day, multiple times a night and a sudden or strong need to urinate immediately.

Functional Incontinence - Medical problems interfering with thinking, moving or communicating such as Alzheimer's disease can often be the cause of functional incontinence making it difficult for one to properly plan a trip to the restroom.

Overflow Incontinence - Sometimes the bladder doesn't empty correctly causing it to spill over. Overflow incontinence is usually caused by a blocked urethra, tumors, urinary stones or nerve damage and is rare in women.

Treatment

Once a doctor has determined the type of incontinence then a treatment plan can be put in action. There are various treatments for each kind of incontinence, but they all normally start with a bladder diary that helps identify patterns and establishes a schedule to help gain control.

• Kegel exercises are an important step in strengthening the pelvic floor muscles. These can be performed in less than 5 minutes each day and a difference is typically noticed within a few weeks.
• Certain medicines blocking the nerve signals that cause frequent urination and urgency can be prescribed by a doctor as well as medicines relaxing the bladder muscles, preventing spasms.
• A stiff ring called a pessary can be inserted into the vagina to put pressure on the wall of the vagina and the urethra. This helps reposition the urethra leading to less leakage.
• Electronic measuring devices can help track when the bladder contracts. When supplemented with electrical stimulation and pelvic muscle exercises, urinary urges can often be controlled.
• InterStim is a device that can be surgically implanted for those not responding to behavioral treatments or drugs. The device stimulates the nerves to the bladder leaving the spine. This form of treatment is called neuromodulation.
• Injections near the urinary sphincter of bulking agents can make the tissues around the bladder neck and urethra thicker. This can close the bladder opening and reduce incontinence.
• Surgery is sometimes the best option for some women. Retropubic suspension and sling procedures are the most common surgeries performed to support the bladder back to its normal position. Over 75% of women who have had these procedures have been satisfied with the results.

It seems most women, including my Grandmother are afraid to talk about this problem. It is embarrassing and I imagine we can all recognize why. I've connected the dots and understand now why she was limiting her fluid intake at certain times, why all of a sudden she would be ready to go home and even why she was so insistent on doing the laundry when it had just been done the day before. It's unfortunate that she feels she has to suffer in silence and even more unfortunate to see something that can easily be treated or managed diminish the quality of her life. Talk to your loved ones and encourage a doctor visit to see what treatment can be most effective.

Carrie Robertson
Research & Community Education

Chicago Skilled Nursing
Chicago Senior Living