Urinary Incontinence in Aging
Urinary incontinence (UI) is the involuntary urine loss that occurs at any age. However, it is most common among the elderly since changes that happen during the aging process lower urinary tract function. Moreover, systematic disturbances of the urinary tract and numerous chronic illnesses the older people have may lead to the disorder. According to Cook and Sobeski (2013), every fifth person over the age of 40 suffers from it. What is more, nursing home population having this problem equals 50%. The fact that the disease is common makes people think that they should accept it. This is the main reason for the underreporting of UI cases and patients’ application to self-treatment. However, most people can be cured. Numerous researches have been carried out to increase people’s awareness and understanding of the condition and advise them of optimal treatment. Hence, UI is a common problem in aging that is associated with numerous diseases and behavior patterns.
Age is the main UI risk factor among men and women. However, UI is not the usual and normal consequence and characteristic feature of the aging process. It has been stated that the disorder affects nearly 30% of the older adults (Cook & Sobeski, 2013, p. 3). Women aged 70-80 tend to suffer from UI more often than men. Nevertheless, UI affects both men and women over the age of 80 equally. Many people with UI problems do not demand medical intervention as they feel shame, thus failing to consult professionals (Vaughan, Goode, Burgio, & Markland, 2011). Therefore, nearly one-half of cases become unreported.
The causes of UI in aging are varied. The simplest one is the lack of consumed water. What is more, with time, the bladder becomes unable to store urine and it begins to leak. Multiple sclerosis and Alzheimer’s disease are the most common diseases that encourage UI. In addition, there are many conditions that may lead to UI. With aging, the body is more apt for the disorder occurrence. Elderly urinary incontinence usually takes several forms. For example, some people dribble urine on a regular basis while others leak it only occasionally. All in all, these people are unable to control their bowel and bladder. Elderly people tend to suffer from the following types of incontinence:
- Stress incontinence. It is common among women as they experience postmenopausal syndrome and other problems. Men with enlarged prostates or those who have ever taken prostate cancer treatments also suffer from it. Stress incontinence occurs in case the abdominal pressure overcomes the closing bladder pressure.
- Urge incontinence. It results from Alzheimer’s disease, Parkinson’s, strokes, dementia, multiple sclerosis, and others. However, constipation, prostate enlargement, and pelvic floor atrophy also cause urge incontinence.
- Overflow incontinence. This type is rarely diagnosed. Overflow incontinence happens in case a person’s bladder is never completely empty. It is usually caused by a bladder or urinary tract system obstruction due to stroke- and diabetes-related damages, enlarged prostate, prostate-related surgery, constipation, and others.
- Functional incontinence. This type of incontinence results from such disabilities as neurological disorders, arthritis, stroke complications, multiple sclerosis, Alzheimer's disease, etc.
- Mixed incontinence. Some people have a combination of stress and urge incontinence. This condition prevails more in women than men. People with neurological disorders, Parkinson's disease, severe dementia, and other diseases can suffer from mixed incontinence (Holroyd-Leduc, Tannenbaum, Thorpe, & Straus, 2008).
As soon as a person is diagnosed with UI, he/she is suggested proper treatment. Hence, the treatment for urinary incontinence in the elderly presupposes medical devices, medication, behavioral therapy, and surgery. It is essential to emphasize that all people with UI can be successfully treated. Prompt treatment is behavioral therapy, which includes pelvic floor muscles exercises, training of the bladder, fluid and diet management as well as scheduled bathroom trips. Bladder training presupposes learning to delay urination while pelvic floor muscle exercises are done to strengthen the muscles responsible for urination. Trips to the bathroom are very effective for the elderly who suffer from neurological disorders. The most common medications for the UI treatment are antibiotics, hormones as well as anticholinergic or antispasmodic drugs. Surgery is considered to be an option, but professional help is the most important step in treatment. Finally, it is essential to make lifestyle changes. It is an effective method of curing UI. Some people should apply constipation prevention, lose weight, quit alcohol drinking and smoking, and drink less caffeinated beverages. As it is a heterogeneous condition, its management is strongly dependent on the proper evaluation and understanding of numerous factors that cause UI. It is essential to identify reversible transient incontinence causes and appropriate management as it may successfully prevent the problem.
Comprehensive UI management in aging includes numerous non-pharmacologic and behavioral strategies. The first-line treatment in the elderly presupposes behavioral changes and noninvasive lifestyle. The main advantages of the behavioral changes are the absence of adverse effects, low cost, easy way of implementation, etc. However, these strategies should be individually tailored to suit individual peculiarities of the UI condition. In addition, they should depend on the patient’s motivation, cognitive function, and functional capacity (Goode, Burgio, Richter, & Markland, 2010).
UI substantially affects psychological well-being and overall health of a person as it may weaken sexual function, considerably increase caregiver and financial burden, limit patient’s activities, cause depression, etc. As a rule, UI results in different social, medical, and economic consequences. It is considered to be the primary institutionalization reason among the aging population. The care of the nursing home residents with UI is more expensive than that of continent residents as the former requires more time, frequent changes of clothing and linen, and others. The condition may cause skin irritation, pressure sores, and skin breakdown resulting in depression, isolation, decreased self-esteem, and other psychological conditions. Hence, many elderly persons are afraid to leave their homes and socialize.
Unfortunately, the number of people suffering from UI is constantly increasing and the problem requires urgent solution (Cook & Sobeski, 2013, p. 3). Although most elderly patients with urinary incontinence benefit from assessment and treatment, there are still many people who do not report the condition and do not seek medical assistance. Proper evaluation is made on the basis of the existing incontinence types. Laboratory tests are needed only in rare occasions. A combination of pharmacologic, behavioral, and surgical treatments ensures considerable improvement and cure of the incontinence symptoms. UI is diagnosed and treated by the primary-care physician. However, in some cases, a specialist’s consultation is required.
Thus, UI is a widely spread and distressing problem for the elderly, their families, friends, and health professionals. Age is believed to be the primary risk factor for UI, but it is not a normal consequence of aging. Timely diagnosis and treatment help to reduce negative outcomes that influence patient’s overall health and psychological well-being. UI is a large issue in the health care system associated with aging. Despite numerous researches and increased awareness of clinical forms, UI types, diagnostic tests, causes, and treatments, there exist different approaches to the treatment and understanding of the disorder. A thorough diagnostic evaluation of incontinence and proper use of different therapies can substantially improve the UI management.