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Talking About Incontinence? Let’s Do It!

June 21 – 27 is World Continence Week. The Urology Foundation says this recognition week is to “highlight the impact urinary incontinence can have on our lives and encourage those living with incontinence to seek help so they no longer have to suffer in silence.”

According to the foundation, half of all adults will experience incontinence at some time in their life. Over 30 million people are living with the problem today. According to the American College of Physicians, over $20 billion per year is spent on incontinence, and it accounts for 6% of nursing home admissions.

Yet incontinence is not a topic that’s discussed much! Sitting around with friends, we might all commiserate with someone who has a sore shoulder, one by one sharing our own experiences with joint pain. But we seldom chat about incontinence in this way. People who are dealing with the problem might feel that they are the only ones.

Experts say many people don’t even bring up the problem with their doctors. In particular: University of Texas Southwestern Medical Center experts found that men who are dealing with incontinence often wait several years to talk to their doctor about it, with 32% waiting five years or longer!

In many cases, this silence at doctors appointments can equal unnecessary suffering. Incontinence can have a major impact on a person’s life, causing skin irritation and infections and interfering with sleep. Dr. JoAnn Pinkerton, Executive Director of the North American Menopause Society, has studied the relationship between incontinence and osteoporosis, and says, “Many women with incontinence find themselves limiting physical activity out of fears of leakage.” As seniors worry about having an “accident,” they might begin to stick close to home, leading to a debilitating decline in social connectedness, physical activity, and intellectual stimulation.

But they should know that treatment for incontinence is available, and medical science continues to provide an improved understanding of the causes of the problem that could lead to further, improved treatments. As just a small but interesting example, a 2020 study from Scripps University pinpointed a specific gene that is responsible for the urge to urinate, which might someday help people who have urinary control problems.

The first step in addressing incontinence is a thorough evaluation by the doctor to determine the type of incontinence a person has:

  • Urge incontinence happens when the bladder begins to empty itself before a person realizes it—sometimes when it’s too late to reach the bathroom. This type of incontinence occurs often in older adults and can be the result of damage to the nerves, or irritation from infection or certain foods.
  • Overflow incontinence occurs when small amounts of urine leak from a bladder that is always full due to an obstruction, constipation, nerve damage, or in men, a prostate problem.
  • Stress incontinence happens when urine leaks from the bladder as a person coughs, sneezes, laughs, or lifts heavy objects. It is often seen in women who have weak muscles in the pelvic floor, usually due to childbirth. In men, it might occur after prostate surgery.
  • Functional incontinence occurs when a person has normal bladder control but is unable to get to the toilet on time because of vision loss, stroke, arthritis, osteoporosis, other mobility problems, or confusion due to Alzheimer’s disease or a related condition.

Once the cause of a person’s incontinence is determined, the doctor can recommend a number of different treatments. Those might include:

  • Bladder training (timed voiding). The patient keeps a chart of urination and leaking, and then works out a bathroom schedule, planning trips to the toilet at certain set times (for example, once an hour). The goal is to increase the interval gradually.
  • Pelvic muscle exercises. Just as we can strengthen other muscles in the body, simple moves such as the commonly recommended “Kegels” can strengthen the bladder muscles and the muscles of the pelvic floor. This helps hold urine in the bladder longer.
  • Some commonly prescribed drugs stop bladder contractions; others relax the muscles to prevent urgent or frequent urination. In postmenopausal women, estrogen pills, creams, or patches may be prescribed.
  • Surgery and medical devices. A number of procedures can be effective, especially in the treatment of stress incontinence and incontinence due to prostate enlargement.
  • Lifestyle changes. The physician may recommend cutting down or eliminating caffeine, alcohol, and tobacco products. All can increase incontinence by irritating the bladder. Increased exercise and weight loss can also help.

When treatments aren’t 100% effective, today’s modern incontinence undergarments can provide an extra level of confidence and dignity.

A note for family caregivers

If you have an older loved one who is experiencing incontinence, this is a time for tact and sensitivity—but also for candor. Share with your loved one that they are just one of the millions of other people who are dealing with incontinence. Encourage them to talk to their doctor about the experiences they are having. If your loved one agrees, come along to a health care appointment to discuss ways you could help, which might be as simple as cleaning up clutter so your loved one can make it to the bathroom on time. To some, it can be an embarrassing problem but consider how much better it is if your loved one doesn’t have to face it alone.

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