Our elders are a great asset in community life. We look up to them for their experience, advice and emotional support, more so when they remain active and young at heart.
Imagine this: when an elderly person suddenly voids while laughing in a party, or even talking to dear ones. It wobbles the person and also those around him, or her.
A sudden, or unexpected and uncontrollable leaking of urine, or faeces, is known to occur in 30 per cent of the elderly population, especially women. The big problem is – many of our elderly do not often reveal their dilemma due to fear and social stigma. This concealed embarrassment and frustration can sometimes lead the affected to isolate themselves, resulting in anxiety and depression.
Dripping, or incontinence, can result in local skin irritation, rashes, and urinary infection. It can also lead to pressure sores in the debilitated and bed-bound.
On the other hand, incontinence also portrays itself as a daunting task for those who care for their beloved elders.
The how and why of it
The urinary bladder and the rectum are muscular receptacles for excreta. When filled, the muscles contract to empty the contents. “Potty training” in early life enables one to voluntarily stop this emptying until suitable place and time for voiding are available. Problems at different levels of this system – from the bladder or rectum to the brain – can result in loss of voluntary control. This leads to incontinence.
It is very important to identify incontinence early; in many cases, it may have to be probed into as elders may not easily reveal it.
A detailed evaluation that may include urine analysis and ultrasound scans of the pelvis would be necessary to find out the cause and plan suitable treatment. The caregiver should be involved in the process and options explained.
Minor to occasional dribbling and/or complete loss of control over voiding is a worrisome problem with the elderly. Leaking can start suddenly; it may also be insidious and chronic.
Sudden changes in bladder or bowel habits like increased frequency or urgency and pain may indicate local infection, and injury, such as a hip fracture or side-effects of certain drugs. Persistent changes in bladder or bowel habits like straining, inability to empty the bladder completely, dribbling of urine, constipation, sometimes alternating with diarrhoea, may indicate local obstruction or even side-effects of drugs.
An inflamed bladder caused because of infection or an overactive bladder [due to a neurological disorder] leads to increased frequency and urgency to void, with inability to hold the urine.
Leaking also takes place if the toilet is not immediately reachable. While infections can be easily identified and treated, urge incontinence due to an overactive bladder is managed by behavioural training, or drugs, that help relax the bladder muscles.
Frequent and timely emptying of the bladder and bladder re-training to tolerate larger amounts, by gradually increasing the intervals between urinations, would help many to avoid the side-effects of drugs.
In elderly men, obstruction to urinary flow due to enlarged prostate gland can cause overfilling of the bladder and overflow incontinence. A loaded rectum, due to constipation, can result in obstruction to urine flow.
Narrowing of urethra in elderly women and weakening of bladder muscles in long-standing diabetics can also result in overflow incontinence.
Retention of urine in the bladder after a person urinates can be ascertained by a simple ultrasound examination. While an enlarged prostate or urethral obstruction might need surgery, those with weakened bladder musculature may be helped by intermittent catheterisation. Patients, or their caregivers, can also be trained to do this easily and safely, typically several times a day.
Sudden loss of urine can take place when a person laughs, coughs, sneezes or engages in physical activity. This is called stress incontinence. The problem could be related to pelvic or sphincter muscle weakness. It is more common in women. Bladder training, pelvic muscle exercises and biofeedback and, in some cases, drugs or corrective surgery may be needed to provide relief from this embarrassing problem.
Elderly people with severe loss of physical and cognitive function, restricted mobility, loss of vision, hearing or speech, and inability to communicate, can also develop functional incontinence. For such patients, prompted and assisted voiding, with easily accessible toilet, would be most helpful.
For those patients who are untreatable, absorbent pads, undergarments, or adult diapers, need to be used. Bed-bound elderly persons with incontinence need special, frequent attention to ensure that their skin stays clean and dry – this will help prevent bed sores.
It can, indeed, be overwhelming for caregivers to deal with incontinence in the elderly in the long- term. Attentive care can also be physically and emotionally draining, particularly for those who have to manage a job as well as household chores. Having a helping hand in the form of a nursing aid or trained caregiver or placing elders in institutional care may help in such situations.
Most important: the problem of incontinence needs to be tackled with an open mind by family members, not blown up to put off the elderly.
- Incontinence in the elderly is common and distressing
- It is not a normal part of aging; it can be treated
- Identification of the cause, behavioural modification and appropriate treatment can minimise, or even cure the problem
- Easily accessible toilets [that are uncluttered] and removable clothing are of great help
- An open mind and understanding helps both the sufferer and the caregiver in tackling incontinence.