Living with dignity in old age

Incontinence in the elderly needs to be tackled with an open mind


Old age is the golden period of your life, where you reap the fruits of what you sowed in your earlier years. Yes it does bring with it some health issues, but don’t let them stop you from living your life to the fullest.

Some health complaints of old age are obvious and hence openly discussed but there are some which are not. One such very agonising complaint that a lot of seniors have is urinary and stool incontinence. This means a sudden, or unexpected and uncontrollable leaking of urine, or stool. This is known to occur in 30 per cent of the elderly population, especially women.

The problem is that many seniors do not reveal their dilemma due to fear and social stigma. If you’re one of them, understand that you are not the only one facing this problem and there is no reason for you to isolate yourself and suffer in silence. Confide in your doctor or in friends and relatives your age and you will be surprised to learn how common this condition is and how easily you can seek treatment for it.

Besides, dripping or incontinence that is left untreated can result in skin irritation, rashes, and urinary infection. It can also lead to pressure sores if the person is bed-ridden.

The how and why of it

The urinary bladder and the rectum are muscular pouches that hold urine and stool. When filled, the muscles of these pouches contract to empty the contents. Potty training during infancy enables us to voluntarily stop this until a suitable place and time for voiding is available. Certain diseases or physical changes due to old age can result in loss of this voluntary control thereby leading to incontinence.

It is very important to identify incontinence early; in many cases,  it may have to be probed into as the person suffering from it may not easily reveal it due to embarrassment.

Other causes

Minor or occasional dribbling out of urine or complete loss of control over voiding is a worrisome problem with the elderly. It can start suddenly or it may set in slowly. Sudden changes in bladder or bowel habits like increased frequency or urgency and pain may indicate an infection, or 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, constipation, sometimes alternating with diarrhoea, may indicate local obstruction or even side-effects of drugs.

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.

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.

Does urine leak when you laugh or sneeze?

Stress incontinence is sudden loss of urine that happens when a person laughs, coughs, sneezes or engages in physical activity. The problem could be related to pelvic weakness and is more common in women. Kegel exercises help to strengthen the pelvic floor muscles. To do these exercises, relax your abdomen and buttock muscles. Now contract the muscles of your pelvis [like you would if you had to stop the flow of urine]. Hold for five counts and relax. Do this repeatedly, several times during the day. These can be done when you are sitting, standing or lying down.

Get help

It can, indeed, be overwhelming for caregivers to deal with incontinence in the elderly in the long-term. Caregiving 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.

Family members should deal with the problem of incontinence with an open mind and delicately. If it is blown out of proportion, it may put off the elderly and embarrass them further.

Why adult diapers are a good choice

  • They are a simple, comfortable and discreet way of dealing with a very intimate problem
  • You need not hold yourself back from having a hearty laugh for fear of urine leaking out. Neither do you need to get stressed about suppressing a sneeze or a cough
  • Travelling will not be a problem any longer as wearing a diaper will allow you to sit comfortably for long hours without worrying about urine leaking out
  • It prevents skin infections and skin rashes that can occur due to long exposure to wetness
  • Especially useful for working professionals
  • If you are bedridden, or less mobile, it makes life easier for your caregiver as well as for you.

This was first published in the February 2014 issue of Complete Wellbeing.

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Prakash Shetty
Dr Prakash Chandra Shetty is M.S. [Gen. Surg.], D.N.B.[Urology]. He is a visiting consultant at the Urology dept, Dr L H Hiranandani Hospital. His special interests are uro-oncology, endo-urology, laparoscopic surgery and renal transplant.