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.

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

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Kidneys are two bean-shaped organs, the size of your fists located near the middle of your back, just below the rib cage. They contain a million tiny structures called nephrons, which filter the blood removing waste products and extra water, which then becomes urine. The urine flows through ureters to your bladder, where it is stored until you go to the bathroom. Damage to the nephrons results in kidney disease. This hampers the removal of waste products from the blood. Damage occurs slowly over years and there are no specific symptoms as such for you to know it is happening.

Chronic diseases affect proper functioning of kidneys. Any problem in kidneys functioning at their optimal level is called kidney failure. Kidney failure is when dialysis or kidney transplant is required to maintain life. The infection could be mild or life threatening condition. Those with diabetes, high blood pressure and having a close family member with kidney disease are at a higher risk.

Kidney functions

Excretory functions

• Remove waste products, toxins, urea, and creatinine
• Remove drugs and drug metabolites
• Excrete acids from the body.

Regulatory functions

• Regulate body water
• Help maintain sodium and potassium balance
• Regulate calcium and phosphate balance
• Maintain acid balance.

Synthetic functions

• Produce erythropoietin [Epo] required for production of RBC’s by bone marrow
• Release hormones that regulates blood pressure
• Synthesis of active form of vitamin D that promotes strong and healthy bones.

Causes of kidney failure

Kidney failure can occur from an acute situation or from chronic problems.

In acute renal failure, kidney function is lost rapidly and can occur from a variety of reasons.

Type-II diabetes: Uncontrolled diabetes is a leading cause of kidney failure. Diabetics with a family history of Diabetic nephropathy and high BP are at an increased risk of renal failure.

High Blood Pressure [Hypertension]: It is the second common cause of kidney failure. Also remember that chronic kidney disease can lead to high BP.

Glomerulonephritis: This disease damages the filtering unit called glomeruli. Loss of protein, high BP, and blood in urine are important signals of this disease.

Kidney infections: Repeated infection of kidney can result in small and scarred kidney. This condition is called chronic pyelonephritis.

Hereditary diseases: Polycystic kidney disease and Alport’s disease cause deafness with renal failure.

Obstruction to urinary tract: Chronic obstruction by stones, prostatic enlargement, posterior urethral valve in male child, pelvic cancer like cervical cancer in females, back flow of urine from bladder to ureter and kidney [VUR] in children can also damage the kidneys.

Analgesic nephropathy: Use of over the counter medications can also cause renal failure, though this is not very common in India.

Lupus nephritis: Vasculitis, amylordosis, heavy metal exposure, reno-vascular hypertension are rare causes of chronic kidney disease.

Dos and don’ts to keep your kidneys healthy

These include everything from diet, exercise and other lifestyle factors. Prevention is better than cure.

General measures

Tips to improve kidney health:

• Eat a healthy diet
• Eat food that is fresh and low in salt, avoid fatty and refined foods
• Stop smoking
• Exercise regularly
• Check blood pressure regularly
• Avoid stress and strain.

Specific measures

If you are diabetic:

• Controlling diabetes will help preventing kidney disease.
• Checking urine proteins, lipid levels, and blood pressure regularly helps.
• Microalbuminuria is the earliest indication of kidney disease in diabetics.
• A low protein diet [consult your dietician, doctor] retards progression of microalbuminuria.
• Urinary protein reduction with angiotensin converting enzyme inhibitor ACEI/ARB retards progression of the kidney disease in diabetes.
• Control blood pressure. Target BP less than 130/90 mm of ig proteinuria should be < 125/75 of Hg. This prevents and retards progression of kidney disease.
• Prompt treatment of urinary tract infections.

For others:

• Every male and female child with recurrent urinary tract infection must be evaluated.
• Avoid excessive use of ‘over the counter’ pain killers, which may
  damage your kidneys.
• Avoid ayurvedic medications which contain heavy metals.
• Once you have kidney disease, a regular follow-up with nephrologists may help retard progression. An in case of advance condition help plan for renal replacement therapy.

Kidneys are vital organs that perform many functions to keep your blood clean and chemically balanced. So take good care of them.

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