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Incontinence in the elderly

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Incontinence in the elderly - now what??!!

As a caregiver, I suppose it's inevitable that, one day, I'll be dealing with incontinence in the elderly. At the moment though, we're dodging that bullet! With the use of a bedside commode and some Depends just in case, I've figured out a way to deal with unexpected urination.

One in five individual over the age of 40 suffers from some sort of incontinence (either urgency or overactive bladder) according to the National Association for Continence. The same organization states that at least 50% of nursing home residents have some sort of urinary incontinence.

I'm the primary caregiver for my 94 year old mama, Gertie. Although she's not incontinent at the moment, in the interest of gaining as much knowledge as I can about this condition, I've explored the issue. This lens was written in the hopes that it may help others who are walking a similar path as they care for the elderly. And, speaking of hopefully helpful lenses, check out my Things I wish I had known about being a caregiver. I had a steep learning curve but you don't have to.

Incontinence can be urinary or fecal. For the purposes of this Squidoo lens, I'm going to only discuss urinary incontinence. I don't even want to think about the other...

Note: if you like this lens, please click the "Thumbs up" button at the top left, right under the title - that helps the lens get more popular. Thanks!

This lens won Lens of the Day, July 21, 2011. Thank you so much to HotBrain for nominating it!

When Death Looms - the signs and symptoms of death

I'm extremely grateful for the lens of the day on this particular lens but I really feel like I have better and more important work. Please read my lens When Death Looms - the signs and symptoms of the last moments on earth. Everyone who cares for the terminally ill or the elderly should understand the mechanics of death and be aware of the symptoms.

What is incontinence?

Incontinence is simply the inability to control one's urination or defecation. Incontinence may start with a leakage of urine or feces and develop into a full blown case where there is no control whatsoever. Incontinence is actually a normal part of the aging process as muscles naturally weaken and gravity takes over.

There are many types of incontinence, most of which are listed below:
  • 1Stress incontinence. Stress incontinence is usually a leakage of urine when stress, such as a cough or sneeze, is exerted upon the body. Any woman over the age of, oh, 45 or so, will tell you (if they're honest) that they have to stop and squeeze their legs together if they're about to sneeze. This is one of the things that your mother should have told you but most of us figure out on our own. Laughter can also cause stress incontinence which is really a shame as I love to laugh...

    Stress incontinence may also be onset (or made worse) by pregnancy, childbirth, or menopause (proof that God has a sense of humor...).

    For more information about stress incontinence, check out this NIH article on stress incontinence.
  • 2Urge incontinence. Urge incontinence is when you leak urine just as you feel the urge to go - in other words, your body is not giving you the signal to pee early enough. Urge incontinence can be caused by bladder spasms or incomplete bladder contractions.

    You know the old prank about how putting someone's hand in water can cause them to pee? Well, this phenomenon can be attributed to urge incontinence. Other triggers for urge incontinence may be seeing or hearing running water, seeing a toilet (I can vouch for this one...) and all of a sudden feeling like you have to go now

    Nerve damage may also trigger urge incontinence. Nerve damage may occur when there is damage to the nerves of the bladder during surgery, or because of underlying diseases such as Parkinson's, Alzheimer's, strokes, TIAs, or multiple sclerosis.

    For more about urge incontinence, see this NIH article on urge incontinence.
  • 3Overflow incontinence. Overflow incontinence is actually a medical condition that can be remedied most of the time. This condition exists when the bladder fails to empty, fills up, and extra urine has no place to go except out (where there's more room than in...). A weak bladder muscle or a blocked urethra may contribute to overflow incontinence. Seeing a doctor may help this type of incontinence.

    For more on overflow incontinence, see WebMD article on overflow incontinence.
  • 4Overactive bladder. This one happens in overachievers (only kidding). I had to lighten up the topic a bit...

    Overactive bladder incontinence occurs when the nerves going to the bladder contract at the wrong time and on their own. Most women urinate about 7 times a day but, those with overactive bladder will have to go more frequently. Overactive bladder symptoms may also include frequent need to urinate either during the day or night or a sudden urge to urinate with little warning.

    For more about overactive bladder, check out this article on overactive bladder.
  • 5Functional incontinence. This condition exists when a person either doesn't know or can't relate to another about the need to pee. Dementia in the elderly, Alzheimer's, or strokes which hamper communication may all cause functional incontinence.

    For more about functional incontinence see WebMDs article on functional incontinence.
  • 6Transient incontinence. This condition is, well, transient and may well clear up. Infections, such as UTIs and colds with coughs or sneezing may cause this temporary type of incontinence.

I'm a caregiver, therefore I am...

...dumb.

It took me a long time to catch onto some of the basics of caregiving as I hadn't explored any educational items. Don't make the same mistake I did. Here's the best sellers in long-term care on Amazon.com

Top Sellers in Long-Term Care

Some aids for elderly incontinence

The below items are things that we've used to help Mom be as comfortable as possible. The medications worked the best but the below items are still necessary to avoid any accidents.
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Treatments for incontinence

Some incontinence may be treated but, in the elderly, it's probably a condition that's there to stay. We'll deal in a minute with what to do about it but, for now, let's see how it can be treated in younger folks.
  • 1Kegel exercises. Women (and men) have a muscle that contracts and relaxes to allow urine to flow. Simply contracting and relaxing this muscle to a count of three, with 10 repeats will strengthen the bladder muscle. If you're just starting to do the Kegel exercises, you might try lying down which is the easiest position as gravity isn't working against you. Graduate to doing a set of Kegels while sitting in a chair and, finally, while standing up (the toughest position).
  • 2If your incontinence is transient, treatment of the underlying infection or disease may cure your temporary spell of involuntary peeing. For UTIs, I've always had luck with an antibiotic and cranberry juice which some think changes the acidity of the urine. I believe this to be true as it's worked for me but it doesn't work for everyone. Nurses and doctors will tell you that you have to drink a lot of cranberry juice to make a difference (now that I think of it, maybe it's the vodka in the cranberry juice that worked for me!).
  • 3Medical condition incontinence, such as overactive bladder may be remedied with medication. For example, my Mom has frequent urination needs at night so I took her to a doctor who put her on two meds - Oxytrol which is a skin patch changed every 3 days, and Enablex, a daily pill. Both of these meds seem to be working as she generally gets up just 2 or 3 times a night, versus her last pattern of awakening up to 8 times a night! No wonder we're forever tired!
  • 4Surgery. If you're a woman, the pelvic floor muscles may weaken (particularly for those who have had children) and a bladder sling may be installed through surgery. The bladder sling actually does what it sounds like - it holds the bladder in a sling so that the muscle doesn't have to work so hard.
  • 5There are certain foods that are associated with irritating the bladder so it's best to limit them in an incontinent patient's diet. These foods include: sodas or any carbonated drinks, citrus juice, caffeinated coffee or tea (offer decaffinated varieties), and alcohol - Now, IMHO, a girl's gotta have a little fun so mom still gets all of these items in moderation. I'd hate to face her and tell her she can't have her morning cup of java...I'd have more problems dealing with her than just a bit of pee leakage...

Books about incontinence

Arming yourself with knowledge will help you deal with a senior citizen's incontinence.
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Avoiding incontinence

There are a few tips and tricks one can do to avoid incontinence. These are from my own caregiving experience so maybe they'll work for you or your senior citizen loved one too.
  • 1Slow the intake of fluids after 2 pm. I have a small container of water for my Mom that she has to drink every day to stay mentally on top of things - dehydration is a really bad thing for an elderly person. So, I remind her during the morning to drink small sips of water very frequently but, by 2 pm, she's done, no matter how much she's had. This doesn't mean that she can't have water or liquids later in the day, I just stop pressing her to drink at 2 pm. This helps with the nocturnal urination urge.
  • 2Remind the elderly to try and urinate just a bit more when they think they're done. Sometimes, when she's reminded, a satisfying trickle is my reward. Every little bit counts.
  • 3If incontinence is of sudden onset, get your elderly loved one to a urologist ASAP. At the very least, take them to see their primary care physician so treatment may be started, if possible. Most likely, if it's sudden onset, it's probably an infection of some sort.
  • 4Put your elderly loved one on scheduled bathroom stops. At the very least, ask them frequently if they have to go and assist them in all tasks when needed.

This waterproof sheet protector will aid in protecting surfaces

Similar to a plastic sheet, this waterproof sheet protector goes under the bedsheets and will protect the mattress from incontinence.
Priva Ultra Plus Waterproof Sheet Protector, 34

Priva Ultra Plus Waterproof Sheet Protector, 34" x 52", White

Amazon Price: $12.00 (as of 05/31/2012)Buy Now

Disposable bed pads may also help guard the bed against incontinence

If your elderly loved one is bedridden, you might prefer a disposable bed pad which can be slipped from underneath your friend rather than a mattress pad when they'd have to get up so you could remove the pad. These disposable bed pads are good to have on hand so go ahead and buy some now!
Protection Plus Fluff-Filled Disposable Underpads(Deluxe Weight)(Size=MSC281260 17 inch x 24 inch )

Protection Plus Fluff-Filled Disposable Underpads(Deluxe Weight)(Size=MSC281260 17 inch x 24 inch )

Amazon Price: $48.99 (as of 05/31/2012)Buy Now

Things to remember when dealing with elderly incontinence

I know that, sometimes, it's hard to hold one's tongue but it's an absolute must when dealing with elderly incontinence. They don't mean to do it and, sometimes, they don't even know!
  • 1Never ever refer to an elderly person's undergarments as "diapers." This is just plain old wrong. Diapers are for children and your elderly loved one doesn't need to feel like he or she is treated like a child.
  • 2Never ever admonish an elderly loved one for having an accident. These things just plain old happen and are signs of natural aging processes.
  • 3Always willingly stop what you're doing and assist your elderly loved one (if needed) in bathroom duties. This one is particularly hard for me as my Mom seems to time her bathroom needs to the second I sit down - literally. Somehow, I must be part of her urge urination needs!
  • 4Assist the elderly into new undergarments immediately if needed. No one wants to sit around in wet pants and, besides that, they could easily get an infection or end up with a rash from sitting on a wet surface too long.
  • 5Help the elderly with bathroom hygiene. If this means that you have to assist them with wiping after going to the bathroom, put on your own big girl panties (pun fully intended) and help them. My Mom is no longer limber enough and her balance is not good enough to do these tasks herself. Somehow, we seem to find humor in it - thankfully.

If you have to join em, instead of fight em...

Here's some good items to have on hand to help with incontinence

Sometimes, it is what it is. If this is the case, it's best to protect the surfaces where your senior loved one resides, such as the bed or a favorite easy chair, keep your loved one as dry and clean as possible, and just grin and bear it. The below items are useful if you have to join in and accept that incontinence is now a part of life.
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Some other lenses about senior citizens that may interest you

Since I take care of my Mom, I've spent a lot of time writing articles which I hope will be helpful. Please give these a read.
Choosing hospice - is it the right choice
Mom is now enrolled in hospice. We're both loving the support!
When death looms - the signs and symptoms of the last moments on earth
I wanted to get a jump on the symptoms of death so that I was not surprised. I hope to be beside my Mom when the time comes - and, I'm hoping it's after her 95th bday in October!
Pneumonia symptoms in the elderly
This lens was prompted by our last 7 day stint in the hospital.
Causes of dementia in the elderly
There's a lot of surprising underlying reasons for dementia in the elderly. This lens points out the most common.
Incontinence in the elderly
It had to be written...
Senior citizen gift ideas
There's some interesting gift ideas for your favorite senior citizen here.
Helping a hospitalized senior citizen
A senior citizen should never be left alone in the hospital.
Senior citizen dental care
Poor Gert lost her first tooth at 94...
Resources for caregivers of aging parents
This lens was a no-brainer. I had to figure out how to take care of Mom when she came to live with me 4.5 years ago...
Caring for the elderly - birdwatching from a lazy boy recliner
I created a window to the world for my mobility-challenged mama.
Good gifts for caregivers
Here's some interesting ideas of things I've been given and have enjoyed.
Anatomy of a caregiver - what makes me tick
Just some info about a day in my life....sigh...

Urinary incontinence websites

Here's a few websites I've perused in my quest to learn all things about pee. I hope these sites may help you too.
National kidney and urologic disease information clearinghouse
Who knew there'd be a .gov clearing house for kidney information? Not me but it's a good site.
Urinary incontinence in the elderly
This website by the Western Journal of Medicine delves into some good information regarding elderly incontinence.
A place for mom's website
This website offers some excellent articles and resources for caregivers and their elderly charges.
Changing of the guard website
Margo Arrowsmith's great blog is not about urinary incontinence but, rather, about caring for her dad in the last phase of his life. It's a must read for all caregivers.

I won't ask if you've ever dealt with urinary incontinence...

...but, if you're a woman over 50, I bet I know the answer!

Please leave me comment on how to expand (or contract - ha ha) this lens.

  • Tipi Jan 26, 2012 @ 12:59 pm | delete
    Returning with angel dust to this very important article of dealing with the challenges of incontinence with dignity....you ladies rock!
  • Fignewton37 Sep 12, 2011 @ 9:41 pm | delete
    Great lens. I worked in a senior care rehabilitation center in an upscale retirement center. I saw a lot of people with incontinence. It is unfortunate that as we age many of us will go through this embarassing and debilitating problem. Great ideas to keep in mind. Thanks for the lens.
  • Sharyn Aug 9, 2011 @ 4:36 pm | delete
    It's so unfair that, as we age, our bodies sort of decide to do what it chooses. Incontinence happens.
  • Irma F. DeWeese Aug 8, 2011 @ 6:53 am | delete
    Very well-written lens with informative content -- thanks a lot! Some of our patients are incontinent, and we like to help them with various Kegel exercises, which we have found to be very effective for both prevention and treatment. We also make sure that there are always protective undergarments around and encourage the use of reusable bed-pads -- two great tools. In the end, though, it all boils down to love and compassion -- incontinence is not their fault, so simply going on with life and not bringing it up when it doesn't need to be is really the best answer.
    /www.evergreencareproviders.com/? target=?_blank?> assisted living facility, assisted living for elderly, home health care service, health care providers, home health care agencies, elderly assisted living, adult day care center.
  • Lori Aug 9, 2011 @ 7:28 pm | delete
    You have adopted a wonderful tactic about just going on with life and not bringing it up. Just make sure no one slips on a wet floor - a bathmat by the bed is helpful.
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gottaloveit

I used to spend most of my days caring for my adorable 95 year old Mom, Gertie; she died peacefully in my arms Feb 15, 2012.

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Gertie's Galavants - my blog 

This blog details my life with 94 year old Gertie and is brutally honest!

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Protect mattresses against incontinence with rubber sheets 

Priva Ultra Plus Waterproof Sheet Protector, 34

Priva Ultra Plus Waterproof Sheet Protector, 34" x 52", White

Amazon Price: $12.00 (as of 05/31/2012)Buy Now

Waterproof rubber sheets are a necessary item to have in any elderly home, even one where incontinence is not now an issue. Rubber sheets can cover beds or the surface of a sofa or chair to protect the underlying material from accidents.

Bottom Buddy Toilet Tissue Aid 

Bottom Buddy - Grey

Bottom Buddy - Grey

Amazon Price: $38.99 (as of 05/31/2012)Buy Now

This bathroom tool is ingenious! You just plug some toilet tissue into it, and, with a longer reach, it's much easier to get yourself, or you loved one cleaned up. Perfect gift for a senior citizen!

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