As we get older, some body parts tend to go haywire. No one wants to talk about it, let alone blog about it, so I will. It’s a dirty job but somebody’s got to do it.
Urinary incontinence is a fact of life for lots of older people. It means you can no longer hold your urine until you get to the nearest bathroom because you cannot control your bladder.
Remember when you used to be able to resist peeing for hours on end when on a long road trip? That’s probably not the situation anymore. Two hours without a pee break?
Uh, not gonna happen! Emergency stop! NOW! And then a mad dash to the convenient store bathroom where you may end up peeing yourself as you are trying to get your pants pulled down.
Loss of Estrogen and the Outcome
Menopausal women, in particular, suffer urinary incontinence because they no longer possess an adequate supply of the hormone estrogen, which for years maintained the health of the urethra and bladder.
When estrogen levels drop significantly, the pelvic muscles become weaker and it is a challenge for females to control the urine stream. Whereas you used to be able to squeeze and stop the flow, you may no longer have this ability due to puny muscles. (I’m squeezing, I’m squeezing but ….here it comes anyway!)
Many are plagued with stress incontinence. If you laugh, sneeze or cough, urine gushes out, always at an inopportune moment, as if there is ever a good time to pee yourself.
Others have urge incontinence. This means the bladder muscles squeeze continuously or at the incorrect time and leakage occurs.
For those who are up multiple times at night, heading to the bathroom, this is call nocturia or low nocturnal bladder capacity or polyuria, according to The Cleveland Clinic.
Ideally a person sleeps six to eight hours without awakening to urinate. Those with nocturia cannot make it through the night without peeing.
Nocturia is the outcome of polyuria, which means a person produces large amounts (more than two liters) of urine during the day, or it is the consequence of nocturnal polyuria, meaning the body produces copious quantities of pee during the night.
Those who have low nocturnal bladder capacity manufacture more urine during the night than the bladder can hold. Mixed nocturia means a person has low nocturnal bladder capacity as well as nocturnal polyuria, which is not a good combination.
Polyuria results when someone has untreated diabetes or gestational diabetes (during pregnancy) or simply because the person drank too much before going to bed.
Nocturnal polyuria is caused by edema (swelling of lower extremities), congestive heart failure, sleep apnea and drugs, including water pills.
A person experiences low nocturnal bladder capacity when there is a persistent urinary tract infection (UTI), bladder swelling, an obstruction or malignancy, interstitial cystitis --- pain in the bladder --- bladder over-activity or benign prostatic hyperplasia in men, which means a non-cancerous overgrowth of the prostate, or obstruction urine flow.
Why Did This Happen?
Urinary incontinence is a symptom, not a disease, according to the Mayo Clinic. Persistent incontinence can be the result of pregnancy and childbirth. The muscles required for bladder control can be debilitated as an outcome of a vaginal delivery.
A prolapsed or dropped pelvic floor can occur during childbirth when the nerves of the bladder as well as supportive tissue are injured. When prolapse happens, the uterus, bladder, small bowel or rectum are thrust down and out of their regular position and bulge into the vagina, leading to incontinence.
Over time, the bladder shows signs of wear and tear like the rest of your body. Storage capability declines at the same time the bladder becomes overly active.
The loss of estrogen in menopausal women results in corrosion of the bladder and urethra lining, which intensifies incontinence.
Women who have had a hysterectomy may have experienced damage to the supportive pelvic floor muscles as a result of the surgery. This can contribute to incontinence.
Older men may have an enlarged prostate (benign prostatic hyperplasia or BPH), resulting in incontinence.
Incontinence is also an indicator of untreated prostate cancer, bladder stones and bladder cancer.
What to Do? Train Your Bladder
This may sound crazy but for a lot of people it works. Bladder training is a behavioral technique aimed at controlling urge and various other kinds of incontinence. The person learns to hold urination after he has the urge to go.
Start delaying urination by 10 minutes and then progress to holding it longer and longer. The goal is to extend the time between trips to the bathroom until you are only peeing every two to four hours.
This approach may also entail double voiding, which means peeing and then waiting a few minutes and peeing again. This enables the person to empty his bladder more effectively, which prevents overflow incontinence.
Again, this may sound like an odd way to approach the issue, but it works for many. Go to the loo based on the clock rather than waiting for the urge to hit. Go to the toilet every two to four hours on a routine basis.
Do Kegel exercises, which work out the pelvic floor muscles and urinary sphincter, controlling urination.
Electrical stimulation is available. It’s a procedure where electrodes are temporarily placed in the vagina or rectum to stimulate and fortify the pelvic floor muscles.
Another option is the urethral insert, comparable to a tampon. It is inserted into the urethra. It serves as a plug to prevent leakage.
An additional alternative is a pessary, which is inserted into the vagina. It is a stiff ring that lies near the vagina and upholds the bladder.
Materials called bulking agents can be injected into tissue surrounding the urethra, which keeps it closed, lessening urine leakage.
Although not yet approved by the FDA for this particular purpose, Botox injections into the bladder muscle help control the bladder.
A sacral nerve stimulator can be implanted under the skin in the butt. A wire is connected to a sacral nerve extending from the lower spinal cord to the bladder. Painless electrical impulses rouse the nerve and help control the bladder.
A tibial nerve stimulator delivers electrical pulses to the tibial nerve in the ankle. The pulses move along the tibial nerve to the sacral nerve, which helps control over-active bladder symptoms. The stimulator is placed under the skin.
It may be a last resort, but in extreme cases surgery is available. One option is the sling procedure. Strips of your body’s tissues or mesh or synthetic material is used to make a hammock (pelvic sling) around the urethra and bladder neck. This encourages the urethra to stay closed. Slings can be adjustable as well as tension free.
An artificial urinary sphincter is another option. This is particularly good for males who have undergone prostate cancer treatment or suffer from an enlarged prostate gland, which weaken the urinary sphincters.
The donut shaped apparatus is implanted around the bladder neck. The ring is fluid-filled and holds the urinary sphincter shut until the person is ready to pee. The individual presses a valve implanted under his skin when he needs to urinate. This makes the ring deflate and the person can go to the bathroom.
A bladder neck suspension is available. This supports the bladder neck and urethra. The bladder neck is thickened muscle. It connects the urethra and the bladder. This technique requires an abdominal incision.
- There are various medications used to treat this problem. Ask your physician about medicines for treating an overly active bladder.
- Applying a low-dose topical estrogen cream helps invigorate the tissues in the urethra and vagina, which diminishes symptoms of incontinence.
- Some preventive steps you can take on your own include limiting or restricting altogether fluids before bedtime.
- If you taking a diuretic (water pill) take it about six hours before going to bed.
- Wearing compression hose prevents fluid accumulation in the legs, ankles and feet. Elevating legs also thwarts fluid accrual.
And, yes, there are adult diapers and pads, which are lifesavers for people battling this problem. These products have come a long way, baby.
The adult diapers are pull-ups, which are very similar to regular underwear. The diapers and pads are less bulky and more comfortable than they were in the past. No one has to know you are wearing them.
Sales of disposal incontinence garments amount to approximately $1.3 billion annually. You are not alone.
Cindi Pearce is a graduate of Ohio University, where she received a bachelor’s degree in journalism back in the dark ages (aka before computers, the Internet and cell phones. Heck, before electric typewriters!) A former newspaper writer/columnist and photographer, her fiction and non-fiction work has been published in national magazines. A full-time freelance writer, as well as an avid gardener, an artist and yoga aficionado, Cindi is a Baby Boomer and proud of it. She has survived the gnarly challenges of the sandwich generation and lived to tell the tale. Cindi has somehow managed to stay married to her first and only husband for nearly 35 years. They are the parents of three grown children and the grandparents of one. She has five large, raucous dogs, five acres to mow on her beloved zero turn mower, and gets the biggest kick out of making people laugh on Facebook. (P.S. She refuses to cut her hair short.)