Toward the end of his life, I was talking to my dad about his friend Bob. The two of them had been friends for nearly 70 years and saw each other frequently, but I hadn’t heard about him coming around very much lately. I couldn’t imagine they’d had a falling out, so I asked why we never saw him anymore. My dad explained that although Bob was “pretty healthy for a guy his age” (as if they hadn’t been born a week apart), Bob had issues with his bladder. He had urinary incontinence, and frequently wet himself.
My dad went on to say that Bob was embarrassed to come out. He also said that, despite his own myriad health ailments, including paralysis on the left side, he was grateful that bladder control was one problem he never had. It’s why we were still able to go to the pub every Friday. It seemed to me that he wouldn’t have traded places with Bob, even though overall Bob was considerably healthier.
And that’s the tragedy of urinary incontinence and bladder control. Despite its widespread prevalence, it’s seen as a source of shame. The emotional and social impacts can be devastating, leading to isolation, depression, and a decline in mental well-being. Combatting social stigma, and helping older loved ones deal with a loss of bladder control in a reasonable way, is a key to being healthy and happy when aging in place.
Understanding the Causes of Urinary Incontinence
One of the perceived social stigmas around urinary incontinence is that you are somehow being “childlike,” as it’s seen as a reversion toward weakness. But that isn’t at all true. There are root causes to this that are often, though not always, based on a normal process of aging. We get older, and our bodies change, and are changed by outside events that accumulate. Sometimes, all of this can lead to urinary incontinence. Some of the causes include:
- Weak or overactive bladder
- Damage to bladder nerve controls from MS, Parkinson’s, or other diseases
- Injuries to spinal cord or nerves that control bladder
- An enlarged prostate (for men)
- Spinal cord issues
The Many Types of Urinary Incontinence
It’s also important to recognize that there are several different types of urinary incontinence including:
- Functional incontinence: This is an issue for older adults who have healthy and functioning bladders, but who have mobility issues, arthritis, or other reasons why they have trouble making it to the bathroom on time. For these people, straying too far from a bathroom can be a scary thing.
- Overflow incontinence: This happens when a bladder is always full because it is unable to be fully emptied, and small amounts of urine leak out. This is especially a problem for men with prostate issues.
- Urgency incontinence: This is very common in older adults. It happens when there is a sudden need to urinate and they are unable to hold it in long enough to find a bathroom. The ability to “hold” is weakened. This is often the case for people with diabetes, MS, Parkinson’s, or other issues.
- Stress incontinence: When a person (usually a woman after menopause) has small leaks when stress is placed on the bladder from laughing, coughing, sneezing, or exercise.
So, there are many reasons why older adults suffer urinary incontinence, and none of these are anything to be embarrassed by, or to feel lessened by. But still it persists. And that can be dangerous.
The Dangers of Shame
Shame is one of the keenest and most powerful human emotions. We can all still recall humiliating things that happened to us years or even decades ago, and still feel that hot flush and burning tingle in the stomach. And that shame can be a daily condition for people with urinary incontinence.
This is unfair. Over 50% of older adults have some form of incontinence, with moderate-to-severe urinary incontinence being found in 25% of older adults. But there is still the desire not to be seen, or at the very least, the need to be near a restroom. This can cut off social engagement, a key to maintaining mental health in older age. Isolation can lead to depression, which can cause a host of other mental health problems, including dementia.
Urinary incontinence isn’t just about the bladder. It can have a deep and cruel impact on so much of life.
So how to make it better? There are several steps older adults can take, often with the help of caregivers and loved ones, to combat incontinence.
Healthy Ways to Combat Urinary Incontinence
There is no silver bullet or magic cure to handling the onset of urinary incontinence. But there are overlapping methods to mitigate it, and to live the life you want.
While there are some conditions that aren’t responsive, the bladder can usually be trained with exercise and training, like any other part of the body. Pelvic floor muscle exercises, including Kegels, can help strengthen the bladder. Experts also recommend training your bladder by setting a strict schedule for urinating (as in every hour or 90 minutes), regardless of need or urgency. As you do this, and exercise, you can expand the space between voids, until you are in more control.
There are a lot of things a person can do to make their bladder more healthy, including:
- Weight loss
- Limiting alcohol
- Avoiding sweet or sugary drinks that put more stress on the bladder
- Less caffeine
- Taking care not to drink too much fluid (enough so that you aren’t thirsty and are properly hydrated, but not just drinking iced tea because you have a taste for it)
But, of course, the best plans don’t always work. That’s why many people need to manage incontinence with adult diapers and pads, furniture protection, creams to help irritated skin, and urinary deodorizing pills. But the other half is not treating this condition like it’s a shameful secret.
When my dad could no longer use his left hand, he was unable to cut his food. So we did it for him. And that was fine. It was par for the course. It happens, it’s nothing to be ashamed of. That’s part of his ailment, and that’s normal. But for many people, things like furniture pads or urinary irritation creams are not something to talk about. It’s something to avoid.
But that shouldn’t be the case. Accept that there are some changes you can make through exercise or lifestyle adjustment, and some you can’t. This doesn’t make an older adult less of a person or less capable. And it doesn’t mean they can’t live at home, by themselves or with a caregiver. It just means that there needs to be some adjustments.
Having urinary incontinence doesn’t mean an older adult needs to stop living. It just means they need to live differently. And that’s part of aging: making the right adjustments so that you can continue to live strongly, age where you want, and experience the life you want.
Institute on Aging provides programs, groups, and services for older adults, their families, and their caregivers. Our mission is to help people age in place with dignity, love, and adventure. Connect with us today to learn more.