Urinary incontinence or inability to hold urine is a common problem in older individuals, especially women. About a third of all women and 10 per cent all men above 60 years of age have urinary incontinence. The magnitude of incontinence ranges from mild discomfort to severe disability and can lead to complete withdrawal from social life. The incontinent patient and his/her carer are often unaware of the treatment options available and unnecessarily suffer. In fact, in most cases, incontinence can be effectively controlled.
Incontinence is not an inevitable result of ageing but results from specific diseases or drugs. Often incontinence can result from an illness accompanied by weakness, confusion, or hospital admission or it may be the only symptom of urinary infection. Chronic incontinence can be of one or more of the following types:
- Stress incontinence or the leakage of urine during exercise, coughing, sneezing, laughing or other body movements which put pressure on the bladder. It occurs in most women in all age groups.
- Urge incontinence or the inability to hold urine long enough to reach a toilet is often associated with stroke, dementia and Parkinson’s disease. Some older patients with arthritis may have difficulty in reaching a toilet in time and have incontinence even with normal urine control. It can also occur in otherwise normal elderly persons as well.
- Overflow incontinence or the leakage of small amounts of urine from a constantly filled bladder occurs in the presence of an enlarged prostate and long-standing diabetes.
Diagnosis and management
The most important step in the management of incontinence is a detailed clinical evaluation to determine its cause. Most patients will require the advice of an urologist (specialist in diseases of the urinary tract) or a gynaecologist. The treatment of urinary incontinence depends on the diagnosis. Drug treatment with oxybutinin (Tropan) is effective but has side-effects such as dry mouth, glaucoma and urine retention. Surgery can improve or cure incontinence when it is due to a structural problem such as an enlarged prostate.
Exercises can strengthen the muscles of the pelvis and control the urinary bladder outlet. Behavioural management techniques of “bladder retraining” are helpful in the control of urination. These methods improve getting the sense of bladder filling and delay voiding until the person can reach a toilet.
Sometimes incontinence is treated by inserting a catheter (flexible rubber tube) into the urethra and evacuating the urine at regular intervals or keeping it permanently inside the urinary bladder. However, long-term catheterization is always associated with urinary infections.
Specially-designed absorbent under-clothing is also useful for patients who cannot be helped by the above-mentioned measures. However , this has significant cost implications.