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Strategies to manage incontinence: don't see the problem as an inevitable part of aging.

About 50 percent of older Americans suffer from incontinence--and for many of them, the problem goes beyond leaking a few drops of urine and strikes at the very core of their self-confidence. "If you're losing control of your bladder, you worry about the smell, and avoid social encounters and physical activity," says Jonathan Vapnek, MD, associate clinical professor of urology at Mount Sinai. "But all types of incontinence are treatable. While aging of the bladder reduces its capacity to store urine, you shouldn't view incontinence as an inevitable part of aging."

Types of Incontinence There are several types of incontinence, and some older adults may have more than one type.

* Stress incontinence This is most commonly seen in older women (especially if they've had multiple pregnancies). It causes urine leakage if increased intra-abdominal pressure is exerted on the bladder, usually by a laugh, cough, or sneeze.

* Urge incontinence is caused by hyperactivity of the detrusor muscle, the large pumping muscle of the wall of the bladder. "People with urge incontinence often can't make it to the bathroom in time," says Dr. Vapnek. Hyperactivity of the detrusor muscle occurs as a part of normal aging, but neurological conditions like stroke and Parkinson's disease also can underpin urge incontinence, as can an enlarged prostate.

* Overflow incontinence There are two types of overflow incontinence. "In one type, the neck of the bladder is obstructed, most commonly by an enlarged prostate," Dr. Vapnek explains. "In the other, the detrusor muscle is underactive." In both types, the bladder fills to capacity, and the sphincter muscle is unable to prevent overflow.

* Functional incontinence In these cases, the urinary system functions normally but something else inhibits normal toileting. For example, people with dementia may not recognize the need to urinate, while somebody with arthritis may find it difficult to lower him or herself onto the toilet.

Contributing Factors Medications (including heart medications, and diuretics used to treat high blood pressure) can exacerbate poor bladder control, as can alcohol and caffeinated beverages, which stimulate the production of urine. "A chronic cough due to smoking can weaken the pelvic floor and increase the likelihood of stress incontinence," says Dr. Vapnek. "Other contributing factors include obesity--it places the muscles of the pelvic floor, which supports the bladder and other internal organs, under pressure."

Talk to Your Doctor Geriatricians typically ask about bladder problems at routine annual physicals, but if your doctor doesn't, mention that you're having difficulty controlling your urine and would like some help. After evaluating you for health conditions that can underpin incontinence, and reviewing your medications to ensure they are not contributing to the problem, your doctor may ask you to fill in a "bladder diary" noting how much you drink, and when and how much you urinate. You also may have urine tests, as well as tests that measure how well your bladder empties.

Treating the Problem If you have stress incontinence, your doctor will likely recommend Kegel exercises. "These strengthen the muscles of the pelvic floor," Dr. Vapnek explains. "The pelvic floor muscles are the same ones you use to interrupt the flow of urine. To do Kegels, slowly contract the muscles--think of them as an elevator, and raise them floor-by-floor--before slowly relaxing them." Aim to do four sets of 10 to 20 repetitions each day--set an alarm or chime on your wristwatch or cellphone to remind you.

Surgery can be an option for stress incontinence if Kegels fail to improve the problem. The most common surgical procedure involves using synthetic mesh tape to create a supportive sling around the urethra (the tube through which urine exits the bladder) and neck of the bladder. Bulking agents also are an option. "These are fillers that are injected into the tissues around the upper portion of the urethra," says Dr. Vapnek. "The aim is to help the sphincter close by increasing pressure on the urethra, but the treatment is often ineffective."

For urge incontinence, your doctor may suggest bladder training, which involves "holding on" for progressively longer periods, the ultimate goal being to lengthen the time between trips to the bathroom. Medications also can help, by blocking a chemical messenger that triggers bladder contractions--but the drugs used (called anticholinergics) are associated with side effects in seniors (see our June issue).

"If overflow incontinence is caused by an enlarged prostate, drugs may be given to shrink the gland," Dr. Vapnek says. A catheter may also need to be used to regularly drain the bladder. There is no specific treatment for functional incontinence, but you may be able to avoid accidents by adopting a policy of 'timed voiding,' so that your bladder is emptied at predictable times." You can also manage overflow and urge incontinence by wearing clothing with elasticated waistbands, and ensuring that there is a clear and well-lit path to the bathroom. "Also consider positioning a commode in rooms where you spend the most time," Dr. Vapnek adds. "


* Lose weight if you are overweight or obese.

* Practice Kegel exercises at least four times per day.

* Avoid drinks that might irritate your bladder (coffee is a common irritant). But don't stop drinking water--this can cause dehydration.

* If you have urge or functional incontinence, remove any rugs or furniture that might impede your route to the bathroom or cause you to trip while hurrying.

* Use incontinence pads such as Depends to soak up minor leaks.

Caption: About half of U.S. seniors suffer from some form of incontinence.
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Title Annotation:WELLBEING
Publication:Focus on Healthy Aging
Date:Aug 1, 2017
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