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Monday, 21 July 2014

Old Age Incontinence

According to a June 2014 report [pdf] from the Centers for Disease Control and Prevention, more than half the U.S. population age 65 and older (50.9%) report urinary and/or bowel leakage.

That's just the group of us who live independently; there are different numbers, higher and lower, for those in care homes of various kinds.

Because it's not a subject anyone likes to talk about much, we giggle and make jokes.

IncontinenceHotLine

Although it is hard to openly discuss incontinence, it is important health issue that can have serious effects on people's lives. When WebMD reported on the CDC study, it noted,

"Bladder and bowel incontinence is a highly prevalent disease that has emotional, health, social and economic impacts in the daily life of our elderly population in the U.S.," said Dr. Farzeen Firoozi, a urologist at North Shore-LIJ Health System in Manhasset, N.Y.”

The first time I wrote about this often taboo subject in 2009, Cop Car posted my favorite comment: “I'm not dressed without a maxi pad.”

Ever since, when the subject comes up, I've laughed again and passed it on (so to speak) to others (with attribution, Cop Car).

The reason for that post was, as I explained then,

”...lately, when I laugh, sneeze or cough with too much force, I leak. Or, more bluntly, I pee in my pants. Not a lot, a few drops, and it happens not just when I need to visit the bathroom; it can happen even when I have just peed.”

So I did some research and reported to you. As I have further explained, more recently, losing weight solved the problem. No more leaks.

All this came to mind a few days ago when I received the weekly mailing from Harvard Medical School selling their topical health booklets – this one titled Better Bladder and Bowel Control. The email itself, headlined Five Ways to Dodge Incontinence, provides some good advice:

Watch your weight. Excess weight and incontinence can go hand in hand, particularly for women. One theory is that extra abdominal fat can weaken the pelvic floor muscles and lead to stress incontinence (leaking when coughing, laughing, sneezing, etc.). In some cases, simply losing weight can improve incontinence.

Don’t smoke. Smoking threatens your health in many ways. It also doubles the likelihood that a woman will develop stress incontinence. Nicotine has also been linked to urge incontinence.

Stay active. In the Nurses’ Health Study, middle-aged women who were the most physically active were the least likely to develop incontinence.

Minimize bladder irritants. Caffeine and alcohol have been linked to urge incontinence (the feeling you need to urinate even when the bladder isn’t full). Carbonated drinks, the artificial sweetener aspartame (NutraSweet), spicy foods, and citrus fruits and juices cause urge incontinence in some people.

Don’t strain with bowel movements. This can weaken the pelvic floor muscles. If your stools are frequently hard or take considerable effort to pass, talk with your doctor. In a study involving people ages 65 and older, treating constipation improved a variety of urinary symptoms, including frequency, urgency, and burning. Increasing the fiber in your diet and drinking enough fluid can help prevent constipation.”

As useful as those items are to know, you can't get the rest of Harvard's information on causes and treatment without shelling out a lot more money than I care to spend.

Therefore, as TGB public service, here are some links to reputable online sources of information on incontinence:

WebMD Incontinence & Overactive Bladder Health Center
Many links to full articles, explanations and discussions of all aspects of incontinence

Medscape Urinary Incontinence in the Elderly
A thorough, single-spaced, eight-page explanation meant for physicians but easily understandable by laymen

Mayo Clinic Urinary Incontinence
A good section with pages on definition, symptoms, causes, risk factors, complications, treatments, drugs, even home remedies

Incontinence is highly treatable with drugs, other interventions and in some cases, surgery. For me – like so many of the minor afflictions of age - just irritating, every single day.

I am grateful my bout of incontinence was so easily solved with weight loss. I always wondered, when I took up Cop Car's solution, what jokes the check out clerks at Rite-Aid were telling each other after this white-haired old woman paid for her Maxipads.


At The Elder Storytelling Place today, Vicki E. Jones: I Accept the Nomination


Posted by Ronni Bennett at 05:30 AM | Permalink | Email this post

Comments

Thanks for talking about this boldly.

Thanks for this post. I haven't experienced it yet, but I am not overweight AND I try to walk daily. I used to be an avid biker, and I really think the peddling up hills strengthens abdominal muscles, which helps prevent incontinence. Unfortunately, due to back/knee problems, I'm only getting exercise by walking (with my dogs).

Lets not leave us men out of this discussion. The old prostate ain't what it used to be and leakage is a definite problem. Fortunately, there are "panty" liners for men too, and we shouldn't be ashamed to use them.

I laughed when I read about what jokes the clerks at Rite Aid were telling after you paid for your Maxi-Pads, Ronni.

I will never forget the look on George's face when he saw my Mini Pads as I put away my groceries.

I tried a prescription for Incontinence, but it didn't help that much so I didn't refill it. My doctor wanted me to try a different drug, but I refused. Like Cop Car, I get along fine with my protection.

There are also nurses in urology clinics (maybe elsewhere) who teach bladder training, how to do Kegels, and give advice about diet.

Bladder training helps with urge incontinence. As Ronni says, avoiding acidic foods may help, too.

Kegels mainly focus on the vagina, but if this exercise is taught correctly, it will help strengthen everything "down there." They strengthen core muscles as opposed to just squeezing -- the old way of doing Kegels. Being able to engage strong core muscles helps lift everything up.

I know whereof I speak.

This is slightly off-topic, but older men seems to dribble all the time, leaving a mess in on the floor in front of the toilet. And worst of all, they don't seem to notice that they do this -- at least my 66-year-old husband doesn't. I'm always mopping up after him. I wish he would pee sitting down to avoid this.

So far I have not talked to him about it, because I don't want to embarrass him and he's very sensitive to criticism. (Neither of us takes personal criticism very well, so we are quite careful with each other.) Fortunately, when he pees at night, he sits on the toilet (to avoid having to turn on a light).

I'll be 77 next month. In 2011-2012 I took of 45 pounds. I really hoped that would cure the leakage problem. But--it has NOT. I don't exercise a lot, and I take prescription pain pills for my arthritis, which I suspect may be a factor. But--for me, at least, the weight loss did NOT solve the problem. Dammit.

They did not mention Kugel exercises...especially for those of us who have had children.

Working out regularly and being fairly active at 71, I drink one to two gallons of water on any day. For a long time, I've used the frequent urinating breaks for cease and hold (~3 seconds, 5-7 times each round) - not sure if that's why, but I credit it with some measure of preventing a problem.

Based on the huge sections and varieties of incontinence pads in drug stores, big box stores and even supermarkets, it appears that incontinence to some degree is endemic in the older population. I agree with Cop Car---just take it in stride, and unless you are seriously peeing your pants in public situations, avoid any and all medications. My experience with medications is that they often cause more problems than they fix. I've had a quad bypass and valve replacement plus a couple of other major surgeries and painful arthritis. I know that the plague of constipation, for example, is a side effect caused almost completely by meds which are necessary to control pain, heart rate, blood pressure, etc. If I have a condition which I can tolerate without medications, I am perfectly happy to deal with it and move on.

Mild to moderate urinary incontinence falls into that category. I'm not in the least embarrassed to buy my Poise pads at the pharmacy or grocery store---the clerks are quite used to it and if not, they can just deal with it too. Now people with bowel incontinence, THEY have a problem and they also have my heartfelt sympathy.

Ha ha ha! So glad to see this issue out in the open for discussion.

About ten years ago, my nurse practitioner sent me for physical therapy (I blithely nicknamed pussy PT) which really helped with a sinking bladder AND with leakage. It was very sophisticated with a machine inserted into my vagina which I had to SQUEEZE with all my might. It told the therapist which side was "weaker" and she taught me more indepth methods of Kegels.

Practice, practice, practice!

Thank you for these resources. I will print out some for my friend who doesn't have internet, but does have a HUGE problem with both kinds of incontinences. She has tried almost everything but surgery, and, at age 82, probably won't do that. It has just about made her life unbearable, and I feel so bad for her. Before I was diagnosed with Celiac Disease, I had a lot of embarrassing accidents, so I know about that.Until we, as a society, get over our Victorian "fecophobia,"incontinence will continue to bother us more than it need do. One good move is seen in the popularity of 2 children's books, "Everyone Poops,"and "Everybody Poops."

I was fortunate enough online to find washable (and gorgeously colourful) incontinence pads. Just in case. They have been serving me steadily for nearly 2 years and over time are a fraction of the cost of disposables (not to mention the environmental impact).

They offer me an assurance as if I laugh/cough/move suddenly, I may leak.

I've researched (amongst friends) bladder hammocks, etc., but they are short term and need replacement after a while and can make the situation worse when they start to fail.

I'm happy with my crazy pads.

XO
WWW

PS Why does TGB keep crashing my feed??

Those Kegel exercises are the best. Do them daily.

Ronni--Oh, gee, you can't imagine how thrilled I am to have my 15 seconds of fame for such a subject. Although my stress incontinence has much improved with deliberate consumption of less caffeine (contrary to the "Caffeine and alcohol have been linked to urge incontinence...." above, I still use maxi pads instead of liners. (If I wore a belt, I'd probably use suspenders, too!)

Thanks for keeping us informed - and laughing!

I'm not making fun of your typing error, Tabor, regarding the "Kugel" exercises - it gave me a great, long laugh while putting together kugel and kegel...Thank you!

Suz, I had the same reaction about the Kugel exercises - I love a "good" typo (usually defined as one in which I provide somebody else with some hilarity to brighten their day). Thanks to Tabor for doing the honors this time!

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