Incontinence In The Elderly – AKA, Oh Holy CR*P!!
As a caregiver, I suppose it’s inevitable that, one day, I’d be dealing with incontinence in the elderly as Mom came to me when she was 90.
For a long time, we dodged that bullet. It really wasn’t until Mom was in the last few weeks of life that I had to deal with full on incontinence.
Prior to that time and with the use of a bedside commode and some Depends just in case, I’d figured out a way to deal with unexpected urination such as buying washable incontinence products such as protective mattress covers or chair pads such as you’ll see in my article: Incontinence is not for the faint of heart.
One in five individuals over the age of 40 suffers from some sort of incontinence (either urgency or overactive bladder) according to the National Association for Continence. The same organization states that at least 50% of nursing home residents have some sort of urinary incontinence.
I was the primary caregiver for my 95-year-old mama, Gertie. Although she was not incontinent until very late in life, in the interest of gaining as much knowledge as I could about this condition, I explored the issue at length.
This article was written in the hopes that it may help others who are walking a similar path as they care for the elderly.
Incontinence in the elderly can be urinary or fecal. For the purposes of this article, I’m going to only discuss urinary incontinence. I don’t even want to think about the other…
What is Incontinence?
Incontinence is simply the inability to control one’s urination or defecation. Incontinence may start with a leakage of urine or feces and develop into a full blown case where there is no control whatsoever. Incontinence is actually a normal part of the aging process as muscles naturally weaken and gravity takes over.
Note, incontinence can happen at all ages, but the statistics show that it is mostly a problem in older women.
There are many types of incontinence, most of which are listed below.
- Stress incontinence. Stress incontinence is usually a leakage of urine when stress, such as a cough or sneeze, is exerted upon the body.
Any woman over the age of, oh, 45 or so, will tell you (if they’re honest) that they have to stop and squeeze their legs together if they’re about to sneeze. This is one of the things that your mother should have told you but most of us had to figure out on our own.
Laughter can also cause stress incontinence which is really a shame as I love to laugh…
Stress incontinence may also be onset (or made worse) by pregnancy, childbirth, or menopause (proof that God has a sense of humor…).
- Urge incontinence. Urge incontinence is when you leak urine just as you feel the urge to go – in other words, your body is not giving you the signal to pee early enough.
Urge incontinence can be caused by bladder spasms or incomplete bladder contractions.
Other triggers for urge incontinence may be seeing or hearing running water, seeing a toilet (I can vouch for this one…) and all of a sudden feeling like you have to go now!
Nerve damage may also trigger urge incontinence. Nerve damage may occur when there is damage to the nerves of the bladder during surgery, or because of underlying diseases such as Parkinson’s, Alzheimer’s, strokes,TIAs, or multiple sclerosis.
- Overflow incontinence. Overflow incontinence is actually a medical condition that can be remedied some of the time. This condition exists when the bladder fails to empty, fills up, and extra urine has no place to go except out (where there’s more room than in…).
A weak bladder muscle, a blocked urethra, or an enlarge prostate may contribute to overflow incontinence. Seeing a doctor may help this type of incontinence
- Overactive bladder. Overactive bladder incontinence occurs when the nerves going to the bladder contract at the wrong time and on their own. Overactive bladder symptoms may also include frequent need to urinate either during the day or night or a sudden urge to urinate with little warning.
- Functional incontinence. This condition exists when a person either doesn’t know or can’t relate to another about the need to pee.
Dementia in the elderly, Alzheimer’s, or strokes which hamper communication may all cause functional incontinence.
During the last 3 weeks of my Mom’s life, she was in a semi-comatose state and had functional incontinence. I quickly learned to recognize when I was to be called into action to freshen her and the bed up.
- Transient incontinence. Infections, such as UTIs and colds with coughs or sneezing may cause this temporary type of incontinence.
There are a few tips and tricks one can do to avoid incontinence. These are from my own caregiving experience so maybe they’ll work for you or your senior citizen loved one too.
- Slow the intake of fluids after 2 pm.
I had a small container of water for my Mom that she had to drink every day to stay mentally on top of things – dehydration is a really bad thing for an elderly person.
So, I reminded her during the morning to drink small sips of water very often but, by 2 pm, she was finished drinking as far as I was concerned, no matter how much she’d had. This doesn’t mean that she didn’t have water or liquids later in the day, I just stop pressing her to drink at 2 pm.
This helped with the nocturnal urination urge.
- Remind the elderly to try and urinate just a bit more when they think they’re done. Sometimes, when she was reminded, a satisfying trickle was my reward. Every little bit counted.
- Put your elderly loved one on scheduled bathroom stops. Just ask them frequently if they have to go and assist them in all tasks when needed.
Treatments for Incontinence
- Kegel exercises. Women (and men) have a muscle that contracts and relaxes to allow urine to flow. Simply contracting and relaxing this muscle to a count of three, with 10 repeats will strengthen the bladder muscle.
- If your loved one’s incontinence is transient, treatment of the underlying infection or disease may cure the temporary spell of involuntary peeing.
For UTIs, I’ve always had luck with an antibiotic and cranberry juice which some think changes the acidity of the urine. I believe this to be true as it’s worked for me but it doesn’t work for everyone.
Cranberry juice also comes in convenient capsules that are easy to take once a day,just in case:
AZO All Natural Concentrated Cranberry Tablets, 50 Count (Pack of 3)Nature’s Way Cranberry, 120 TabletsAZO Cranberry Urinary Tract Health, 25,000mg equivalent of cranberry fruit, Softgels 100 countSpring Valley Super Strength Cranberry 500mg 60 Capsules
- Medical condition incontinence, such as overactive bladder may be remedied with medication. For example, my Mom had frequent urination needs at night so I took her to a doctor who put her on two meds – Oxytrol which is a skin patch changed every 3 days, and Enablex, a daily pill.
Both of these meds seemed to work well as she generally got up just 1 or 2 times a night, versus her last pattern of awakening up to 4-6 times a night! No wonder we were forever tired!
- Surgery. If you’re a woman, the pelvic floor muscles may weaken (particularly for those who have had children) and a bladder sling may be installed through surgery. The bladder sling actually does what it sounds like – it holds the bladder in a sling so that the muscle doesn’t have to work so hard..
Protect your loved one (and the bed) from nighttime incontinence
Especially if your loved one takes sleeping pills, there may be nights where there will be accidents – after all, accidents happen. I found that it was so much easier to change these washable incontinence bed pads than to change the sheets, even if there was a plastic mattress protector underneath. Just roll your loved one over as you tuck a new incontinence bed liner underneath and back to sleep you both go.
I had 5 of these washable bed liners so I always had plenty available. IMHO, we liked the washable bed pads over the disposable ones but you can try both and see what is your preference.
Sofnit 300 Washable Underpad,34×36 in., Pack/4 pinkPremium Quality Bed Pad, Quilted, Waterproof, and Washable , 34Reusable / Washable waterproof bed pad 35 x 80Premium Quality Bed Pad, Quilted, Waterproof, Reusable and Washable , 35McKesson StayDry Ultra Underpads, 30Blue Disposable Underpads (Chux), Large Size 23 X 36, Case/100 2 Bags of 50Prevail Underpad, Super Absorbent, 10 Packs of 10 (100 count)NorthShore Premium Tuckable Disposable Underpads, 30×36 in., Pack/10
Things To Remember When Dealing With Incontinence in the Elderly
I know that, sometimes, it’s hard to hold one’s tongue but it’s an absolute must when dealing with elderly incontinence. They don’t mean to do it and, sometimes, they don’t even know!
- Never ever refer to an elderly person’s disposable undergarments as “diapers.” This is just plain old wrong. Diapers are for children and your elderly loved one doesn’t need to feel like he or she is treated like a child.
- Never ever admonish an elderly loved one for having an accident. These things just plain old happen and are signs of natural aging processes.
- Always willingly stop what you’re doing and assist your elderly loved one (if needed) in bathroom duties. This one was particularly hard for me as my Mom seemed to time her bathroom needs to the second I sat down – literally. Somehow, my sitting down must have activated her urge urination!
- Assist the elderly into new undergarments immediately if needed. No one wants to sit around in wet pants and, besides that, they could easily get an infection or end up with a rash from sitting on a wet surface too long.
- Help the elderly with bathroom hygiene. If this means that you have to assist them with wiping after going to the bathroom, put on your own big girl panties (pun fully intended) and help them. My Mom was no longer limber enough and her balance was not good enough to do these tasks herself. Somehow, we seemed to find humor in this role reversal anyway – thankfully.