January 24, 2020
Aging and Incontinence: a Physical or Mental Problem?
There are plenty of changes we can expect to see and experience as we get older, like wrinkles and worsening eyesight, which are all clear signs of our bodies aging. One problem that older adults may face during the aging process is the development of urinary incontinence, or light bladder leaks. There are different forms that urinary incontinence can take, and the reasoning behind the leaks may vary from person to person. While some forms of bladder leaks can be directly linked to physical changes in our bodies as we age, certain forms develop as a result of a mental disability or lack of mental function. How can we tell the difference and how can we get help to improve overall quality of life for those experiencing leaks?
Kinds of Urinary IncontinenceAs mentioned above, bladder leaks are a result of different forms of incontinence. There are technically six kinds of urinary incontinence that people of all ages may develop. Some forms of incontinence are more common than others. Stress Incontinence - Stress incontinence is when pressure or “stress” is applied to the bladder, urinary tract, or abdomen, and in turn causes leaks. People that suffer from SUI experience leaks when they’re laughing, lifting, coughing, or running, for example. This is most commonly seen in women. Urge Incontinence - Sometimes called overactive bladder (OAB), urge incontinence is the sudden and intense urge to go, regardless of how full the bladder is. This problem is seen more frequently in people of all genders as they age. Overflow Incontinence - This type of incontinence occurs because the bladder is unable to correctly empty itself, leading to a residual build-up of urine in the bladder. With too much fluid in the bladder, people may leak (whether they feel the urge to go or not). Mixed Incontinence - Sometimes, people may be suffering from a mixture of both SUI and OAB symptoms. This is more common in women and older adults. Functional Incontinence - If the urinary tract is fine, but an illness, disability, or accessibility issues are leading to light bladder leaks, it’s likely functional incontinence. Reflex Incontinence - This kind of incontinence occurs because the bladder muscle contracts with no warning or urge. People with reflex incontinence often times leak a large amount of urine compared to other forms of incontinence.
Is it Physical or Mental?While most forms of urinary incontinence can be tied to physical changes to the body, like SUI and its linkage to depleting estrogen in post-menopausal women, some may be correlated with mental capabilities and function as a result of age or medical condition. One way to be certain whether or not the bladder leaks are a result of declining physical or mental health, is to assess the awareness surrounding the leak. A functioning adult with the mental and physical abilities to be aware of, and take care of the leaks (even if it means getting another person to help), is likely suffering from incontinence due to physical changes in the body, not declining mental state or function. Certain forms of incontinence like functional and reflex, are more commonly seen in individuals with mental disabilities or nerve damage. That being said, different forms of incontinence can have either an underlying physical or mental cause and it depends on the individual and their medical history. Let’s take a look at how physical and mental abilities can impact continence: SUI - stress incontinence is more likely a physical problem than a sign of declining mental health and ability. While older individuals are more likely to experience SUI leaks than younger individuals, it can impact people of all ages. Older people are more likely to experience this as muscle function and mass are in decline, as the pelvic floor muscles that control and help regulate the flow of urine are weakened with age. Urge - there is no one identifiable cause for urge incontinence, although it is common. Physical changes like muscle weakness, lack of estrogen production to support the urinary tract, and drinking bladder irritants like caffeine or alcohol may trigger the bladder to contract and give the feeling of urgency. Harvard Health goes on to explain that OAB may develop in individuals that have a neurological disease or damage. “Neurological diseases (such as Parkinson's disease and multiple sclerosis) can also result in urge incontinence, as can a stroke. When hospitalized following a stroke, 40% to 60% of patients have incontinence; by the time they are discharged, 25% still have it, and one year later, 15% do.” Overflow - Overflow is another form of incontinence that is likely due to a physical change or problem. Men are more likely to be diagnosed with overflow incontinence than women are, as it can be a result of an enlarged prostate, surgery to remove the prostate, scar tissue from surgeries, or even kidney stones. Women may also experience overflow incontinence as a result of the bladder or uterus falling out of place and bending the urethra. Medications and nerve damage from past surgeries can also contribute to the development of overflow incontinence. Functional - technically, functional incontinence can be both a mental and physical problem and it depends on the individual. Physically, an individual can have challenges that may inhibit their ability to use the bathroom. These include physical disabilities, arthritis making it difficult to undress in time to go, or being unable to reach the bathroom safely in time (no obstacles or safety hazards). Mentally, diseases like dementia can render the individual unconcerned to find a toilet or be aware that they’re going. Reflex - reflex incontinence is the result of physical impairment and nerve damage. This is most commonly seen in people with serious neurological impairment from multiple sclerosis, spinal cord injury, other injuries, or damage from surgery or radiation treatment. The overarching theme for incontinence is that it can be both a physical and mental problem in older adults and it really depends on the person and their medical history.
Finding Help and TreatmentFinding solutions for either yourself, or a loved one that is experiencing bladder leaks, should start with talking to a healthcare professional. They can help you decipher symptoms and properly diagnose whatever form of incontinence is causing the leaks. Different forms of incontinence require different treatment options and finding what is right for you and your lifestyle should be decided after a discussion with your doctor. Some common solutions for bladder leaks include the following:
- Pads and liners - these absorbent products are meant to be worn inside the underwear to help absorb urine after a leak. These can be used for all bladder leaks.
- Medications - these are prescribed for people with OAB or overflow incontinence. They are used to relax the bladder muscles.
- Estrogen - topically applied estrogen can be prescribed to women who are suffering from SUI, OAB, or mixed incontinence as a result of a menopausal decrease in estrogen production. This may help to line and support the urinary tract.
- Exercise - exercises that are meant to strengthen the muscles that help regulate the flow of urine may help reduce leaks. Talk to your doctor to see what kind of exercises would be appropriate for you.
- Reusable products - Reusable incontinence garments and products like Revive® are designed to reduce leaks and reduce the amount of waste that is produced from traditional incontinence products.