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What is urinary incontinence?
Urinary incontinence is the involuntary loss of urine.
This guide talks about urinary incontinence in the elderly.
Urinary incontinence in the elderly can be caused by:
- normal age-related changes, for example:
- weakened pelvic floor muscles;
- dryness of the mucous membranes of the vagina or urethra;
- an increase in the size of the prostate.
- overweight
- certain conditions:
- constipation;
- chronic cough;
- urinary tract infection (cystitis);
- stones (stones) in the bladder;
- damage to the nerves of the bladder, for example with
- multiple sclerosis (MS);
- Parkinson disease ;
- diabetes.
- some drugs:
- diuretics;
- sedatives;
- antidepressants;
- painkillers.
Urinary incontinence usually has a big impact on the quality of life.
Incontinence can be treated, talk about it.
Types of incontinence
There are different types of urinary incontinence:
- Urge incontinence, also called urgency, urge incontinence, instability, or bladder instability with incontinence:
- you have an urgent need to urinate and you cannot hold back
- you do not make it to the bathroom on time.
- Stress incontinence, also called stress incontinence:
- you lose urine:
- during physical activity;
- when the pressure suddenly increases in your belly, for example when:
- you cough,
- you sneeze,
- you laugh,
- you push,
- you receive a shock.
- Mixed incontinence:
- you lose urine during your activities and you also have a sudden, unstoppable urge to urinate.
- Overflow incontinence:
- you cannot empty your bladder well, for example because of a descent (prolapse) of the bladder or uterus. Your bladder may then overflow. You then lose urine.
How often does it occur?
Urinary incontinence in people over 70 affects:
- more than 1 in 2 women. It is then:
- usually mixed incontinence;
- but also often from stress incontinence.
- about 1 in 4 men. It is then:
- usually urge incontinence;
- more rarely from stress incontinence, except after prostate surgery, for example.
How to recognize it?
In case of urge incontinence (urge incontinence):
- you have a sudden urge to urinate;
- you cannot control this urge and you have to go to the bathroom immediately;
- you often have what is called an “overactive bladder”, which means:
- you urinate often;
- you often pass small amounts of urine (pollakiuria);
- you have to get up several times at night to pass urine (nocturia).
With stress incontinence, you lose urine:
- during physical activity or exertion, such as running or playing sports;
- during an activity that increases pressure in the lower abdomen, such as lifting a heavy weight;
- in the event of a sudden impact, such as when driving a car through a pothole;
- coughing or sneezing.
In case of overflow incontinence:
- you have occasional urine leaks, apparently for no reason;
- you may feel a need to urinate or pain in your lower abdomen because the bladder is tight.
How is the diagnosis made?
Your doctor will determine the type of urinary incontinence you have:
- by asking yourself the following questions:
- When exactly do you have involuntary urine leaks?
- Since when ?
- What is the impact on your daily life?
- by evaluating the presence of:
- risk factors;
- a change in weight;
- smoking;
- of ailments;
- operations in the past.
- by offering to keep a diary of your urinary habits (voiding diary) for a few days to 2 weeks.
Your doctor can test your urine to see if there is an infection.
Your doctor can assess whether the medications you are taking may be the reason for the leakage.
Your doctor will refer you to a specialist if he is not sure of the diagnosis.
What can you do ?
General measures
Try :
- talk about your incontinence problem:
- there is nothing to be ashamed of; after all, it happens to a lot of people;
- it is a fairly common problem and there are effective treatments available.
- avoid certain drinks:
- coffee, colas that irritate the bladder;
- alcohol that stimulates nighttime urination.
- lose weight if you are overweight as being overweight can make incontinence worse;
- stop smoking if you smoke. Nicotine is bad for the bladder, as is chronic smoker’s cough. Ask a tobacco specialist for advice (see ‘Find out more?’);
- avoid constipation;
- move more:
- you will feel better;
- exercise has a good effect on bladder control;
- being able to get to the toilet quickly enough on your own helps reduce losses from urge incontinence;
- this allows you to avoid constipation.
Exercises
The accompaniment by a specialized physiotherapist allows you to perform the exercises properly and to understand them.
In case of urge incontinence and stress incontinence, training of the pelvic muscles is important.
- The muscles of the pelvic floor are the ones you use when you refrain from urinating;
- A 6-8 week daily workout can help you:
- better control of your bladder;
- reduce urine loss when you cough, sneeze, laugh, walk, jump, lift a weight, when you bend or squat, …
- The training of the pelvic floor muscles is carried out as follows;
- your bladder should be empty;
- focus on your pelvic floor muscles, trying to feel them, spot them, release them, and then contract them in different ways: hard, slowly, fast by maintaining the contraction and controlling the relaxation;
- breathe calmly during these exercises, do not block your breathing;
- your abs, buttocks, and thighs should be relaxed during these exercises.
In case of urge incontinence (urge incontinence) or overactive bladder, bladder rehabilitation through bladder training may be helpful. It is about setting up a kind of urinary habit: you go to the toilet at a fixed time, and you leave more and more time between 2 trips to the toilet. In this way, you learn to better understand the signals from your bladder: the feeling when your bladder is full and the feeling when your bladder is emptying.
To do this, you can request the support of a specialized physiotherapist.
What can your doctor do?
Exercises
Your doctor can recommend exercises you can do at home to train your pelvic floor muscles and / or bladder. He can recommend a physiotherapist specializing in pelvic floor muscle training and physiotherapy before and after childbirth.
Medications
Your doctor can adjust your treatment. For example, your doctor may suggest that you change the time you take your diuretics or change your treatment for diabetes.
Your doctor may prescribe medicines for you:
- in case of dryness of the mucous membranes;
- in case of overactive bladder. But beware :
- these drugs have unpleasant side effects (dry mouth, constipation, confusion …),
- their effect is not certain,
- they are quite expensive.
Equipment
Your doctor can give you advice on incontinence supplies: incontinence pads and panties, protective bedding, collection bags (condom catheter) for men. He can apply for an incontinence package in the event of untreatable incontinence.
Orientation
Your doctor may refer you to a specialist in the following situations:
- to confirm or clarify the diagnosis;
- in case of :
- blood in the urine;
- pain when urinating;
- descent (prolapse) of the bladder or uterus;
- obstruction by the prostate;
- full bladder impossible to empty (urinary retention), the bladder is then emptied with a urinary catheter;
- suspicion:
- severe cystitis;
- a tumor;
- a neurological problem;
- an abnormal connection (fistula) between the bladder and the intestine or between the intestine and the vagina.
- if, in case of stress incontinence, training of the pelvic muscles and / or medications do not provide you with the desired benefit. The specialist may consider an operation such as placing a strip in the form of a small hammock under the urethra. He may also suggest a means such as a pessary, a kind of plastic cap or ring to put in the vagina to support the descended bladder or urethra;
- in case of uncontrollable overactive bladder (urge incontinence) to place a sacral pacemaker. This stimulator helps to control the nerves of the pelvic floor muscles and therefore the activity of the bladder. This intervention does not always provide the desired benefit.
What can you do with your physiotherapist ?
A physiotherapist specializing in urinary disorders can:
- assess your problem;
- explain to you how the urinary system works, your problem and possible treatments;
- look for the factors that make your problem worse;
- teach you how to train your pelvic muscles and / or your bladder, as well as more general exercises (breathing, etc.);
- …
For more information on physiotherapy in case of stress incontinence, we advise you to read the patient guide on this subject.
Want to know more?
- Prevent and treat urinary incontinence in women – CHU Montreal
- Prevent and treat urinary incontinence in men – CHU Montreal
- Stop smoking. It’s possible – Tabacstop
- The food pyramid – Eat Move – Health Question
- Move at any age… After 50 too! – Eat Move – Health Question
- Alcohol, the point on your consumption – Stop or else?
- Calculate your Body Mass Index (BMI)
Sources
- Foreign clinical practice guide ‘Urinary incontinence in the elderly’ (2000), updated on 03.08.2017 and adapted to the Belgian context on 07.04.2019 – ebpracticenet
- Dutch practice guide ‘Urinary incontinence in women’ (2015) – NHG – Nederlands Huisartsen Genoostchap
- Dutch practice guide ‘Urinary stress incontinence’ (23.09.2016) – KNGF – Koninklijk Nederlands Genootschap voor Fysiotherapie (summary in French)
- Dutch practice guide ‘Stress urine-incontinence’ (2011), updated in 2017 – KNGF – Koninklijk Nederlands Genootschap voor Fysiotherapie (original)
- https://defysiotherapeut.com/aandoeningen-en-klachten/incontinentie/
Other sources
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