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Training your bladder

Training your bladder

A weak bladder is common among the elderly, particularly in those above 80. Here’s what urinary incontinence means and how it can be managed and treated


Age-related health disorders increase along with the candles on one’s birthday cake too. If puffing out the 80th candle makes some folks pee in their pants, chances are that it’s not just out of happiness but because of an overactive bladder.

Urinary incontinence (UI) is when the bladder leaks urine without control. It’s also called an overactive bladder and is common among 80-year-olds.

While UI can be embarrassing and uncomfortable, it can be treated. The treatment depends on the cause of the problem.


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Typical causes of urinary incontinence in the elderly

Urologists reveal that UI is a common occurrence in the elderly population and can affect older women and men differently.

“As people age, the bladder and the muscles around it become weaker, and that’s when incontinence can happen,” informs Dr Santosh Palkar, consultant urologist, Zen Multispecialty Hospital, Mumbai.

He attributes UI to various health conditions. “Alzheimer’s disease, Parkinson’s disease, diabetes, stroke, multiple sclerosis and obesity are some old age diseases that can damage the nerves that control the bladder muscles. A urinary tract infection (UTI) if left untreated can also invite this condition. In older men, prostate cancer, as well as an enlarged prostate gland, can lead to blockage and incontinence,” he explains.

Types of UI

According to the National Institute on Aging, USA, UI has been classified into four broad types:

  • Functional incontinence is common among the elderly who have normal bladder function and control but are unable to reach the loo in time to pee. The reasons could be that they cannot walk fast enough, have arthritis that makes it painful for them to get up and walk, etc.
  • Stress incontinence is a type of UI that occurs commonly in women. In this type of UI, urine leaks when there’s pressure on the bladder when they cough, laugh, sneeze, lift or move heavy objects, or even exert during exercise. While it usually begins around the time of menopause, it can reappear in old age too.

“Stress UI which is common in elderly women can be due to existing factors that include obesity, multiple childbirths, delivering big babies, prolonged delivery, pelvic surgery and so on,” explains Dr Dilip C Dhanpal, consultant urologist and transplant surgeon, Sagar Hospital, Bengaluru.

  • Urge incontinence, as the name suggests, happens when there’s a sudden and uncontrollable urge to pee and the urine leaks before reaching the loo. This is common in the elderly who suffer from diabetes, Alzheimer’s disease, multiple sclerosis, stroke or Parkinson’s disease.

“Urge incontinence is seen in a majority of men. This type of incontinence occurs when a man has an urge to urinate, leading to sudden, involuntary urine leakage,” points out Dr Palkar.

  • Overflow incontinence is where small squirts of urine leak from the bladder whenever it’s full. A man can have trouble emptying his bladder if an enlarged prostate is blocking the urethra. Diabetes and spinal cord injuries can also cause this type of incontinence.

Treatment for urinary incontinence

The bright side to UI is that medical science has made immense strides in quick diagnosis, treatment and management to make the twilight years more comfortable and less embarrassing.

“Treatment for UI is based on the type of incontinence, its severity and the underlying cause. In some cases, a combination of treatments may be needed,” shares Dr Palkar. “The treatment will not be common for everyone. You will be given several treatment options such as bladder training, medications such as alpha-blockers, electric stimulation and interventional therapies. Only when these are ineffective will you need to undergo a sling procedure, bladder neck suspension or even prolapsed surgery,” he adds.

Common therapies for Urinary incontinence

Doctors advise making certain lifestyle modifications to treat an overactive bladder:

  • Avoid excessive tea, coffee, herbal teas, alcohol and caffeinated fizzy drinks which are bladder stimulants and cause frequent urination.
  • Drink water instead but limit water intake before bedtime.
  • Lose weight because obesity increases the pressure on the abdomen which in turn puts pressure on the bladder causing stress UI.
  • Prevent constipation by eating a healthy diet rich in fibre.

Train your bladder

According to Dr Dhanpal, there are two ways to train the bladder:

  • Pelvic floor muscle training (PFMT) or Kegels are excellent conservative exercises to strengthen the muscles around the bladder. These can train the bladder to hold the pee in without leaking it.
  • Time voiding is another remedy that is recommended. Maintain a diary and set a time to pee every hour. Gradually increase the gap between the loo break from one hour to two and more.

Tips for caregivers and family

Family and caregivers of the elderly must discuss the condition with the treating urologist to learn how to manage the condition.

“Most cases of UI are chronic and will remain so unless one seeks timely treatment. If the cause of UI is temporary then it will go away. But most of the elderly suffer from it and it doesn’t get better,” cautions Dr Palkar.

“This is the reason family members should educate themselves about this involuntary disorder and the various treatment options that can help the elderly,” says Dr Dhanpal. “The caregivers and the family should ensure the elderly member is not neglected; they should boost their morale. Simply place a ‘urine can’ next to the bed to prevent any embarrassing moments,” he advises, adding that keeping a supply of adult diapers can be helpful.

The elderly folks suffering from Alzheimer’s disease may need to be monitored even more closely and need more encouragement because of their failing memory.

The National Institute on Aging has a few tips for the family:

  • Mark a clear pathway to the bathroom and remove all obstacles out of the way. Ensure someone accompanies the elderly person on the bathroom visits.
  • Hang a sign outside the bathroom mentioning ‘TOILET’ or ‘BATHROOM’.
  • Install an electronic reminder or alarm at the bedside to remind the person to visit the loo every two or three hours.
  • As far as possible, avoid serving any beverages such as tea, coffee, fruit juices, carbonated drinks or soups near bedtime.
  • Serve whole fresh fruit instead of liquids if they are thirsty at bedtime.

Incontinence today is far more easily manageable with conservative measures, medications and sometimes, surgery. Prevention of UI-induced complications can go a long way in boosting the health of the elderly.

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