Elderly Incontinence: Treatment Options and Caregiver Tips

• Urinary tract infections, also known as UTIs
• Nerve damage in the pelvic or back area
• Waiting long periods of time to release urine
• Living with arthritis, making it harder to get to the bathroom
• Organ prolapse in the pelvis ^[01,03]

Types of urinary incontinence

• Stress incontinence. Most common in middle-aged women, stress incontinence happens when urine leaks due to pressure on the bladder. This can happen during exercise, laughing, sneezing, coughing, or lifting heavy objects.
• Urge incontinence or overactive bladder. When a sudden urge to urinate happens and reaching the restroom in time is a challenge, urge incontinence or overactive bladder is occurring. Adults living with Alzheimer’s disease, multiple sclerosis, or the effects of a stroke often experience this type of incontinence.
• Overflow incontinence. This type of incontinence occurs when the bladder is consistently full and leaking small amounts. Those with spinal cord injuries or diabetes often experience this type of incontinence. It’s also common in men with enlarged prostates that block the urethra.
• Functional incontinence. This type of incontinence affects those with normal bladder control who have issues making it to the bathroom in time due to physical ailments like arthritis.
• Mixed incontinence. As its name suggests, mixed incontinence is when a person experiences a mix of overactive bladder and stress incontinence at the same time.^[03,06]

• Frequent diarrhea or constipation
• Damage to muscles in the rectum or anus
• Nervous system damage
• Abuse of laxatives
• Prolapse in the rectum ^[07]

Bladder control training techniques for urinary incontinence

• Kegel exercises. These exercises help strengthen the pelvic floor muscles that support the bladder, allowing a person to hold urine longer and avoid future accidents.
• Urgency suppression. This practice helps control strong urges to urinate to help get to a bathroom quickly. This is done by distracting oneself by taking breaths, holding still, and squeezing the pelvic floor muscles.
• Timed voiding. This helps control incontinence by going to the restroom on a set schedule so that the bladder does not get too full.^[03]

Medical treatments for urinary incontinence

• Medication. Doctors may prescribe medicines in pill, liquid, cream, or patch form to treat incontinence problems. Be sure to talk with your loved one’s doctor about any potential side effects.
• Bulking agents. This is when a thick paste or gel is injected to thicken the area around the urethra. This option may need to be repeated.
• Medical devices. Catheters drain urine from the bladder, urethral inserts prevent leaks, and vaginal pessaries provide pressure against the urethra to prevent leaks.
• Biofeedback. These sensors make your loved one aware of signals the body sends and may help them regain muscle control.
• Electrical nerve stimulation. This treatment sends mild electric currents to nerves around the bladder to help control urination and reflexes.
• Surgery. If incontinence is caused by a change in the position of the bladder or blockage due to an enlarged prostate, surgery might be recommended. For men, another surgical option includes sling surgery, which involves placing a supportive mesh sling underneath the urethra by making a small incision underneath the scrotum. ^[03,08]

Nonsurgical treatment options for bowel incontinence

• Diet changes. Reducing foods or drinks that can loosen stool, like caffeine, alcohol, and artificial sweeteners, and replacing them with foods that can thicken stool, like bananas, apple sauce, and creamy peanut butter, can help manage symptoms.
• Bowel training. There are two different forms of bowel training. One form is developing a bathroom routine to manage bowel movements better, and the next is learning exercises that strengthen muscles around the anus.
• Medication. Prescribed medications usually include anti-diarrheal drugs and fiber treatments to firm and decrease stool movement through the intestine.
• Skin protection. As fecal leakage can cause skin irritation, moisture barrier creams and adult diapers can be used to limit discomfort.

Surgical treatment for bowel incontinence

• Sphincteroplasty. This procedure stitches damaged anal sphincter muscles back together to secure the muscle on both sides.
• ACE procedure. This is when a small pathway is created from the lower abdomen to the colon, and through a small tube an enema is administered to allow for a daily flush of the bowels.
• Artificial bowel sphincter. An artificial device is implanted around the anus to mimic normal anal muscle movement.
• Sacral nerve stimulation. Stimulation therapy uses a small device implanted under the skin. It sends mild electrical impulses to nerves close to the lower back to influence the bladder, sphincter, and pelvic floor muscles.
• Colostomy. An operation that implants a special bag to an opening on the abdomen to collect stool. This treatment is only considered when other options have failed.^[07]

• Create a bathroom schedule. Helping your parent create and maintain a bathroom schedule can take the stress off of them and minimize the likelihood of accidents.
• Manage diet. Helping your loved one avoid foods and beverages that make their incontinence worse can help manage their symptoms.
• Consider the timing of food and drinks. If your parent is primarily having incontinence issues at night, it can help to look at their food and drink intake in the evening. While it is important to stay hydrated, reducing the amount of fluid they consume later in the day may help with overnight issues.
• Remain patient, kind, and supportive. Although dealing with incontinence can be uncomfortable, be empathic and patient with your loved one as they learn to manage their ailment.
• Have the right products. Having extra sheets, gloves, wet wipes, and adult diapers on hand can help maintain cleanliness and hygiene.
• Know when to contact a doctor. When symptoms become unmanageable, reach out to your parent’s doctor to make sure incontinence is not a symptom of a more significant issue.