Incontinence in Adults: Regaining Control

Have you ever lost urine or feces when you laughed, coughed, sneezed or lifted a heavy object? Have you ever not made it to a toilet in time when you have felt the urge to eliminate either urine or feces? Have you ever thought you had finished voiding (peeing) or having a bowel movement to either dribble when standing up or discovering some urine or feces in your underwear? This is incontinence. It is the inability to voluntarily hold your urine or feces until you reach the correct place to eliminate. 1 in 4 middle-aged and older women experience incontinence. 15% of all men aged 60 years and older also are incontinent. Over 1.5 million Canadians have incontinence.

It is commonly believed to be part of normal aging. In fact this is not true. 80% of incontinence is curable and 20% can certainly be managed better. Continence requires that you feel the urge to void (pee) or defecate (eliminate from your bowels); are can totally hold your urine or feces until you reach the toilet; and can completely empty your bladder or bowels once you get there.

This article will provide you with some very basic information and tips that you may be able to try. However, the most important action for you to consider is to be assessed and managed by health care professionals that have specific expertise in the areas of incontinence.

The first consideration when looking for a possible cause for incontinence is to ensure that the parts of the brain, spinal cord, bladder, bowels and muscles are working correctly. Leakage of urine or feces may be because your pelvic floor muscles are too weak to support the organs or openings through which urine and feces must pass. Childbirth and chronic constipation can over-stretch these muscles.  Menopause also affects these muscles and the openings. If the bladder or uterus drop down (prolapse) they obstruct your ability to completely empty often causing you to have to void frequently in small amounts. An enlarged prostate in men can also cause the same effect. Nocturia (needing to void more than twice during the night) often happens as you age. This is due to a normal decrease in the production of a hormone that concentrates urine. Anything that irritates the bladder to contract and make you feel strong urge can lead to you needing to toilet quite frequently. This includes not drinking enough water, drinking bladder irritating fluids like coffee, tea, alcoholic and carbonated beverages. Bladder infections can contribute to incontinence as well.

Some bladder and bowel care tips:

1. Drink at least 6-8 cups of water or non-caffeinated or non-carbonated beverages a day. This ensures that urine remains dilute in the bladder and promotes hydration and prevents constipation.
2. Stop drinking any fluids after 7 pm at night to prevent having to get up frequently at night. However, make sure you drink a lot of fluids in the morning to help your hydration.
3. Personal hygiene: wash your private parts with soap and water once a day. Be sure to wipe front to back after voiding or having a bowel movement.
4. Eat a diet high in fibre, drink lots of fluids and take a walk after you eat to keep your bowels working properly. When sitting on the toilet for a bowel movement make sure that your feet are supported on the floor or use a foot stool so that your thighs are at a 30 degree angle to your bottom.
5. Discuss with your family doctor if you are experiencing any changes in your bladder or bowel functions; see blood in your urine or stool; have difficulty voiding despite feeling strong urge; leak feces despite feeling you have emptied and cleansed well.
6. Pelvic muscle floor strengthening and toning exercises called Kegel exercises. There are pelvic muscle floor physiotherapists with the majority being private therefore they charge a fee. Nurse continence advisors can also teach and help you with these exercises.
7. Discuss with your family doctor or specialist (urologist, gastroenterologist, geriatrician, neurologist) about a referral to a nurse continence advisor (NCA) who is a registered nurse with a specialty certificate in continence care from McMaster University, Hamilton, Ontario. There are NCAs in the following hospitals and clinics:

• Vancouver Coastal Health (UBC Bladder Care Centre)
• Providence Health (Mount St. Joseph’s and St. Paul’s Hospitals)
• Fraser Health (New Westminster Specialized Seniors Clinic – Continence Clinic; White Rock Specialized Seniors Clinic; Jim Pattison Out-Patient and Surgical Centre – Urology Clinic; Abbotsford Hospital – Urology Clinic)
• Vancouver Island (Seniors’ Outreach)
• Interior Health (Kelowna General – Seniors’ Clinic)
• And some private clinics.

Gaining control over your bladder and bowels is possible. If you would like to have a lecture provided by a nurse continence advisor, please let the Nikkei Seniors’ Healthcare and Housing Society know.

 

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Written by Marcia Carr (RN, BN, MS, GNC(C), NCA) – Clinical Nurse Specialist in Care of Older Adults

Japanese translation by Hiromi Platts

This article was originally published in the July 2018 issue of the Bulletin.

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