Guide To Urinary Incontinence in Seniors

Urinary incontinence is the passing of urine that a person cannot control. It is a problem that affects between a quarter and a third of Americans, however, it is not a “normal” part of the aging process.

By reading this guide, you will learn more about the effects of urinary incontinence on seniors and their caregivers. You will also learn about the short-term and long-term care needs of seniors with urinary incontinence and how to help a family member or individual access resources to manage this disorder.

Types Of Urinary Incontinence

There are different types of urinary incontinence. Some of the most common include:

    • Stress incontinence  - The unintentional passing of urine through the urethra. This occurs when the bladder experiences increased intra-abdominal pressure such as when a person sneezes or laughs due to weak pelvic-floor muscles.
    • Overactive bladder (OAB) - When the urge to urinate comes on suddenly resulting in urine leakage. It often occurs due to an unstable detrusor muscle of the bladder and it is also referred to as urge incontinence.
    • Overflow incontinence - This occurs when other conditions cause a person to be unable to completely empty their bladder resulting in urine leakage.
  • Total incontinence - This occurs when the bladder cannot store any urine so an individual constantly needs to pass urine.
  • Mixed incontinence - This type of incontinence is a combination of both stress incontinence and urge incontinence or OAB.
  • Functional incontinence - This occurs when an individual has a normal urge to urinate, however, they cannot get to a toilet in time due to physical or cognitive impairments. Functional incontinence is more common in seniors.

Urinary incontinence may be caused by treatable conditions such as constipation or urinary tract infections. Conversely, urinary incontinence also increases a person’s risk of having recurring urinary tract infections. Although urinary tract infections may affect any part of the urinary system, the lower urinary tract consisting of the urethra and bladder are most commonly affected.

Treatment Of Urinary Incontinence

There are many treatments for urinary incontinence that can support individuals in leading a normal life, however, treatment depends on the type of incontinence that a person has and what is causing it.

The type of incontinence a person has is usually determined through a urinalysis, a post-void residual urine measurement, and/or urodynamic testing which looks at how well the bladder muscle, urethral sphincters, and urethra retain and release urine.

Once the cause and type of incontinence has been identified, one or more of the treatments below may be used including:

  • Pelvic-floor exercises - Also called Kegel exercises which help strengthen weak pelvic-floor muscles.
  • Bladder training - Involves delaying urination for progressively longer periods of time after the urge to urinate occurs to increase the amount of urine the bladder can hold.
  • Medications - Such as antimuscarinic agents which help relax the bladder muscle and alpha-adrenergic agonists which relax bladder neck muscles in the prostate in men making it easier to urinate.
  • Surgery - Including procedures such as prolapse surgery, various sling procedures, bladder neck suspension, and a burch colposuspension.

Although urinary incontinence is more common among seniors, it can affect people of any age, particularly women. Stress incontinence is more common in women due to weaker pelvic-floor muscles following pregnancy and hormonal changes that occur in menopause. Men with prostate problems and those with diabetes or high blood pressure are at a higher risk for urinary incontinence as well.

The belief that urinary incontinence is a normal part of aging is a common barrier against seeking help to treat and manage the problem, however, there are many steps that can be taken to manage urinary incontinence effectively.

Effects Of Urinary Incontinence On Seniors

Individuals experiencing urinary incontinence often feel embarrassed about their condition and therefore delay seeing a doctor for longer than they should. Worry about bladder control may have a negative impact on self esteem and leave individuals anxious and nervous when out in public.

There is a link between urinary incontinence and depression which is likely related to a lack of self-efficacy experienced by individuals with this disorder. Women with urinary incontinence report feeling like they have a lower quality of life

Many people with urinary incontinence suffer from some social isolation as well since they are reluctant to be too far away from a toilet at any one time. This may limit the experiences available to them and make even routine daily activities an anxiety-inducing experience. For this reason, social isolation is common among adults with urinary incontinence.

Urinary incontinence is also an early indicator of frailty and other health problems. It has been linked to nursing homes admissions and an increased risk of falling. The increased exposure of skin to urine may cause skin problems as well.

As a result, it is important to watch for changes in the overall health of an individual with urinary incontinence. Individuals usually rate their own health as poor when they have incontinence which may lead to feelings of anger and helplessness as well.

Effects Of Urinary Incontinence On Caregivers

In the early stages, urinary incontinence may place a significant burden on family caregivers. The relationship between the person with incontinence and the caregiver  undergo change as this new dynamic has to be accounted for. In addition, the financial strain of continence management and the need to clean soiled clothing and other items may increase the stress and workload of family members responsible for care.

As individuals are often embarrassed and unwilling to talk about their condition, denial, or avoidance when the issue is raised may be difficult for a family member who is trying to address the problem. Denial may also be linked to the assumption that there is nothing that can be done for incontinence so individuals may feel there is no point in sharing the problem with others. For these reasons, learning about the ways to treat and manage urinary incontinence is important.

Caregivers struggling to manage an individual’s condition may feel that a nursing home or assisted living facility (ALF) may be the best option to preserve the relationship. In these cases, caregivers may suffer from intense feelings of guilt or inadequacy in their role as a caregiver.

Short-Term Care Needs For Urinary Incontinence

There are a number of products available for managing urinary incontinence on a daily basis. These include:

  • Absorbent pads
  • Incontinence underwear (reusable underwear with a waterproof, absorbent liner)
  • Disposable underwear
  • Skin care and hygiene products such as wipes and moisturizers

It is important to find the right products for an individual to manage their incontinence.

Assuming that urinary incontinence is a natural part of aging or making do with improvised methods of managing urinary incontinence may lead to an individual missing the opportunity to find a more appropriate and lasting solution.

If a family member or individual is having urinary incontinence, be sure to find an expert to speak to as soon as possible. One resource for locating experts is through the National Association for Incontinence.

Urinary incontinence has also been linked to a number of lifestyle factors such as weight, smoking, and alcohol and caffeine intake. Therefore, it may be helpful to encourage a family member to make some changes to their lifestyle which could help them better manage their incontinence. Joining them in regular exercise, cooking healthy meals, and encouraging the person to drink enough water are all steps that may help support an individual with urinary incontinence.

Supporting a family member to access treatments is another important step that may help motivate the individual to become actively involved in managing their incontinence.

For example, pelvic floor exercises for OAB may help individuals with urinary incontinence. Studies have shown that pelvic floor exercises contributed to a 61% increase incontinence in women. These lifestyle changes in conjunction with medication if required may significantly improve one’s quality of life.

Surgery is another option that is sometimes used to treat urinary incontinence if other treatments have been ineffective. In this case, an individual may need to depend on family for transportation to the hospital for the surgery and for assistance during recovery. This may require additional time commitments on behalf of the family.

Long-Term Care Options For Urinary Incontinence

Individuals with urinary incontinence may also be dependent on caregivers to help them with activities of daily living (ADLs). Depending on a person’s total care needs, different care options are available.

Home care offers at home support for individuals who are able to live in their own home but need a little extra help to manage daily life. For an individual with incontinence, this may include help with laundry, changing incontinence pads or supporting them in exercises to improve their condition.

Independent living facilities allow an individual with incontinence to access services that may improve their quality of life such as exercise groups or organized social activities. These are available without a person having to sacrifice their independence or privacy. This may be a good option for individuals who want to maintain their independence while enjoying the benefits of a more social and engaging retirement community.

Assisted living communities allow individuals to maintain their independence and privacy but provide caregiver support to help them with ADLs such as bathing, dressing and toileting. This is a key difference between independent living and assisted living communities. For an individual with urinary incontinence, this ensures they are able to manage their condition effectively without the losing the independence they have remaining.

In some circumstances, it may be necessary to give up some independence in order to ensure one’s safety and quality of life. If an individual has Alzheimer’s disease or another form of dementia, they may develop urinary incontinence during later stages of the disease. When incontinence is combined with other health conditions, having assistance close by may be a necessity. Nursing homes offer round the clock care to ensure a family member’s needs are being met.

Our guide to The Difference Between Skilled Nursing and Nursing Home Care may help individuals and families identify which level of support they require.

Selecting A Care Provider For Urinary Incontinence

Urinary incontinence may at first be treated as a medical concern but its long term management is an important part of a individual’s quality of life. Finding a care provider that views urinary incontinence as a condition to be managed and improved is essential. Caregivers that include an individual in decisions regarding their incontinence care help preserve the person’s well-being and self-esteem.

Since there are different forms of urinary incontinence that are treated in different ways, it is important to find a caregiver that can offer the right support. Even with underlying conditions such as dementia, urinary incontinence may be improved with the right care plan.

When selecting a long-term care provider, it is important to ask some of the following questions:

  • What types of treatment or care do they offer to residents with urinary incontinence?
  • Are they able to support residents in exercise programs and ensure they stay hydrated?
  • What is their process for monitoring patients for falls?
  • How do they monitor the progression or improvement of conditions like urinary incontinence?
  • Do they have access to specialist information on urinary incontinence to support daily practices?

A well-informed care provider will be able to answer these questions and will take the time to answer any questions individuals and their families may have.

It is important to visit potential facilities in person on a number of occasions to get an accurate picture of how various facilities function and what daily life is like for residents. Visiting in the evening, at mealtimes and at different times throughout the day will help individuals and their families gain a feel for what daily life is like.

Individuals with urinary incontinence often need to get up at night to urinate and are more likely to suffer a fall. Because of this, it is important to find out how various facilities help residents with toileting and incontinence during the night. Some questions to ask include:

  • Will the individual be disturbed during the night by environmental noises or light?
  • What care measures are in place to ensure residents have as restful a sleep as possible?
  • Can the route from the bed to the bathroom be arranged to make toileting at night safer?

The choice of care providers for urinary incontinence may seem overwhelming so using an online resource such as the Eldercare Locator may be useful in narrowing down the range of options.

Options For Paying For Long-Term Care For Urinary Incontinence

When considering how to pay for long-term care, there are a number of options available. An individual may wish to consider using home equity to fund long-term care.

This is a loan taken out against the value of a home which may be withdrawn over an agreed period from 5 - 25 years. The loan is paid back at the end of this period as a lump sum usually by selling the house. This option allows individuals to continue living in the family home while financing long-term care such as home care services.

Similarly, individuals may take out a reverse mortgage against the value of their home. Unlike home equity, this does not have to be paid back until the borrower passes away or has lived away from the home for a year.

Repayments are usually made by selling the property on which the reverse mortgage is taken out. If an individual anticipates needing care for more than a few years, a reverse mortgage may be a better option than a home equity loan since loan repayment is only required once the last borrower leaves the home.

Another option may be to sell one’s home to pay for assisted living or nursing home care. An obvious drawback with this option is that it provides limited sources of funds which may run out while services are still required. It also does not allow an individual or their spouse/partner to continue living in the home while accessing funds to help pay for care.

An alternative to using an asset such as property to pay for long-term care is to access a health insurance policy. Long-term care insurance allows policyholders to withdraw a fixed amount per day to fund long-term care services. This may be a sustainable way to pay for assistance with ADLs such as bathing, dressing, and urinary incontinence management.

The cost of long-term care insurance depends on a number of factors including:

  • how old the policyholder was when they took out the policy
  • the daily payment amount they would like to receive
  • the maximum number of days that a policy will pay for.

In addition, an individual may not be eligible for this type of insurance if they are already accessing long-term care.

In some cases, an individual may be able to convert a life insurance policy into a long-term care plan. This takes the form of monthly premiums which may help cover the cost of long-term care.

When converting a policy from life insurance to a long-term care plan, ownership of the policy is passed to a benefits administrator, meaning the previous life insurance policy is no longer counted as an asset when applying for Medicaid.

If an individual is a veteran, they may be eligible for Veterans Aid and Attendance Benefits which cover the costs of home care help with ADLs making it a good option for those with urinary incontinence. This benefit may also be used to help pay for home care, assisted living, or nursing home care.

Other Financial Support Options For Urinary Incontinence

Urinary incontinence may place a significant financial burden on families. This may be due to the cost of urinary incontinence products and laundry and/or the cost of long-term care. Having a financial plan in place will help reduce stress and preserve the relationship between the caregiver and the person with incontinence.

For support with the costs of caregiving in the home, be sure to contact the local Aging Disability Resource Center (ADRC). This organization provides assistance to individuals so they may stay in their home as long as possible.

If the cost of incontinence products causes financial hardship for an individual or they do not have the finances to purchase these products, local non-profit diaper banks may be able to help with this expense.

Another source of financial support for incontinence products may be Medicaid in some states. If an individual is eligible, they may be able to access financial assistance to provide long-term care at home as well as financial assistance for assisted living or nursing home care.

If an individual has a Medicare supplemental plan, they may be eligible for financial help with urinary incontinence products. However, Medicare does not pay for home care help when an individual does not require any skilled care so it may necessary to explore other payment options.

Legal Considerations Regarding Urinary Incontinence

Urinary incontinence is a treatable and manageable condition, however, as with any health condition, it is important to be aware of possible legal needs in the future relating to long-term care. Understanding legal issues surrounding long-term care before the need arises gives individuals the time they need to fully consider their options.

A living will allows individuals to make their wishes clear in the event of an illness or accident where they cannot speak for themselves. For those with urinary incontinence, this need may occur due to a fall or due to other health problems such as dementia.

In a living will, individuals identify in advance which treatments they would accept or refuse in the event of a serious injury, for example whether they would consent to being kept alive with the support of a ventilator. A living will helps ensure that an individual’s wishes are adhered to in the event that they are unable to communicate.

For the same reasons, it is helpful to have a durable power of attorney in place as well. This is legal document that allows a person to appoint an individual to make decisions related to health care on their behalf. Establishing a durable power of attorney may provide peace of mind that one’s financial and health needs will be taken care of in the event they cannot manage these for themselves.

A power of attorney is usually a spouse or close relative who can make decisions relating to the health and finances of a family member should they be unable to do so. This may take the form of managing financial assets (for example canceling bills for services they no longer use or selling items to pay for care) and health directives (agreeing to or refusing certain procedures based on their family member’s wishes).

The individual with power of attorney (the agent) must act according to the wishes laid out by the principal (the person who has this legal document drawn up). This legal agreement is closely monitored to ensure that the agent is acting in the best interests of the principal.

Another approach to financial management is to set up a living trust. With a living trust, the property of the beneficiary is placed into the trust which can then be managed by the beneficiary themselves or a separate trustee. Setting up a living trust allows an individual to avoid the fees associated with the last will and helps homeowners and their family maintain their privacy when the homeowner passes away.

Preparing a will is also essential to ensure the wishes of an individual are carried out and to remove the burden of deciding how to settle a family member’s estate from family when an individual passes away. Basic wills may usually be written without the support of a lawyer but it may be wise to seek legal counsel if a will entails complex arrangements.

Organizational Support For Urinary Incontinence

Because urinary incontinence may be difficult to discuss with family members, it is important to know which organizations offer support and information about this health condition. The following organizations provide support for individuals and their families related to stress urinary incontinence:

  • The Urology Care Foundation - A site dedicated to providing the most useful, up-to-date information for concerns about urinary issues.
  • The Incontinence Resource Center - An informative site also featuring an incontinence forum where one may ask questions or seek advice from fellow individuals with incontinence.
  • Daily Strength - This urinary incontinence support group is a place to find support from like-minded people.

FAQs About Urinary Incontinence In Seniors

1. Will urinary incontinence get better if I drink less liquid?

No, you still need to ensure you are drinking a proper amount of fluid. Drinking less fluid makes urine more concentrated which may cause irritation to the overactive bladder which can make incontinence worse.

2. Does urinary incontinence get worse with time?

Urinary incontinence is a treatable condition so while it may get worse, it may also improve with time. A doctor will be able to advise a person about the right medication, exercises or medical procedures to best manage their stress urinary incontinence.

3. What should I do if my parent refuses to acknowledge their urinary incontinence?

Denial is common among individuals with urinary incontinence and it is important to see the situation from their point of view. They may be feeling helpless from the lack of control they are experiencing, angry that this has happened to them, or frustrated about the effect this is having on their life. Listen to their concerns and then calmly state yours as they relate to their well-being. If things persist, you may need to seek support from professional caregivers.

4. I feel burned out from taking care of my relative. What can I do?

The role of the caregiver may be challenging, especially if it has significantly affected your lifestyle and daily life. The Family Caregiver Alliance offers support and guidance to those who are caregiving for a family member. Seeking out support may help you find other caregivers who can support you and relate to what you are going through. Support groups often provide caregivers with important ideas for how to take care of themselves and what to do to prevent and treat caregiver burnout.