Question: My elderly mother, who lives in a residential care facility, has had a problem with urinary incontinence for several years. She is alert and vigorous, and this problem distresses her. Is there anything that can be done for it?
Answer: Nothing is as embarrassing or troublesome as a leaking bladder. This is particularly true for men and women who are elderly or debilitated, especially if they are bedridden. Approximately 15 million people suffer from urinary incontinence, about 80 percent of whom are women. Half of nursing-home residents have urinary incontinence.
Sometimes incontinence is a temporary problem, as in the case of a bladder infection or a woman who has recently delivered a baby. However, as in the case of your mother, most cases of urinary incontinence are chronic and unremitting.
Depending on how one looks at it, there are about six kinds of incontinence. I will mention the two most common kinds — urge incontinence and stress incontinence.
Urge incontinence occurs when a person cannot hold urine in the bladder for a reasonable period of time without involuntarily letting some leak out. It is usually a problem of abnormal function and occurs because the bladder is "hyperactive" or "unstable"; that is, the bladder muscle contracts when it isn't supposed to.
People with urge incontinence may not even feel the urge to urinate — the leaking may occur unpredictably and without notice. For those who do feel the urge, the time between sensing a need to empty the bladder and losing urine may only be a few seconds or minutes. Urge incontinence is sometimes a consequence of a stroke, a brain tumor, Parkinson's disease or multiple sclerosis, but most of the time, there is no obvious cause.
Treatment for urge incontinence includes two general interventions. The first is called scheduled voiding — the bladder is emptied on a scheduled basis in order to prevent it from overfilling. The second is the use of medications that relax the bladder muscle or strengthen the sphincter muscle.
The second kind of incontinence is called stress or anatomic incontinence. It is different from urge incontinence because it is usually a problem of abnormal anatomy, rather than abnormal function. It almost always occurs in women as a result of damage to the pelvic floor with childbearing, but it can also result from the effects of aging. A woman develops stress incontinence when the bladder, the urethra and their supporting structures "drop" out of their normal position, causing the urethra to not function properly when a woman coughs, sneezes or lifts heavy objects.
Several different kinds of treatments are available for stress incontinence. Isometric contraction and relaxation of the muscles that support the vagina, bladder and urethra, called Kegel exercises, can result in improvement of this kind of incontinence. Pessaries, which are objects made of rubber, can also be placed in the vagina to stabilize the urethra in a near-normal position to prevent urine leakage. Finally, a variety of surgical approaches is available for treatment.
Commonly called bladder suspensions, surgery entails lifting or returning the bladder and its supporting structures to their former anatomic location. These surgeries may be done through the abdominal or the vaginal route. Other surgical procedures involve the placement of slings that are designed to stabilize the urethra. These surgeries are often done in conjunction with a hysterectomy.
I recommend you take your mother to a gynecologist or a urologist so she can be properly evaluated. You should be aware that in some cases, it is not easy to distinguish between the different kinds of incontinence on the basis of a routine examination. In addition, patients may have more than one type of incontinence. Therefore, a more advanced evaluation may be required in order to determine the exact nature of your mother's problem before an appropriate treatment plan can be recommended.
Stephen Lamb practices obstetrics and gynecology at the Millcreek Women's Center in Salt Lake City. He is also the co-author of "Between Husband and Wife." E-MAIL: slamb@desnews.com