Urinary incontinence. It’s not a topic people like to even think about, much less discuss. And yet, it is far more common than people realize.
Among seniors who are living in the community, 5-10% experience urinary incontinence. If someone is in acute care, such as a hospital setting, that number increases to 10-20%. And the highest proportion of all is within long term care with 50-70% of all residents are incontinent.
These numbers increase so markedly for a number of reasons.
For starters, there is such a wide range in percentages precisely because people fail to report urinary incontinence. Many people attempt to hide it, and sadly, only 25% seek medical attention for incontinence. Urinary incontinence is not inevitable and it is not a necessary part of ageing. There are many different causes and possible treatments to improve urinary incontinence and people should always seek medical attention for incontinence. It is not something to be embarrassed about; it is important to discuss the issue openly with a doctor.
Among the frail elderly, 11% are incontinent upon their admission to the hospital. They were previously living with urinary incontinence. The astounding part is that upon discharge from hospital, 23% of the frail elderly are incontinent. And extended hospital admission puts a frail elderly senior at higher risk of becoming incontinent.
In many cases, seniors are effectively put on bedrest while in hospital. They are not getting up, and they quickly lose their muscle mass and strength to be able to get up and go when they need to. Added to that, they may have worn incontinence products without attempting to use the washroom. After a few days or possibly weeks of failing to follow their body’s urges, they may not be as attuned to their body’s toileting needs.
Worst of all, if someone is catheterized for extended periods, their bladder muscles have been held open to accommodate the catheter. Once the catheter is removed, the muscles do not always return to their previous condition and this greatly increases the risk of urinary incontinence.
When someone is discharged from hospital with the additional personal care need of incontinence care, their risk of being moved to long term care increases. One of the top reasons for long term care admission is incontinence—that someone simply cannot manage their personal care needs at home, and their elderly spouse or other relatives cannot supply the increased care.
Within long term care, the high rates of urinary incontinence (between 50 and 70%) are partly due to this being a reason for admission. But others lose their ability to toilet within long term care. If they moved to long term care due to advancing dementia, they may have trouble learning their new surroundings. Finding and identifying washrooms can be a challenge. Within the washroom, nothing looks the same as their home bathroom and they can be easily confused. If they require toileting assistance either with physical transferring or cognitive cueing, they may have trouble waiting for staff who are attending to other residents. They may start to wear incontinence products and slowly their continence abilities are reduced.
Of course it is not as simple as saying “just don’t go to the hospital and don’t go to long term care and you won’t become incontinent.” If someone needs acute hospital care, they would be foolish not to seek medical help! And for some people, long term care is where their needs can best be served.
Overall though, urinary continence is largely a function of “use it or lose it”. Bladder muscles must continually be used to maintain their strength and form. As much as possible, elderly loved ones should be encouraged to toilet frequently and continue toileting independently.
To further support bladder health there are some natural ways to reduce an overactive bladder, as well as functional toileting support for those with dementia to help maintain toileting independence for as long as possible.