DEAR SAVVY SENIOR: What are the best treatments recommended to help seniors with bladder control problems?
— Leaking Linda
DEAR LINDA: Incontinence is common in older adults. According to the U.S. Centers for Disease Control, more than half of women and 30 percent of men ages 65 and older are affected by it.
Fortunately, there are a wide variety of treatment options that can help, as well as a number of absorbent pads or underwear you could use for leakage protection. Here’s what you should know.
SEE A DOCTOR
If you leak unexpectedly (also known as stress incontinence) or sometimes have such a strong urge to urinate (urge incontinence) that you fear you won’t make it to a bathroom in time, your first step is to make an appointment with your primary care doctor or see a gynecologist, urologist or urogynecologist.
A doctor can determine whether a medication side effect or a condition like diabetes or a urinary tract infection might be causing urine leakage. They can also set you up with a treatment plan. Depending on the reason or the type on incontinence you have, here are some common treatment options.
>> Nondrug therapies: There are a number of exercises, bladder training techniques and lifestyle strategies that should be the first line of treatment. Kegel exercises (repeatedly tightening and relaxing the muscles that stop urine flow to strengthen them) are especially helpful for women with stress incontinence or who leak when they laugh, cough, sneeze, lift heavy objects or exercise.
Bladder training involves keeping a diary of urination and accidents, then slowly increasing the time between bathroom visits. It’s most effective for those with urge incontinence.
There are also a number of lifestyle strategies that can help, such as cutting down on caffeinated and alcoholic drinks, which cause the kidneys to produce more urine. Getting sufficient fiber in your diet to keep yourself regular is important because constipation can contribute to incontinence. Losing weight can help if appropriate because excess weight puts pressure on the abdomen and bladder, and being overweight can also lead to Type 2 diabetes, which causes damage to the nerves that control the bladder. And if you smoke, quit because smoking leads to excess coughing, which can cause urine leakage.
>> Medications: Several drugs are approved for urge incontinence (or overactive bladder), such as prescription mirabegron (Myrbetriq), oxybutynin (Ditropan XL and generic), solifenacin (Vesicare) and tolterodine (Detrol and generic). While drug treatments are effective for many people, you also need to know that more than half of those who take incontinence drugs stop within six months because of side effects. These include constipation, drowsiness, dry mouth, blurry vision and dizziness.
Injections of Botox into the bladder muscle are also approved for this condition and might reduce the urge to urinate.
>> Electrical stimulation: Mild electric shocks to nerves in the lower back or the pelvic area can stimulate and strengthen muscles that are involved in urination. This can help with both urge and stress incontinence, but it requires multiple treatments over many weeks.
>> Surgery: Several surgical procedures are available for stress incontinence. The most common is sling surgery, where strips of synthetic mesh are implanted to support the urethra. This surgery is effective in most patients but should be a last resort.
Jim Miller is a contributor to NBC-TV’s “Today” program and author of “The Savvy Senior.” Send your questions to Savvy Senior, P.O. Box 5443, Norman, OK 73070; or visit savvysenior.org.