A few years ago, “Tammy” called us in desperation. Between working every day and caring for her aging mother, Tammy was burning the candle at both ends and was finally researching home care companies for help. One of her mother’s biggest problems was the pervading smell of urine in her tidy apartment because of her severe urinary incontinence issues. Not only did the bed linens require frequent washing, her mother regularly filled the garbage bins with soaked Depends undergarments, which would remain in the apartment for several days. The same was true for her urine-soaked clothing, which would sit in a laundry basket until Tammy could come and wash them. Her apartment constantly smelled. It was a daily issue that needed regular attention. As a result, her mother’s health issue was not only affecting her mother’s quality of life, but it was affecting Tammy’s as well.
The National Association for Continence estimated in 2004 that urinary incontinence affects 25 million people, including 65% of those folks living in nursing homes. The elderly are prone to urinary incontinence for many reasons, including that, as people age, their ureters (the tubes that carry urine from the bladder to the urethra) shrink to about half size. This makes elderly people more prone to bladder infections, which can cause incontinence. Bladder capacity also shrinks from one-half to one-third of its original size. This means that older people have to void (or empty their bladders) more often. As we age, muscles often relax, making it more difficult for the bladder to hold urine. Some medications, such as diuretics or muscle relaxers, can also cause urinary incontinence.
Types of Urinary Incontinence
There are three primary types of urinary incontinence. The first is urgency. This simply means that you feel a significant need (urge) to go to the bathroom and urine loss occurs very shortly after you feel the need to void. Urgency usually starts when the bladder is approximately half full.
Stress incontinence is when a person loses urine as the bladder or the muscles controlling the bladder are under stress, usually caused by coughing, laughing, jumping, walking, etc.
Mixed incontinence is a combination of the urgency and stress incontinence and is the most common type of incontinence.
Physical and Social Repercussions
It is no secret that as people age, urinary incontinence becomes more of an issue, equally for men and women over the age of 65, and can significantly lower quality of life. If you are prone to urinary incontinence, there are many consequences if it is not well controlled.
Some significant physical consequences of urinary incontinence include skin breakdown from failing to keep clean or from the skin being constantly moist from the urine loss; increased urinary tract infections; and falls or injuries from rushing to the bathroom and from needing to make frequent trips to the bathroom.
Because seniors have a less acute sense of smell, they many times have an odor that they don’t notice. If it was apparent to them at one point, they may have gotten accustomed to the urine smell and may no longer be aware of it. The urine odor gets to be a nuisance to those around them, and it can be embarrassing. Urine odor can be both in their homes and on their person. It may be on their body from not bathing often enough, or it may permeate their clothing. As a result, some people with urinary incontinence isolate themselves and eventually altogether withdraw from social activities.
Treatment
Since urinary incontinence is embarrassing to discuss, many people go untreated, when, in fact, there are several treatment approaches that can be quite successful. These techniques include scheduling voiding at regular intervals, bladder re-training, prompted voiding, special exercises to strengthen the pelvic floor, and electrical stimulation. Sometimes medications are helpful. A good team of physical and occupational therapists and nurses together can help a person to manage incontinence issues. This will help to make people with these problems feel more confident and comfortable participating in activities and in leaving their own homes or apartments.
On the practical side, it would also help to have an in-home senior care provider scheduled to help keep the home free of urine odor, if the senior is not able to perform needed homemaking tasks herself. Tasks that a non-medical senior care agency could assist in performing would include prompt and regular garbage removal, regular bed linen changes, prompt laundering of soiled clothing and bedding, and cleaning the bathroom regularly. By removing urine-soaked Depends and other items, it will be less likely for the odor to linger or permeate the home.
Other practical suggestions to manage this health condition would be to wear clothing than can be pulled up instead of clothing with buttons, having grab bars in place in the bathroom, and making sure that there is a clear pathway to the bathroom from wherever the person spends most of his or her time. (Sometimes physical limitations, rather than underlying incontinence issues, can cause urinary accidents simply because of difficulty in getting to the bathroom in a timely manner). Limiting water intake is not a good solution since you don’t want your elderly parent to become dehydrated, but limiting fluids after 6:00-7:00 p.m. at night may help. It should also be noted that alcohol, artificial sweeteners, and caffeine can increase the incidence of urinary incontinence.
If you are taking care of elderly parents with urinary incontinence issues, don’t be afraid to address it with them. Even though it may not be possible for them to be totally continent, it is possible to figure out ways for them to be dry and for their homes and apartments to be clean and free of odor.
Julie Ellingson, LSW
May 17, 2012
A few years ago, “Tammy” called us in desperation. Between working every day and caring for her aging mother, Tammy was burning the candle at both ends and was finally researching home care companies for help. One of her mother’s biggest problems was the pervading smell of urine in her tidy apartment because of her severe urin
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