Help available for seniors with bladder control problems

DEAR SAVVY SENIOR: What are the best treatments recommended to help seniors with bladder control problems? — Leaking Linda

DEAR LINDA: Incontinence is very common in older adults. According to the CDC, 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 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 if 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 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 leaking 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 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, because constipation can contribute to incontinence. Losing weight 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 including constipation, drowsiness, dry mouth, blurry vision and dizziness.

Injections of Botox into the bladder muscle are also approved for this condition and may reduce the urge to urinate. This is usually prescribed to people only if other first line medications haven’t been successful.

Medications should only be considered for those who continue to have bothersome symptoms despite having tried lifestyle changes and therapy exercises.

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 very effective in most patients, but should be a last resort.