Myths about Incontinence in Aging Adults

     At least a half-dozen myths about urinary incontinence continue to be perpetuated. Here is some information to help combat ignorance regarding incontinence in the elderly.

     Myth #1: Urinary incontinence is a normal part of aging. The National Association For Continence’s (NAFC) nationwide surveys of consumers — comprising men and women — confirm that one third (34%) hold to the belief that incontinence is an inevitable, accepted part of aging, especially in older women. Granted, bodily changes as we age may increase vulnerability. The bladder loses elasticity and subsequently its ability to store the same volumes of urine as in younger years. The bladder also loses muscle tone; because it fails to contract fully, residual urine continues to send signals to the brain that the bladder needs to be emptied. Bladder signals can be faulty as nerve endings lose their communication sharpness over the years or are damaged by disease or other trauma. Still, symptoms of problems with bladder and bowel control should be considered medical indications of a condition to be diagnosed and treated. Many people in their 80s are fully continent.

     Myth #2: Nothing can be done to treat urinary incontinence in older adults. Because there are multiple intervention pathways, older people with incontinence need to be carefully assessed to determine the reasons for their symptoms. With careful assessment and intervention, incontinence can be dramatically improved or completely reversed. Increasingly, clinicians are recognizing that combination therapy — ie, attention to diet, assisted and timed toileting, and medications — is the most effective approach.

     Myth #3: The only successful treatment for urinary incontinence is surgery. Surgery is becoming increasingly less invasive but for older adults it is likely the last option utilized (eg, when other treatments have failed or are contraindicated). Clinicians need to be resourceful, combining behavioral intervention, lifestyle modifications, exercises, medications (eg, local estrogen for women), and device technologies to address the problem. Absorbents (diapers) may be viewed as a supplemental factor as “preventive wear” in this equation. It is important to educate the public about this wide range of options so older people, deterred by the concern they will be told to have high-risk, invasive surgery, are not fearful of seeking diagnosis and intervention.

     Myth #4: Drinking less fluid will improve urinary incontinence. Older adults frequently limit their fluid intake with the mistaken belief they will produce less urine and have to urinate less often. Unfortunately, the opposite occurs if fluid intake, especially water, is severely limited. More concentrated urine irritates the lining of the bladder and can worsen the symptoms of urgency and frequency. Restricted fluids can aggravate constipation as well, which in turn can send signals to the brain that the bladder needs emptying when in fact the problem is in the bowel. The older adult on multiple medications such as diuretics for congestive heart failure and hypertension needs to be mindful of medications that can be flushing more fluids through the kidney and bladder.

     Myth #5: The older person is having accidents on purpose. Sometimes caregivers become frustrated with the thought that older adults are deliberately having incontinence episodes. In general, this is illogical — the last thing an older person wants is to lose independence and personal dignity. When older adults have toileting accidents, more likely they cannot reach the toilet in time or memory loss makes them unaware of proper toileting habits or their clothing has interfered with timely toileting. Prompted toileting and bladder retraining, as well as attention to simplified closures in clothing and safe ambulation, provide solutions to this problem.

     Myth #6: Absorbent products are the only option for urinary incontinence management for older people who are homebound or in long-term care facilities. Although absorbent products may be the most appropriate management strategy for some people, combination therapy may be effective for many others. Absorbents should never be used as the exclusive solution. Use always should involve proper sizing, fit, and absorbency level for optimal satisfaction and product performance. Absorbent products should not be used solely for the convenience of first-line staff caregivers or family.

     The patient should be thoroughly assessed to individualize management options to find the best intervention for each person as an individual. To help dispel these costly, burdensome, and harmful myths, take the time to serve not only as clinician, but also as public health educator in your local community. Seek the NAFC as a resource for slides, consumer handouts, or statistics. Don’t “myth” the opportunity to help.

The National Association For Continence is a national, private, non-profit organization dedicated to improving the quality of life of people with incontinence. The NAFC’s purpose is to be the leading source for public education and advocacy about the causes, prevention, diagnosis, treatments, and management alternatives for incontinence. This article was not subject to peer review.