More than half of the 1.5 million Americans in nursing homes suffer some loss of bladder control. But this study shows that incontinence is not a normal part of aging.
Researchers at the University of California at Berkeley assigned 133 incontinent women to either a 13-week behavior therapy program or a control group. By prompting the women hourly to go to the bathroom, offering assistance when requested, and reinforcing positive behavior by spending extra time talking with patients, behavioral therapists helped lower the number of daily wettings by 26 percent overall. The improvement was maintained even six months after the therapy.
One of the biggest challenges to wide-scale implementation of this program is finding a way to motivate nurse’s aides to provide better care. Because they are usually overworked and underpaid, nursing home aides typically handle incontinence with a catheter. This leads to higher rates of bladder infections, which, in turn, contribute to the misery of this particular population.
Now that we know how simple the health treatment is, there must be something we can do to help older patients help themselves.
A New Exercise for Bladder Control
In other news, it’s now apparent that a series of weighted cones may help incontinent women control their bladders. Until now, doctors have prescribed Kegel exercises, the repetitive squeezing of the pelvic muscles that control your flow of urine. But cones, as you’ll see, have a significant advantage.
The cones fit inside a woman’s vagina and range in weight from less than an ounce to almost 4 ounces. In a British test, doctors asked 24 incontinent women to try to hold as heavy a cone as possible twice a day for 15 minutes. By the end of four weeks, almost 80 percent of the women noticed an improvement in their symptoms.
Not only that, but the women said that they always knew whether they were doing the exercise correctly: The cone slips out if it’s not squeezed tightly enough.
Effects of Caffeine on The Bladder
Patients with symptoms of urinary frequency and urgency, particularly those due to destrusor instability, often report that coffee and teas worsen their symptoms. To determine whether caffeine is responsible for this effect, health researchers from St. George’s Hospital in London tested the effects of caffeine on bladder function in women with detrusor instability and normal controls.
Twenty women with proven detrusor instability and 10 normal controls consumed 200 mg of caffeine citrate and underwent urodynamic studies 30 minutes later. The patients were also tested on another occasion after abstaining from caffeine for 24 hours. In the patients, there was a significant increase in the detrusor pressure rise on bladder filling after caffeine administration compared with no caffeine. The control group showed no abnormalities after consuming caffeine.
The findings indicate that caffeine consumption causes a decrease in bladder compliance in patients with detrusor instability. This effect is likely to be responsible for symptoms noted.
Stress incontinence – having problems holding one’s urine when running, coughing, crying, or doing heavy work – is a surprisingly common but rarely discussed complaint among women.
It is usually the result of child-bearing. During delivery the pudendal, inferior rectal and perineal nerves leading to the muscles around the urethra and anal canal are damaged, either by being over-stretched by the passage of the baby’s head, or by direct pressure. Statistics show that the more children a woman has had the more likely she is to suffer incontinence and that forceps delivery increases the chance of nerve damage.
Dr. Michael Swash, a neurologist at The London and St Mark’s Hospital, has made a study of incontinence due to nerve damage. He says that although most of the cases he investigates are due to child-birth, straining due to long-standing constipation can also be responsible and that in old age women with arthritic spines are also apt to suffer damage to the nerve roots.
Once it has occurred the symptoms can be prevented from worsening by surgical repair of the pelvic floor. As full recovery – even after surgery – is unlikely, prevention becomes of prime importance. So, when labor is likely to be difficult, early caesarean section holds the advantage of preventing damage to the pelvic floor nerve supply – and preventing future incontinence. The gynaecologist who boasts about ‘getting away with a forceps delivery’ or the midwife who allows her patient an overlong labor in order to deliver naturally may be sentencing women to a life-time of wet underclothes.
For those of our members who are approaching the “fourth age”, having successfully negotiated their sixth and seventh decades, it is not ageing per se that is of concern: it is the likelihood of the onset of debilitating diseases and impotence that destroy quality of life and independence.
High priority must be given to challenging dementia, blindness, incontinence, immobility and the other afflictions of old age. The scientists and medical professionals require greatly increased financial support in order to conduct the research which will help to ensure that the increasing number of 80, 90 and 100-year-olds enjoy their extra years as long as they want to.