Urinary Incontinence

Catherine E. DuBeau, MD

My mom lives by herself and is having trouble getting to the bathroom fast enough. How can I keep her independent?

Older women may not get to the bathroom "fast enough" for several reasons:

• They have difficulty walking fast enough to get to the bathroom on time, due to conditions such as arthritis. Help your mother talk with her health care provider about her difficulty getting around, and whether further evaluation and specific treatments can be helpful. Physical therapy may be beneficial as well.

• The bathroom may be too far away, especially when going outside the home or if there is nighttime incontinence. For the former, there are now "toilet maps" available for major cities to help locate public toilets (type "toilet map" into your search engine to help find one applicable to your area). In general, coffee shops, department stores, and hotels have public toilets that you can use. When one has to ask to use a public toilet, stress that you have a medical condition. If getting to the bathroom at night is the problem, a bedside commode can be helpful.

• They may be drinking beverages containing caffeine or alcohol, or drinking more fluids than they really need. A number of older persons may be unaware of the amount of caffeine in soda, or believe that green tea is herbal and doesn’t contain caffeine. Another problem may be diuretic medications, especially furosemide. The thiazide diuretics (e.g., hydrochlorthiazide) typically do not cause the same rapid need to find a bathroom. Review with your mother’s physician whether she still requires her current dose. Try to have your mother take the diuretic at a time when she knows she will be near a bathroom.

• They are more likely to have one or more of the medical conditions or take one of the medications that can cause or worsen incontinence. Ask her physician to review her medications and medical status to see if this is the case, and make treatment recommendations or adjustments as needed. If you are not satisfied with his/her response, consider having her see a geriatrician who can help with this assessment.

• Finally, she may have urge incontinence which can respond to behavioral treatment and medications. However, it is important that her health care provider not jump to these treatments before addressing the issues above.

For those rare cases where urge incontinence is severe and has not responded to any treatment, there is an surgical option called augmentation cystoplasty, in which the bladder is cut open and a piece of intestine is sewed in to create a new part of the bladder wall. These are major operations with potential complications, and hence a real but potentially effective "last resort."

Catherine E. DuBeau, MD
Director, Geriatric Continence Clinic
University of Chicago
National Association for Continence
American Geriatric Association