Continence Care for Older People

Abstract

Surveys of incontinence among the elderly in Japan have shown that about 10% of Japanese men and 40–50% of Japanese women have some degree of incontinence. Unfortunately many of those with incontinence seem to think that there is nothing that can be done about it. They give up because they think incontinence is a part of aging. Incontinence is not simply a part of aging, continence can be regained. However, an assessment to find the causes of an individual's incontinence and his/her possibility of improvement must first be accomplished. Causes of incontinence include bladder functional disorder, intelligence disorder, mobility and dexterity problems, and environment problems. Incontinence is categorized into several types, based upon the particular cause of the incontinence. Bladder functional disorder has been identified as the cause of three types of incontinence: urge incontinence, stress incontinence, and overflow incontinence. Urge incontinence is recognized as the involuntary loss of urine associated with an abrupt and strong desire to void. Urge incontinence often is associated with urinary frequency and is a symptom of bladder muscle irritability. Both urge incontinence and urinary frequency can be controlled by medication that relaxes the bladder muscle. Stress incontinence has been defined as the involuntary loss of urine secondary to increased abdominal pressure. The most common cause of stress incontinence is a weak pelvic floor muscle. Therefore, pelvic floor muscle exercises are useful for the prevention and improvement of stress incontinence. Overflow incontinence has been recognized as the involuntary loss of urine due to over‐distension of the bladder. In order to control overflow incontinence, it is necessary to determine whether the bladder distention is due to enlargement of the prostate gland or is a side‐effect of medication. Functional incontinence has been shown often to be secondary to an intelligence disorder, or to mobility and/or dexterity problems. Regardless of the cause of the incontinence, an appropriate environment is needed in which to treat the incontinence. Treatment and care for the incontinent individual needs to be done by a multidisciplinary team in accordance with the type of incontinence being experienced.