Incontinence

Encouraging Older Loved Ones to Manage Incontinence

Gail noticed that her 75-year-old mother, who was normally very active, wasn't going out much any more. Mom finally confided to Gail that she'd had an "accident" at the theater, and that she liked to be close to a bathroom at all times these days. "I guess it's just part of being old," Mom said sadly. Gail asked Mom if she'd talked to her doctor about the problem, but Mom said, "Oh no! I'd be too embarrassed!"

When an older adult is dealing with incontinence, embarrassment may stand in the way of seeking treatment. _______________

Over 25 million Americans experience incontinence. Yet most seniors who are dealing with the condition may well feel that they are all alone, because this isn't a topic that comes up very often! Family caregivers may be the only one their loved one confides in—or their loved one might avoid discussing the issue, even when family caregivers know there is a problem.

But it is very important that the person discuss this issue with his or her healthcare provider. Left untreated, incontinence usually worsens, and can be the first step to a debilitating withdrawal from life. This in turn leads to a decrease in the basic elements of healthy aging: social connectedness, physical activity and intellectual stimulation. Incontinence causes skin irritation, interferes with sleep, and can lead to depression. It is so important to reassure loved ones and encourage them to seek help for the condition!

What is urinary incontinence?

Urinary incontinence is the inability to maintain control over the release of urine from the bladder. The causes of incontinence vary widely, as does the degree of the problem. Incontinence may be brought on by illness, fatigue, confusion, or a hospital admission. It also may be caused by weakening of the muscles which control bladder outflow, disorders of the central nervous system or obstruction to the bladder.

It is helpful to be able to distinguish between the different types of incontinence:

• Urge incontinence occurs often in seniors and can be the result of neurological damage, strokes, diabetes, or the aftermath of bladder infections or kidney stones. In this circumstance, the individual does not receive a signal in time to reach the bathroom before the bladder begins to empty itself.
  
  
• Overflow incontinence occurs when small amounts of urine leak from a bladder that is always full due to such conditions as obstruction, constipation or nerve damage. In men, enlarged prostate is often the cause.
  
  
• Stress incontinence means the involuntary passing of urine during any increase in abdominal pressure, such as coughing, sneezing, laughing or lifting heavy objects. It is often seen in women who have had relaxation of the muscles of the pelvic floor, usually due to childbirth.
  
  
• Functional incontinence occurs when a person has normal bladder control, but is unable to get to the toilet on time because of a mobility problem. Alzheimer's and other types of dementia may also be a factor; people with these conditions may not be able to think about getting to the toilet or may forget how to get there and negotiate clothing.

Can incontinence be treated?

Like Gail's mother, many people believe that incontinence is just "a normal part of growing older." But—just as with memory loss, inactivity and so many other conditions— we now know that this isn't necessarily true. Yes, incontinence becomes more common as we grow older, but in many cases, it can be treated effectively.

So at the first sign of incontinence, it is important to consult a physician to determine its cause and type. Your loved one's physician can diagnose and treat underlying diseases, check and reevaluate medications that might cause or increase incontinence, and evaluate the severity of the problem. The patient may be asked to keep a "bladder diary," recording incidents of incontinence and the amount and frequency of urination. Ultrasound and other tests provide an idea of bladder volume, as well as any blockages or other contributing factors.

A variety of treatments are available, including:

Bladder training. The patient keeps a chart of urination and leaking, and then works out a bathroom schedule, planning trips to the toilet at certain set times (for example, once an hour).

Pelvic muscle exercises, such as "Kegels," can strengthen the bladder muscles and the muscles of the pelvic floor. This helps hold urine in the bladder longer. The time can be gradually extended so that urine is held for longer periods.

Medications. Some commonly prescribed drugs stop bladder contractions; others relax the muscles to prevent urgent or frequent urination. In post-menopausal women, estrogen pills, creams or patches may be prescribed.

Surgery. While only a physician can tell if treatment would be effective for any particular case, surgery can be effective, especially in treatment of stress incontinence and incontinence due to prostate enlargement.

Lifestyle changes. The physician may recommend cutting down or eliminating caffeine, alcohol and tobacco products. All can increase incontinence by irritating the bladder.

When treatments don't completely work…

People who are living with incontinence may feel more secure wearing special absorbent, disposable undergarments which are inconspicuous and quite effective in masking the incontinence. These undergarments are sold in drug stores and supermarkets, and though they don't "solve" the problem, they may bring a sense of peace of mind and dignity to your loved one.

If mobility problems prevent the person from making it to the bathroom in time, consider having a commode chair nearby.

Specially designed clothing makes it easier for people with arthritis, stroke or Alzheimer's to negotiate fasteners in time.

How can family help?

When dealing with an incontinent loved one, tact and sensitivity are always necessary. Try not to overreact if an older family member or friend has an accident around you. Dignity is a fragile thing in all of us, and it is something we all need to maintain. This is one of those occasions in which you need to be particularly careful in your caring.

But it's also important to talk about the problem with your loved one, and encourage him or her to seek treatment. The National Association for Continence estimates that the average senior waits close to seven years to report the problem to the doctor! The sooner treatment begins, the better.

For More Information

The National Association for Continence website offers information and support for older adults and caregivers, including the Bladder and Bowel Diagnostic Tool.

The National Kidney and Urologic Diseases Information Clearinghouse website includes extensive information and resources on urinary incontinence.

70's moment

Listening to an LP (vinyl record) "Looking for Mr. Goodbar" soundtrack from 1977. Hearing the music from that year brought back lots of memories. Life passes you by in flash. Before you know it the years have gone and there is no going back.

Death Valley ride by my friend

Lloyd writing to tell you of my latest undertaking. In an effort to help a family (5 sisters and their children) that I have grown to know and love dearly over the years, I will ride my bicycle 105 miles through Death Valley this October. Two members of this family have been afflicted by juvenile diabetes, as have millions of children and adults around the world.

I will be raising awareness and money for juvenile diabetes research. The hope is to find a cure for this disease within our lifetime. I have made the initial pledge of $100.00 and will work my heart out to make you all proud. If you wish to join me in my efforts you may pledge your support for my ride at www.sistersonbikes.com .

1. At the home page you click on “Make a donation”

2. Then click on my name

3. Then click on “Donate to this rider”

4. Enter your information

Cindy, Elizabeth, Lynn, A. J., and Diane along with their husbands and children and myself will united as a family to embrace the challenge of a 105 mile bike ride in Death Valley to raise funds to further the research of diabetes that will lead to finding a cure for AJ, Britain (Lynn's 14 year old son) and the other millions of children and adults that live with this disease daily.

I am blessed to have each and every one of you in my life and I will appreciate any support that you may offer.

Best regards,

Lloyd Carter

Wells Fargo Bank in Phoenix, AZ

I am seeing RED dealing with Wells Fargo Bank. My client is from out of town and her step-father passed away in March. Her mother is in a nursing home setting and is difficult. Very smart lady but stubborn as can be. My client had a power of attorney from her mother and WF said no it does not have the "verbiage" to comply in AZ. This was a POA done in AZ! WF wanted a power of attorney (their own form) giving my client the power to conduct business for the deceased signed by the mother (his widow), an Affidavit of collection (no probate needed) and the death certificate. WF gave them the form (POA) and we went to the Mariopa county self help page for the affidavit took them to the mother to sign and notarize. Daughter then takes the docs to WF and they call back saying the affidavit that was signed was not the right one; their form is required. I meet with them, read the form and it clearly says "on behalf of" and ask the daughter to sign it and put as POA for ... they go back to the bank to drop off the new form and leave to go back home. Monday afternoon she calls me because WF called her to state the Affidavit she signed was not good enough, it had to have the mother's signature. He wanted the mother to go to the bank to sign the form. I called WF spoke to the person and he says their legal department did not want the daughter to sign because it appears that she is taking the money. She was given POA on Wells Fargo's form by her mother; how in the world is she taking the money when she is trying to get the step-father's money to put into the mother's account to pay for her care? Both accounts are in the same bank! The employee told me he could not explain the reasoning and he would have the legal department call me. As of today, I have not heard from them. I called and was told the person I spoke to first is off and the bank manager would be back in an hour and would call me back. Hmmm.... no call.

Could this be one of the reasons banks are failing? They are not customer friendly and we are not talking millions of dollars here. Not even hundreds of thousands, a measly $20,000 or less after the bank charge whatever charges they can think of. Mother's cost of care is $2,500 a month, she has run out of money and daughter has started to use her 401K to pay for it. In the mean time, Wells Fargo is sitting on this money and a client might lose health care and medical care because they are worried about signatures.

Bilirubin

When bilirubin levels are high, a condition called jaundice occurs, and further testing is needed to determine the cause. It is not uncommon to see high bilirubin levels in newborns, typically 1 to 3 days old. This is sometimes called physiologic jaundice of the newborn.
Newborns: Excessive bilirubin damages developing brain cells in infants (kernicterus) and may cause mental retardation, learning and developmental disabilities, hearing loss, or eye movement problems. It is important that bilirubin in newborns does not get too high. When the level of bilirubin is above a critical threshold, special treatments are initiated to lower it. An excessive bilirubin level may result from the accelerated breakdown of red blood cells due to a blood type incompatibility between the mother and her newborn (e.g., the mother is Rh-negative and has antibody to Rh-positive blood - the father is Rh-positive, and the fetus inherits this trait from him; the mother’s antibody crosses the placenta and causes the fetal Rh-positive red blood cells to hemolyze, resulting in excessively elevated bilirubin levels with jaundice, anemia, and possible kernicterus.)

Mother's Day stats

Americans will spend an average of $123.89, compared with last year's $138.63. Total Mother's Day spending is expected to reach $14.10 billion -- slightly more than for Easter -- but almost $2 billion less than last year. The majority of consumers (66.8 percent) will buy flowers for Mom, while 54.8 percent will treat her to a special dinner or brunch.About one-third (30.2 percent) of shoppers are expected to purchase Mom's gift from a discount store; 27.2 percent will visit department stores. Sources: U.S. Census Bureau; BIGresearch; National Retail Federation

Rummage Sale

Helping Sahuaro Ranch Elementary this Saturday to earn some money for their PTSO. Need customers and donations as well. Check it out at 10401 N 63rd Ave in Glendale, AZ.