Q: My elderly father has lived with us for almost 10 years. Over the past year he has developed difficulty controlling his bladder, frequently wetting the bed at night and even his clothes during the day. Do you have any suggestions to help deal with this problem?
A: The medical term for your father's problem is urinary incontinence, which can be defined as the involuntary loss of urine. Incontinence creates not only embarrassment but also depression and social isolation.
Urinary incontinence is quite common, especially among women. some studies, as many as 5 percent of men and 25 percent of women under the age of 60 reported loss of urine at some time during their life. Urinary incontinence is not an inevitable consequence of aging. Rather, it is due to an underlying abnormality, often one that can be overcome, either partially or totally. There are three major types of incontinence: stress, urgency and overflow.
Stress incontinence is the involuntary loss of urine that occurs when some activity, such as laugh, coughing, sneezing or lifting increases the pressure within the abdomen and thus on the bladder. Urge incontinence is the undesired loss of urine associated with a strong and abrupt desire to void. Overflow incontinence is defined by the loss of urine due to an overdistended bladder.
Large amounts of urine can be lost by persons with urge incontinence; frequent or constant dribbling is more a feature of overflow incontinence.
Among the many causes of urinary incontinence are nerve damage (such as from a stroke, multiple sclerosis or spinal cord injury) urinary tract infection, tissue damage from childbirth and side effects of medications. Obstruction of the urethra by benign prostatic hyperplasia (BPH) is a common cause of overflow incontinence in older men.
The first step to take with your father is to begin an "incontinence chart" -- a record of the time of day, amount and circumstances of each urination. At times, such a record alone might decrease or eliminate episodes of incontinence. For example, if it becomes apparent that urinary loss occurs at roughly four-hour intervals, assuring a planned urination every 3 1/2 hours may be effective.
The second step is to have your father describe his difficulties to a physician. To do this, your father may have to overcome the embarrassment that often makes people hesitant to discuss incontinence.
Alternatively, you or your father's physician may suggest that he go to one of the local continence programs that specialize in the management of urinary incontinence. You may obtain the location of such programs, as well as other valuable information about urinary incontinence, by calling the Help for Incontinent People (HIP) organization at (800) BLADDER (252-3337). You might also consider a worthwhile book, "Staying Dry" by K. Burgio, L. Pearce and A. Lucco, published by the Johns Hopkins University Press.
One thing you should not do is use the adult diapers or pads that are widely advertised. They can promote complications, except for very short periods or when specifically recommended by the doctor.
Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.