Treatment Options for the Elderly and Disabled

As a caregiver it is important that you know the treatment options available for your loved one. There are many options, such as changes in behavior, medications, and surgeries that can reduce or eliminate symptoms.

Behavioral Options

Certain reversible factors can influence a person’s ability to maintain control over their bladder function. Often these factors can be controlled or modified before medical treatment is initiated and cure or reduce the symptoms of bladder or bowel control problems.

Diet and Fluid

  • Diet and fluid intake can have a significant effect on bladder and bowel control. Read more about how diet can affect continence in the section of our site on Diet and Daily Habits.

Smoking

  • Smoking is irritating to the bladder surface and is associated with bladder cancer. Coughing associated with smoking may lead to stress urinary incontinence (SUI) during coughing spasms.

Prompted Voiding

  • A schedule of voiding around daily activities can be successful, especially after fluid and diet modifications have been made. One may expect a 50% reduction in frequency following voiding treatment in chronic care elderly patients.52
  • Typically, a voiding schedule should consist of voids promptly when the person first gets up, within 30 minutes before and after meals, immediately after a nap, and before bed.
  • Alarms on watches are useful reminders that the person needs to go to the toilet. Kitchen countertop timers are also helpful. However, if this does not work, verbal prompting can be successful. It may also be helpful to keep a written schedule.
  • Encourage double voiding. After the individual empties their bladder, but feels that the bladder is not completely empty, they should stand up, then sit back down again and lean slightly over the knees to double void. Straining, however, should be avoided.
  • Keep a bladder diary as the caregiver for one or two days if any problems arise to help a physician or nurse practitioner identify their sources.
  • Bladder retraining involves educating the person to resist or inhibit the urge to urinate (void). This program trains the bladder to delay voiding for larger time intervals and has been proven effective in treating urge incontinence. Visit out online store to get a copy of our Bladder Retraining Program pamphlet.

Pelvic Muscle Rehabilitation

  • Another behavioral therapy technique involves pelvic muscle exercises (PMEs), usually referred to as Kegel excercises. The name "Kegel" comes from the doctor who first developed and promoted the concept of pelvic muscle rehabilitation. PMEs may be used alone or in conjunction with biofeedback therapy, vaginal weight training, pelvic floor stimulation, and magnetic therapy.

Pharmacologic Therapy (medications)

Doctors can prescribe medications to help control incontinence, and sometimes they will take a person off a drug that is causing or contributing to incontinence. Of course, only your healthcare provider should tell you to stop using a drug he/she has prescribed.

The only drugs available for bladder control in the United States are formulated to address overactive bladder, but no the leakage associated with stress urinary incontinence. When behavioral and drug therapy for urge incontience were combined in older patients, additional benefit was noted.54

  • Anticholinergic drugs represent a broad category of pharmaceutical agents, including some of the medications used for allergic reactions, diarrhea, depression, and overactive bladder. Several recent studies have raised concerns about possible memory decline in older persons taking anticholinergic medications over a number of years. Studies are ongoing to assess the degree of risk of memory decline from medications used for overactive bladder.
  • An antidiuretic hormone (vasopressin-used in the treatment of nocturia) is not to be given to elderly patients with a history of congestive heart failure. Regardless of the drug employed, the general principle for pharmacologic treatment of elderly patients is to start with a low dose and increase it slowly.52
  • Another drug that may be used is imipramine, although this is not an official use. Caution should be exercised in using imipramine in the elderly because of its possible side effect of lowering blood pressure.
  • Click here to learn more about medications.

Non-surgical Treatment for Stress Incontinence (SUI)

Surgical Treatment for SUI

Surgical treatment should be preformed only after receiving a thorough diagnosis from a healthcare provider. All appropriate non-surgical treatments should be tried before deciding on surgery. There are many different surgical procedures that may be used to treat incontinence. The type of operation recommended depends on the type and cause of incontinence. Some of the more common procedures performed to treat urinary incontinence include bladder neck suspension or sling procedures, periurethral bulking injection (collagen injections around the urethral), or implantation of an artificial urinary sphincter or sacral nerve stimulator.

Overactive Bladder (OAB) and Urgency Urinary Incontinence (UUI)

In addition to medication and behavioral therapies mentioned aboved, there are several other treatment options for OAB. Learn about the other treatment options for OAB and UUI.

Nocturia

Nocturia can occur at any age, although it is less frequent in the age range below 60 years, and becomes more common as the person becomes older. Treament includes behavioral therapy and medications. Read more about these treatment options for nocturia.

Enlarged Prostate

OAB in elderly males can be due to the normal aging process, or it may be secondary to outflow obstruction or neurologic causes. Urethral obstruction due to an enlarged prostate in elderly men can be treated as in younger patients.52 Become more familar with treatment for enlarged prostate.