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If I laugh too hard, I’ll pee my pants! Social isolation and urinary incontinence: there are many effective treatments.

The Bottom Line

  • Incontinence is related to social isolation.
  • Education is key for learning about reversible risk factors that contribute to urine leakage.
  • If you experience incontinence speak to a health professional and they will direct you to the most appropriate treatment.
  • There are many effective treatments for incontinence that do not involve medication or surgery.

Have you ever heard anyone say, “If I laugh too hard, I’ll pee my pants!”?  This well-known expression derives from the difficulty many women and men have controlling their bladder as they age. Any involuntary urine loss, no matter how small an amount, can be referred to as urinary incontinence. Unfortunately, incontinence is no laughing matter for over half a million Canadian seniors (1).

Often stigmatized and considered a taboo subject, few people chat comfortably about the fact that they need to wear pads in their undergarments to protect against urine loss, or that they dribble on the way to the toilet. Worse, waking up in bed and finding the sheets wet with urine can be devastating.  This is especially a concern if you have a bed partner, or if incontinence occurs during sex. The trauma of wetting your pants in public is not easy to wipe from memory. The solution for many people is to stay at home alone and isolate themselves socially, in order to avoid public shame. 

A recent report by Statistics Canada (1) indicated that 53% of older women with incontinence report being lonely compared to 38% without incontinence. Among men, 34% with incontinence admit to feeling lonely compared to 24% without incontinence. Loneliness and social isolation can lead to depression, heightened stress levels and trouble sleeping. 

Treating incontinence can really help!

The tragedy is that incontinence can be treated at any age, yet few people know this. The first step to treatment is education. Changing beliefs that incontinence is NOT a normal part of aging is very important (2). Having your local community center organize a public lecture around incontinence is effective for activating older persons with incontinence to apply evidence-based strategies to reduce risk factors for leakage (2;3). Dispelling the myth that incontinence is a shameful secret you have to live with also stimulates help-seeking from a continence professional for this problem (2;3). Reducing caffeine intake, practicing pelvic floor muscle exercises (often called Kegel exercises), and losing weight are strategies that can be applied to improve incontinence symptoms (4-7). Lest you think very old people cannot be cured, there is proof that a ninety-eight year old woman was cured with simple solutions: she limited the number of  caffeinated beverages she consumed (caffeine stimulates the bladder to contract) and performed pelvic floor muscle strengthening exercises daily for 6 months (4). This may not be possible for everyone, but if you don’t try you will never know!

A tool to assess and manage your incontinence

There are several self-management tools for urinary incontinence and the link to one type is on the McMaster website.  It is available free of charge if you would like to see what your risk factors are for incontinence (click here) (8). The tool will provide suggestions on how to improve your situation, based on the latest scientific evidence. Even more effective, why not have your local community organization give a public lecture on incontinence; it would be a good idea to hand out the self-management tool to all who attend. This community approach seems to be very helpful in showing people that there are many solutions. A recent clinical trial demonstrated that a community approach was effective for reducing urinary symptoms in 1-out-of-every 2 older women with incontinence (3). Alternatively if you experience incontinence, speak to a health professional, a physiotherapist or a continence nurse advisor immediately. Many conditions are not curable as we age, but incontinence is!  Wouldn’t it be great to be able to laugh freely without worrying about peeing your pants?


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References

  1. Ramage-Morin PL, Gilmour H. Urinary incontinence and loneliness in Canadian seniors. Health Rep 2013 Oct 16;24(10):3-10.
  2. Tannenbaum C, Drali R, Holroyd-Leduc J, Richard L. Lessons learned: impact of a continence promotion activity for older community-dwelling women. Neurourol Urodyn 2010 Apr;29(4):540-4.
  3. Tannenbaum C, Agnew R, Benedetti A, Thomas D, van den Heuvel E. Effectiveness of continence promotion for older women via community organisations: a cluster randomised trial. BMJ Open 2013;3(12):e004135.
  4. Tannenbaum C, Bachand G, DuBeau CE, Kuchel GA. Experience of an incontinence clinic for older women: no apparent age limit for potential physical and psychological benefits. J Womens Health Gend Based Med 2001 Oct;10(8):751-6.
  5. Tannenbaum C, Brouillette J, Corcos J. Rating improvements in urinary incontinence: do patients and their physicians agree? Age Ageing 2008 Jul;37(4):379-83.
  6. Dumoulin C, Hay-Smith J. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev 2010;(1):CD005654.
  7. Shamliyan T, Wyman JF, Ramakrishnan R, Sainfort F, Kane RL. Benefits and harms of pharmacologic treatment for urinary incontinence in women: a systematic review. Ann Intern Med 2012 Jun 19;156(12):861-10.
  8. Holroyd-Leduc JM, Straus S, Thorpe K, Davis DA, Schmaltz H, Tannenbaum C. Translation of evidence into a self-management tool for use by women with urinary incontinence. Age Ageing 2011 Mar;40(2):227-33.

DISCLAIMER: The blogs are provided for informational purposes only. They are not a substitute for advice from your own healthcare professionals.

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