Debunking Myths about Older People and Incontinence by Dr Joan Ostaszkiewicz
Dr Joan Ostaszkiewicz, Director Aged Care Division, National Ageing Research Institute (NARI) and Ms Elizabeth Watt, Senior Research Fellow, Aged Care Division, NARI
Just like any other stage of life, older age can present us with many challenges as well as opportunities. However, many older people experience discrimination in the form of ageism, which is prejudice or discrimination based on a person’s age. The World Health Organisation (WHO) states:
“Ageism is one of the most pervasive and accepted forms of prejudice in societies throughout the world and is ingrained in our social interactions, cultural practices, and institutions” (WHO)
A survey conducted by EveryAGE Counts found 25.7% of people experience ageism in the workplace, 11.3% in a medical situation, 19.1% in a retail situation and 16.3% when seeking work. If you are in any doubt, just think about the positive portrayals of younger people compared to older people in social media. Negative images of older people can be damaging, particularly when we internalise them or believe them about ourselves or others, and ageism can lead to a person being assigned lower value or importance.
Ageism can also lead people to believe that their health concerns such as incontinence, are a necessary and inevitable part of getting older. In addition, if healthcare practitioners hold ageist beliefs, older people’s concerns may be dismissed or go untreated. This can reinforce an older person’s sense of powerlessness and lack of importance.
The website, EveryAGE Counts states ‘our later years are more likely to be defined by peace, gratitude and fulfilment than by sorrow, dread and regret’. They also note that one in 10 of us will live past 95, and for many, the time spent seriously ill or with disability is likely to be compressed into only the very final years or even months of our lives.
American anti-ageism campaigner, Ashely Applewhite says “aging is a natural, powerful, lifelong process that unites us all.” The contributions older people make to society are significant and include volunteering, helping and caring for others, caring for nature and the environment, endorsing equal treatment for all, and many actively pursue goals that are both personally meaningful and contribute to the greater good.
Older people can develop treatable conditions, just like younger people. For example, the onset of confusion in older age is often judged to be a sign of dementia, when in fact, it could relate to the side effects of a new medicine. Similarly, the onset of incontinence could be a sign of a treatable condition such as an infection. Dementia and incontinence are not a normal part of ageing, and they are far from inevitable.
Most people find speaking about bladder and bowel issues difficult, even with health professionals or trusted loved ones or friends. However, another major barrier for people seeking help for a bladder or bowel issue is the misconception that the problem is simply related to ageing. It is not uncommon to hear people say, “what do you expect at your age?” Unfortunately, this belief may also be held by others in the community, which can make it even more difficult to talk about the issue.
There are many changes in the body that are the normal result of ageing. The most obvious changes are in the tone and elasticity of our skin and muscles. A reduction in muscle tone can particularly affect the strength of the pelvic floor muscles, making it more likely that you leak urine especially when you cough, sneeze, bend, rise from sitting to standing or lift something heavy. Like any other muscles in the body, the pelvic floor muscles need to be exercised to maintain their strength and we should all incorporate pelvic floor muscle exercises into our daily routines. For more information go to continence.org.au/about-continence/continence-health/pelvic-floor
A loss of muscle tone can also affect bowel continence. As we age, bowel motility reduces which may predispose an older person to developing constipation. Constipation can cause further bowel issues including faecal incontinence and can contribute to urinary incontinence by putting pressure on the bladder. Over time, constant straining to pass a bowel motion leads to stretching of the pelvic floor muscles. To reduce the likelihood of becoming constipated simple adjustments to fluid and food intake can be made, as well as correcting toileting position and increasing exercise and activity levels.
Adults normally need to empty their bladder about four to six times a day. As we age, reduced bladder muscle tone and capacity to hold urine, can result in increased urinary frequency, the need to go to the toilet more often. Take your time when you go to the toilet and make sure that you are not rushing so that you are able to empty your bladder or bowel completely. Despite the temptation to do so, don’t go to the toilet ‘just in case.’ If you are over 65 years of age, it is not unusual to need to get up once during the night to pass urine. In men, the prostate gland enlarges from about 50 years of age, which can lead to difficulty in starting to pass urine, slowing of the stream of urine, and the sense of needing to pass urine frequently. It may also increase the need to pass urine during the night, which can significantly interrupt the person’s sleep. For more information go to continence.org.au/who-it-affects/men/prostate ).
There’s no denying that some of us will develop incontinence as we age, but it is important for everyone, including older people themselves, that we don’t accept this as an inevitable aspect of older age. After all, we don’t accept blood loss as something to just tolerate. Even if incontinence is not cured, symptoms can be reduced to enable people to continue to engage in normal life and find meaning and purpose. So, while there are changes in our bodies that occur as we age, most of the significant changes we experience are related to lifestyle, environment, life events such as pregnancy and childbirth, and disease or surgery rather than just ageing.
Don’t put up with uncomfortable symptoms related to your bowel and bladder. Seek help by calling the free National Continence Helpline on 1800 33 00 66 (8am to 8pm Monday to Friday) or talk with your preferred healthcare practitioner. The helpline is staffed by Nurse Continence Specialists who offer confidential information, advice, and support to people affected by incontinence and other bowel and bladder issues. They also provide a wide range of continence-related resources and referrals to local services and an interpreter service is available. Go to continence.org.au/get-support/who-can-help/national-continence-helpline