How do I approach my father about is intermittent incontinence?

Kathyleen asked...

HI, I am wondering how to approach my father (79) about what I call intermittent incontinence meaning it is not a constant problem but seems to happen in social situations. One of my brothers spoke to him but it became emotional and ended badly. I would like to discuss it with my dad but do not want the same ending. I realize it is a delicate conversation and since it has not happened while he has been visiting it is more difficult to bring it up. Any thoughts would be apprecitated.

Expert Answer

Jennifer Serafin, N.P. is a registered nurse and geriatric nurse practitioner at the Jewish Homes for the Aged in San Francisco.

I am not suprised that your brother had a difficult time talking to your dad about his incontinence. Many older persons who develop incontinence are very embarrassed about it, and it is common for them to get upset when it is discussed.

First, your father should see a urologist for an evaluation of his incontinence problem. As they age, men may get prostate enlargement, or BPH, which causes obstructive and irritative urinary symptoms. Obstruction causes slow urine flow, eventually leading to hesitancy and starting/stopping of the urine. Irritative symptoms include urgency, nighttime urination (nocturia), and frequency. Some men may even have difficulty emptying their bladder completely. There are medications out there that can help with this problem. While he is seeing the urologist, he should be checked for a bladder infection, and screened for prostate cancer with a prostate exam.

Now, when bringing up the incontinence subject with your father, here is what I would recommend. Talk to him in a private place, just the two of you. I would address it as a medical concern (not a hygiene problem). For example, I would say something like: "Dad, I know there are times when you just cannot make it to the bathroom in time, and you have accidents. I am concerned that this may mean you have a problem with your prostate. Can we go to the urologist to get this checked out? Maybe they can help you." By focusing on the fact that this is a medical problem, it should make it less embarrassing for him. Please do not focus on the hygiene issue. I wouldn't use terms like "wetting your pants" or "peeing your pants", as this may make him feel like your treating him like a child. However, if your father refuses help from a urologist, don't push him.

You can help him by getting him to go to the bathroom more frequently. Remember, an empty bladder is a happy bladder. I think his main problem is that he is not getting the urge to go until his bladder is ready to burst, so then he tries to rush to the bathroom. Since he is in an unfamiliar place (not at home), it takes him longer to find/ get to the bathroom. He just can't hold his urine that long. He should probably go to the bathroom about every 2 hours when he is in a social situation, to try and avoid accidents. You can help remind him to go to the bathroom before he feels like he has to go. Don't say "Dad, you need to go to the bathroom now!", like he is a child. Instead quietly say, "Hey Dad, do you want to go to the restroom before we sit down to eat/before we leave/etc?".

Hopefully, this will help. Good luck!