Urinary Incontinence In Older Adults: What You Need To Know

• Urinary incontinence is a condition that involves accidentally leaking urine.
• Urinary incontinence is more common in older adults, but it is not an automatic sign of aging.
• Urinary incontinence can have an impact on a person’s life in multiple ways, from social to physical.
• There are multiple ways to treat urinary incontinence, including bladder training and medication.

Urinary incontinence happens when a person accidentally leaks urine regularly. This can occur due to the bladder muscle contracting at inappropriate times, causing the immediate urge to urinate. Urinary incontinence can happen to anyone but most commonly occurs in older adults, especially women.

Bladder control issues can occur for several different reasons and can be embarrassing to deal with. However, there are ways to treat and manage them.

This article will focus on urinary incontinence in older adults, including symptoms, causes, and treatment.

When it comes to urinary incontinence, there are a variety of different types and causes such as stress incontinence, urge incontinence, and more.

Stress Incontinence

Stress urinary incontinence occurs when leakage is caused by pressure on the bladder through physical movements, such as exercising or lifting heavy objects.

Urge Incontinence

Urge incontinence happens when a person has a sudden urge to urinate but cannot hold the urine in to make it to the bathroom.

Overflow Incontinence

Overflow incontinence occurs when small amounts of urine leak from a bladder that is always full.

Functional Incontinence

Functional incontinence occurs when a person has a functional bladder but cannot go to the restroom due to other conditions, such as arthritis, that make it harder to move.

Mixed Incontinence

Mixed incontinence is when a person experiences multiple types of urinary incontinence.

There are a few symptoms that can indicate urinary incontinence, such as:

• Leaking urine unexpectedly, especially during everyday activities such as exercising or walking
• Not reaching the toilet in time
• Constantly feeling the ​“urge” to go (overactive bladder)
• Wetting the bed at night when you sleep
• Suddenly urinating without any urge or warning

Depending on the type, urinary incontinence has a few different causes ranging from weak bladder muscles, overactive bladder, and more.

Weak Bladder/​Pelvic Muscles

A weak bladder or pelvic floor muscles can contribute to urinary incontinence. A weak bladder makes it difficult to hold urine until you can reach the restroom. 

Weak pelvic floor muscles don’t provide enough support for your bladder, resulting in leakage.

In older adults, pelvic floor muscles may weaken over time as a natural part of aging. However, some conditions, including diabetes, limited mobility, and obesity, may contribute to this as well.

Overactive Bladder

An overactive bladder occurs due to a contraction in the bladder wall, which causes a sudden ​“urgency” to urinate. This can happen even if the urine in the bladder is low, but it can still lead to accidental urination.

As adults age, muscle fibers in the bladder are replaced with stiffer tissue that can affect the ways your bladder responds to urination. For example, your bladder may wait until it’s fuller than normal before urgently unforming you to urinate.

Lower Urinary Tract Symptoms (LUTS)

As adults age, changes to their lower urinary tract can make urination more unpredictable. Bladder muscles may contract less forcefully, the urethra and urethra sphincter may become looser, especially in older women, and nerves that run to the bladder muscles may decline over time. 

The lower urinary tract, which includes the bladder and the urethra, can experience infections or blockage, resulting in various issues such as difficulty peeing, issues with storing urine in the bladder, or the feeling you haven’t fully emptied the bladder.

If you have LUTS symptoms, it can make the likelihood of urinary incontinence much higher.

Nerve Damage From Medical Conditions

Some illnesses or conditions can cause nerve damage in the body, making it difficult to control the bladder.

Some of the conditions that may cause nerve damage include multiple sclerosis (MS), diabetes, Parkinson’s disease, or Alzheimer’s disease.

Medical Conditions

Some medical conditions, such as arthritis or stroke, may not cause direct damage to the bladder but can make it difficult to get to the restroom to relieve yourself in time.

Some conditions that are more common in older adults, such as dementia or Alzheimer’s, can cause loss of cognitive function, making it difficult or impossible to use the restroom on their own.

Pelvic Organ Prolapse (POP)

Pelvic organ prolapse occurs when the pelvic floor muscles become so weak that pelvic organs ​“drop” in the body. When the bladder falls, it’s referred to as cystocele prolapse. This can make bladder control difficult.

Bladder Blockage

Urinary incontinence can also occur due to bladder outlet obstruction caused by an enlarged prostate. This can result in urinary retention, a condition when you can never fully empty your bladder when urinating, and can make you feel as if you constantly need to urinate.

Urinary Tract Infection (UTI)

UTIs can cause temporary urinary incontinence, as they can make you feel the constant urge to ​“go.” In this case, the urinary incontinence goes away when the UTI clears up.

To diagnose urinary incontinence, your healthcare provider will ask a few questions to get a sense of the issue. They may ask about how much and what types of beverages you drink, as well as how many times a day you urinate. They will also ask how often you leak urine and how long it’s been occurring.

If urinary incontinence is suspected, they may run a few tests to help confirm it. These tests can include:

• Urinalysis/​urine culture
• Bladder stress test
• Pad test
• X Rays or ultrasound
• Cystoscopic exam

These exams can help determine if the urinary incontinence is temporary or ongoing, and help you understand your treatment options.

There are a few different methods for urinary incontinence treatment. These treatment strategies include bladder training, medications, lifestyle changes, and potentially surgery.

Bladder Control Training

One of the first steps to managing urinary incontinence is by trying to train your bladder to control the urge to urinate frequently. Some of the ways to do this may include:

• Pelvic Floor Muscle Exercises: Also referred to as ​“kegel exercises,” these help strengthen the pelvic floor muscles, which in turn support the bladder and help you hold in your urine.
• Urgency Suppression: These are ways to help control strong urges to go to the restroom without immediately doing so. Examples include distracting yourself, taking deep breaths, or squeezing the pelvic floor muscles.
• Time Voiding: This involves scheduling specific times to urinate, such as once an hour, and then slowly extending the time between those breaks.

Medications

Medications or medical treatments may also be used to help with treatment. These can include:

• Urinary Incontinence Medications: These medications can be pills, patches, creams, or liquids to help manage bladder control.
• Medical Devices: Some medical devices, such as a catheter, may be implemented to help with urine leakage.
• Bulking Agents: This can involve injecting a bulking gel or paste, which can thicken the area surrounding the urethra and help close the opening. This process may need to be repeated.

Lifestyle Changes

Certain lifestyle changes may help with bladder issues, such as:

• Losing weight
• Limiting alcohol intake
• Drinking more water
• Avoiding heavy lifting (to reduce bladder stress)
• Quitting smoking

Surgery

If normal treatments, medications, or lifestyle changes aren’t effective, surgery may be considered. Surgery is only an effective solution if the urinary incontinence is caused by the position of the bladder (such as dropping due to POP) or due to an enlarged prostate creating a bladder blockage.

While some forms of urinary incontinence can be managed personally by an older adult, some conditions, such as limited mobility or dementia, may require a caregiver to help. Those experiencing urinary incontinence can feel embarrassed about the situation, and treating them with care and dignity is deeply important. 

Confirming the Cause

urinary incontinence can result from multiple conditions, not always dementia or cognitive impairment. If the issue is linked to a reversible condition, such as an infection or medications, then treating or managing those causes can help relieve urinary incontinence before taking more drastic measures. 

Managed Incontinence

if the urinary incontinence isn’t due to a reversible condition, then the best approach for a caregiver is to try managed incontinence. Rather than relying on medications, which can cause confusion or impact alertness, this involves options such as:

• Using continence products to help with leaks (such as pads or adult diapers)
• Time voiding 
• Bedside equipment, such as catheters or urinals, to make going to the toilet easier. 

Be Mindful

Urinary incontinence can be a difficult condition for older adults to talk about, as they may feel embarrassed. It’s important for caregivers to be aware and mindful of how they treat and talk about urinary incontinence. Some ways to accomplish this include:

• Educate Yourself: Urinary incontinence can occur for many different reasons, and there are multiple different types. Educating yourself on the type and cause of their incontinence can help you approach it in the best possible way.
• Use Different Language: Some older adults may not like having to wear incontinence materials, and may struggle with being told to wear an ​“adult diaper,” given the association with children or toddlers. Using different wording, such as pads or briefs, may make the transition to using these products easier.
• Talk to Their Doctor: Accompanying your loved one to their doctor can allow you to ask questions about the best ways to help manage their incontinence and encourage your loved one to ask questions of their own.

The most common complications of urinary incontinence include:

• UTIs: Urinary tract infections can repeatedly occur due to urinary incontinence.
• Skin issues: rash, redness, and swelling can occur due to consistently wet skin.
• Lifestyle implications: urinary incontinence can be embarrassing and lead to social isolation, as you may not want to go out and socialize for fear of leaks. This reason can also result in an impact on your personal relationships and depression.

If you only leak occasionally, you may not feel the urgency to see your provider.

If you feel as though urine leakage is impacting your life, if you can’t make it to the bathroom in time, even when you rush, or if you struggle to empty your bladder, you will want to contact your healthcare provider to see what your treatment options are.

What is the most common cause of urinary incontinence in older adults?

The most common cause is often linked to a weak bladder or pelvic muscles that cannot correctly support the bladder.

What is the average age for urinary incontinence?

While it can occur at any age, urinary incontinence is more common in women 50 or above and men 65 or above.

Does drinking more water help with bladder leakage?

While it might seem contradictory, drinking more water can help with bladder leakage in patients with kidney issues, such as stones or kidney disease, or those with painful bladders due to highly concentrated urine.

For those with healthy kidneys, drinking too much water may irritate the bladder and cause incontinence issues.