Last Updated: April 29, 2015
For many people, a trip to the bathroom is something they can
easily delay. But for roughly 13 million Americans who suffer from
urinary incontinence, holding it in isn't an option.
Although incontinence can happen at any age, it's more common in
older adults. According to the National Association for Continence,
one in five individuals over the age of 40 suffer from overactive
bladder or urgency or frequency symptoms, some of whom leak urine
before reaching a restroom. In the nursing
home population, at least 50 percent of residents have elderly
"Incontinence is a common part of aging but it is never normal,"
says Dr. Lisa Rosenberg, M.D., of the University of Pittsburgh's
geriatric department. "Because it is so common, people think that
they should accept it. In almost all cases, it is something a
well-trained physician or nurse practitioner can help with. We can
actually cure most of those people."
Causes & Symptoms
The diversity of causes behind incontinence are vast and varied,
from something as simple (and counterintuitive) as not drinking
enough water to more serious conditions like an inflamed bladder
wall. Several diseases can bring about incontinence, such as multiple
sclerosis and Alzheimer's
disease. In women, prior pregnancies, childbirth, and the onset
of menopause can lead to incontinence. In men, prostate problems
can hamper urination. Even drinking coffee or tea or taking
prescribed medications can aggravate your bladder. As one ages,
changes in the body can make elderly urinary incontinence a more
Elderly urinary incontinence can take several forms. Some people
may only leak urine occasionally, others may constantly dribble
urine, while still others experience a complete lack of both
bladder and bowel control. Here are the main types of
- Urge Incontinence
The most common diagnosis, this involves an urgent need to urinate
resulting in the loss of urine before one arrives at the toilet.
"We believe urge incontinence is caused by involuntary contractions
of the bladder that the patient can simply not stop," says
Rosenberg. Urge incontinence, also called overactive bladder, can
be caused by strokes, dementia, Alzheimer's disease, multiple
sclerosis, Parkinson's, or injuries. Conditions such as pelvic
floor atrophy in women, prostate enlargement in men, or
constipation in either sex can also lead to urge incontinence.
- Stress Incontinence
This occurs when an increase in abdominal pressure overcomes the
closing pressure of the bladder. Abdominal pressure rises when you
cough, sneeze, laugh, climb stairs, or lift objects. According to
Judith Veit, R.N., a nurse in the outpatient urology department at
Virginia Mason Medical Center in Seattle, the bladder muscles of
older people may be so weak that leaking can occur even when they
get up out of a chair. Stress incontinence is more common in women
due to pregnancy and childbirth, and a lack of estrogen in
postmenopausal women can also cause muscular atrophy that may lead
to the condition. Men who have enlarged prostates or who have had
prostate cancer treatments or prostate surgery can also develop
- Overflow Incontinence
Rarely diagnosed, this occurs when one's bladder never completely
empties. Sufferers frequently feel the need to go and often leak
small amounts of urine. This condition is often caused by an
obstruction in the urinary tract system or by a bladder that either
has very weak contractions or is unable to contract at all. Causes
include an enlarged prostate or damage from prostate surgery,
constipation, fecal impaction, and nerve damage from stokes or
- Functional Incontinence
This diagnosis decribes incontinence caused by other disabilities.
For example, if arthritis makes unzipping one's pants difficult or
a bad hip means a trip to the facilities takes longer than
expected, accidents can ensue. Neurological disorders, stroke
complications, Alzheimer's disease or multiple sclerosis can also
cause functional incontinence. Often the patient still feels the
urge to void, but his mind cannot plan or carry out a trip to the
- Mixed Incontinence
Sometimes patients experience more than one type of incontinence.
Usually patients have a combination of stress and urge
incontinence, especially women. But people who have severe
dementia, Parkinson's disease, neurological disorders, or have had
strokes can suffer from urge and functional incontinence.
Urinary Incontinence Diagnosis
Your loved one may feel embarrassed by his or her accidents and
avoid scheduling a doctor's appointment. Or perhaps one is unsure
of whom to see: a primary care physician, a nurse practitioner, or
a urology specialist. Maybe your loved one is using absorbent pads
or protective underwear. But the best reason to see a doctor is
this: elderly urinary incontinence is a very treatable
If your loved one feels comfortable with his or her primary care
doctor, start there. Women can also find a urogynecologist while
men could visit a urologist; either can see a geriatrician. Often,
you can locate nurse practitioners who specialize in incontinence
Whomever one sees, Rosenberg says, you should expect the
following from a visit:
- A urinalysis to rule out infection or blood in the urine
- Blood tests to check on kidney function, calcium and glucose
- A thorough discussion of one's medical history
- A complete physical exam, including a rectal exam and a pelvic
exam for women, and a urological exam for men
Often, a patient will be asked to bring a bladder diary to the
first visit, or create this before her second appointment. In this
journal, she records what she drinks, when she urinates, how much
she urinates (placing a special "measuring cup" over the toilet
bowl to record volume), and describe her accidents. If the medical
provider skips any of these important steps, you may want to
consider finding someone whoiswilling to evaluate your loved one's
situation properly and completely.
If the previous tests and exam don't point to a diagnosis, the
patient could undergo one or more of the following procedures:
- Postvoid Residual
After urination, an ultrasound wand is placed on the abdomen,
creating a bladder scan to show if any urine remains. Or a catheter
is placed into the bladder to drain and measure any urine
- Urodynamic Testing
A catheter fills the bladder with water. This test measures the
pressure in the bladder when it is at rest, when it's filling, and
when it empties. This test looks at the anatomy of the urinary
tract, the functioning ability and capacity of the bladder, and
what sensations the patient feels.
A catheter is inserted through which dye is injected into the
bladder. An x-ray is then taken while the patient urinates,
highlighting the urinary tract system.
The doctor views the patient's bladder through a small telescope,
checking for capacity, tumors, stones, or cancer.
Treatments & Practical Management
After a diagnosis is made, a treatment for elderly urinary
incontinence can include behavioral therapy, medications, medical
devices, and surgery. "For the majority of the people in the
community, it is 100 percent treatable. Most of the time, it's a
non-surgical treatment," Smith says.
Usually the first line of treatment is behavioral therapy, which
will often cure the incontinence. Treatments can include bladder
training, scheduled bathroom trips, pelvic floor muscles exercises,
and fluid and diet management. "The nice thing about behavioral
therapies is that there are no side effects and the response is
proportional to the work of the patient," Rosenberg says.
Bladder training can involve learning to delay urination by
gradually lengthening the time between bathroom trips. Or one can
practice double voiding: after urinating, the patient waits a few
minutes, and then urinates again. This teaches the patient to drain
the bladder more thoroughly.
Scheduled bathroom trips are effective for people with mobility
issues or neurological disorders, even if this means someone else
is in charge of taking you to the restroom.
Pelvic floor muscle exercises, called Kegels, strengthen the
muscles that help regulate urination. Usually one needs to practice
these a few times a day, every day, for the rest of one's
life-stopping can mean the return of incontinence. Learning how to
contract the right muscles can be confusing, so a provider must
check to see if the Kegels are performed correctly by inserting a
finger in the anus or vagina to check pressure. Or one can work out
with the aid of biofeedback. Transducers, connected to a computer,
are placed on the body, and lines on a video monitor show when one
is doing the exercises correctly.
Medications are frequently used in combination with behavioral
- Anticholinergic or Antispasmodic Drugs
These are usually prescribed for urge incontinence, and examples
include Vesicare®, Detrol LA®, Ditropan
XL®, Oxytrol® skin patch, and
Sanctura®. The most common side effect is dry mouth.
Less common side effects include blurred vision, constipation, and
- Hormone Replacement
Estrogen therapy-with a vaginal cream, ring, or patch-is used to
counteract the atrophy of the skin lining of the urethra and vagina
in post-menopausal women.
These are prescribed when incontinence is caused by a urinary tract
infection or an inflamed prostate gland.
In addition to these treatments, medical devices may be
prescribed for women, including:
- Urethral Inserts
This is a tampon-like insert that a woman places in her urethra,
usually during activities related to her incontinence episodes,
such as tennis. The woman removes it when she needs to urinate.
These are not as commonly prescribed, says nurse practitioner
Smith, as they can be uncomfortable and can cause urinary tract
This is an intra-vaginal device similar to a diaphragm that
supports the bladder. A medical provider places the pessary, which
needs to be taken out, inspected, and cleaned by the provider every
If your loved one suffers from elderly urinary incontinence,
self care helps avoid complications such as skin rashes and urine
odors. For cleaning, use a mild soap such as Dove. Petroleum jelly
or cocoa butter can protect skin. Make sure to pat the skin dry
after urinating. If he or she rushes to the restroom, slip-and-fall
accidents can ensue, so try to set up the home to make bathroom
trips easier. Use pads and protective garments such as plastic or
washable underwear until you find a successful cure, or if his or
her treatment isn't 100 percent effective.
Surgery is an option that is usually only discussed after all
other treatment options have been tried. Although more than 150
surgical procedures exist, the following are the most common
- For women, sling procedures support the urethra by placing
abdominal tissue or synthetic materials under the urethra.
Complications include the inability to void temporarily after
- Women can also have a doctor inject collagen around the
urethra, which is a two to three minute procedure. This fix
typically lasts 3 months, so it must be repeated.
- For men (and infrequently for women) with stress incontinence,
an artificial urinary sphincter can be implanted around the neck of
the bladder. This fluid-filled, doughnut-shaped device holds the
sphincter closed and is attached to a valve implanted in the
testicles or labia. To urinate, one presses the valve twice and the
- A sacral nerve stimulator, which is a device implanted in the
abdomen with a wire connecting to a nerve related to bladder
function, is a fairly rare procedure, used in roughly .5 percent of
the population, according to Smith. Electrical impulses transmitted
from the device prompt the nerve, helping the bladder
Of course, the most important step is to seek professional
medical help. If elderly urinary incontinence is keeping your loved
one at home and away from his or her favorite pastimes, please
realize that this is a highly treatable condition. With the proper
and appropriate treatment, your loved one will soon be enjoying
that stroll in the park or a night out at the movies again.