Last Updated: April 4, 2013
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-the involuntary leaking of urine-holding it in
isn't an option.
Although incontinence can happen at any age, it is 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 urinary
"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 and 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 likely occurrence.
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. The five main types of incontinence help
explain these various experiences.
Among older adults, the most common diagnosis isurge
incontinence, 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 incontinenceoccurs 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 incontinenceis rarely diagnosed. Out of a random
sampling of a hundred patients with incontinence, about 2 of them
would suffer from this, according to Diane Smith, M.S.N., C.R.N.P.,
a geriatric nurse practitioner in the Philadelphia area. In this
scenario, one's bladder never completely empties, so one frequently
feels the need to go and often leak small amounts of urine. This 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 diabetes.
An inability to reach the bathroom in time leads to the
diagnosis offunctional incontinence. 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 bathroom.
If one experiences more than one type of incontinence, the
diagnosis ismixed 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
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; and
- a thorough 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 left.
- 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.
- Cystogram: 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.
- Cystoscopy: The doctor views the patient's bladder through a
small telescope, checking for capacity, tumors, stones, or
Treatments and 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.
- Antibiotics: These are prescribed when incontinence is caused
by a urinary tract infection or an inflamed prostate gland.
- Others: For men with enlarged prostates, medications either
relax the muscles used in urination or shrink the prostate.
Flomax®, which relaxes the muscles, is commonly
prescribed for this condition. If one's bladder doesn't contract
enough, a provider can prescribe a medication to help it contract
Medical devices can be prescribed for women:
- 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 infections.
- Pessary: 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 three months.
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.