What You Need to Know About Elderly Urinary Incontinence
By Merritt WhitleyJune 20, 2020
For many people, a trip to the bathroom is something that can easily be delayed. But for 25 million Americans who experience bladder leakage daily, it’s not that simple.
What exactly is urinary incontinence? It’s the involuntary loss of urine, according to the National Association for Continence (NAFC).
Although incontinence can happen at any age, it’s generally more common in seniors. One out of two women older than 65 experience bladder leakage sometimes, according to the Urology Care Foundation. It can be caused by typical aging, lifestyle choices, or a range of health conditions.
Urinary incontinence isn’t something you should simply accept or live with, according to the NAFC. In fact, there are many effective ways to treat elderly incontinence regardless of its cause. Learn more about the cases, types, treatment options, and more.
What causes urinary incontinence?
From not drinking enough water to childbirth to a health condition such as diabetes, there are many different reasons behind urinary incontinence.
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The following health issues can cause urinary incontinence in both women and men:
Common urinary incontinence causes in women include:
Onset of menopause
Pelvic floor atrophy
For men, prostate problems are a common cause of urinary incontinence.
As you age, changes in the body can make elderly urinary incontinence more likely. Elderly urinary incontinence can take on a few forms:
Some people may only leak urine occasionally
Others may constantly dribble urine
Some experience a complete lack of both bladder and bowel control
What are the main types of incontinence?
There are six common types of urinary incontinence:
Urge incontinence is the most common diagnosis, often referred to as an overactive bladder. It involves an urgent need to urinate resulting in the loss of urine before arriving at the toilet.
Total incontinence indicates your sphincter muscle is no longer working. It results in constant and uncontrollable bladder leakage.
Stress incontinence occurs when an increase in abdominal pressure overcomes the closing pressure of the bladder. You may feel abdominal pain when you cough, sneeze, laugh, climb stairs, or lift objects. Stress incontinence is more common in women due to pregnancy and childbirth. However, it can affect men who’ve had prostate cancer or surgery.
Overflow incontinence occurs when your 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 isn’t able to contract at all.
Functional incontinence is incontinence caused by other disabilities. Neurological disorders, stroke complications, or arthritis can prevent someone from unzipping their pants quickly enough, resulting in an accident. People with functional incontinence feel the urge to urinate but aren’t physically able to plan or carry out a trip the bathroom.
Mixed incontinence is a combination of more than one type of incontinence. People with mixed incontinence — especially women — usually have a combination of stress and urge incontinence. But people with severe dementia, Parkinson’s disease, or neurological disorders — as well as people who have had strokes — can have urge and functional incontinence.
Whom should I talk to about urinary incontinence?
Your loved one may feel embarrassed by their accidents and avoid scheduling a doctor’s appointment. They may be using absorbent pads or protective underwear to help, but urinary incontinence is very treatable with medical assistance.
They may also hold off because they’re unsure what kind of doctor to see. A primary care doctor, geriatrician, nurse practitioner, or urinary specialist are viable options. If your loved one feels comfortable with their primary care doctor, it’s generally good to start there.
Women can also find a urogynecologist, while men can visit a urologist.
What happens at the doctor’s appointment?
At your medical appointment, you’ll likely have:
A urinalysis to rule out infection or blood in the urine
Blood tests to check on kidney function, calcium, and glucose levels
A thorough discussion of your medical history
A complete physical exam, including a rectal and pelvic exam for women, or a urological exam for men
A patient may also be asked to bring a bladder diary to the first visit, or to create one before the second appointment.
In this journal, they will likely record:
Types of drinks they consume
Times they urinate throughout the day
How much they urinate, which is measured by placing a special measuring cup over the toilet to record volume
A description and frequency of their accidents
How do procedures pinpoint a diagnosis?
If the previous tests and exams don’t point to a diagnosis, the patient could undergo one of these procedures:
Bladder ultrasound and post-void residual (PVR) After urination, an ultrasound wand is placed on the abdomen, creating a bladder scan to show if any urine remains in the bladder. This procedure usually takes around five to 10 minutes, and a catheter may also be placed into the bladder to drain and measure any urine left.
Cystography 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. X-rays of the kidney, ureter, and bladder will be taken so the urinary system is completely visible.
Urodynamic testing A catheter fills the bladder with water to measure the pressure in the bladder when it’s at rest, when it’s filling, and when it empties. This test looks at the anatomy of the urinary tract, the bladder’s functioning ability, and capacity of the bladder, as well as what sensation the patient feels.
Cystocopy The doctor views the patient’s bladder through a bladder scope, which acts like a telescope. It is used to check for capacity, tumors, stones, or cancer.
Behavioral therapy: A first treatment for bladder incontinence
After a diagnosis is made, behavioral therapy is often the first treatment. This may involve:
Learning to delay urination You can do this by gradually lengthening the time between bathroom trips. One can also practice double voiding, which is when a person urinates, waits for a few minutes, and then urinates again. This teaches the person to drain their bladder more thoroughly.
Scheduled bathroom visits This is often 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, these exercises strengthen the muscles that help regulate urination. Usually one needs to practice these a few times a day, every day. Learning how to contract the right muscles can be confusing, but your medical provider or this step-by-step guide to performing Kegel exercises can help.
Fluid and diet management Although diet alone can’t cure urinary incontinence, it can improve bladder control. Certain beverages like carbonated drinks and alcohol can cause your bladder stress. Even drinking coffee or tea while taking a prescribed medication can aggravate it. Additional bladder irritants to avoid include milk, tea, honey, soda, and very spicy foods.
Medications used to help with urinary incontinence
Medications are frequently used in combination with behavioral therapies. Here are some commonly prescribed options:
Anticholinergic or antispasmodic drugs These are usually prescribed for urge incontinence. Examples include Vesicare®, Detrol LA®, Ditropan XL®, Oxytrol skin patch®, and Santura®. The most common side effect is dry mouth. Less common side effects include blurred vision, constipation, and mental confusion.
Antibiotics These are prescribed when incontinence is caused by a urinary tract infection or an inflamed prostate gland.
Tofranil® (imipramine) and Sudafed® (pseudophedrine) These are used to treat stress urinary incontinence, and they work by tightening muscles around the bladder.
Medical devices for urinary incontinence in elderly females
In addition to medicinal treatments, these medical devices may be prescribed for women:
Urethra insert This is a tampon-like insert that a woman places in her urethra, usually during activities related to her incontinence episodes, such as exercising. While wearing the insert, you’ll be able to urinate and have bowel movements. It’s a good option for senior women who want to remain active. It can be worn safely for up to eight hours, but just like a tampon, it will need to be changed as directed to avoid health and hygiene issues.
Pessary This is an intravaginal device, similar to a diaphragm, that supports the bladder. It comes in different sizes. After it’s placed, it will need to be taken out, inspected, and cleaned by a health care provider every three months. You can purchase a single-use disposable pessary over the counter, but it’s best to check with your doctor or nurse practitioner to determine which option is best for you.
Surgical options for urinary incontinence
About 285,000 incontinence procedures are performed annually, up 7.5% from 2015. If other treatment methods don’t work, surgery may help.
These are common surgical procedures for urinary incontinence:
Sling procedures For women, this supports a woman’s urethra by placing abdominal tissue or synthetic materials beneath it. For men, it involves making a cut between the scrotum and anus. Complications can include not being able to empty one’s bladder fully. However, this surgery is generally preferred because it’s well-known and has a history of long-term success.
Colposuspension For stress incontinence, a cut is made into the lower stomach, and the bladder is lifted up and stitched. The surgery can also be performed through one or more small cuts using surgical instruments, which is called a laparoscopic colposuspension. Both procedural types can help prevent long-term incontinence.
Artificial urinary sphincter This is generally used for men with stress incontinence. A device is placed 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, when used in women, the labia. To urinate, one presses the valve twice and the bladder empties.
Incontinence care tips for families
If your elderly loved one suffers from urinary incontinence, self-care can help avoid complications such as skin rashes, urine odors, and accidents.
Cleaning 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.
Avoid falls If they frequently run to the restroom, slip-and-fall accidents can happen more easily. Try to make the bathroom as accessible as possible at home. Use pads and protective garments or washable underwear until you find a successful cure.
Ask for help If elderly urinary incontinence is keeping your loved one isolated and unable to enjoy their favorite pastimes, talk to them about treatment options and encourage them to see a doctor. With the proper and appropriate treatment, your loved one could soon be enjoying life more fully.
Merritt Whitely is an editor at A Place for Mom. She developed health content for seniors at Hearing Charities of America and the National Hearing Aid Project. She’s also managed multiple print publications, blogs, and social media channels for seniors as the marketing manager at Sertoma, Inc.