Elderly Incontinence: What You Need to Know, Treatment Options, and Tips for Care

Incontinence in the elderly at night and throughout the day is fairly common as adults age and their bodies change. What exactly is urinary incontinence? It’s the involuntary loss of urine, and it affects between 25-33% of adults in the U.S.^[01]

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.

One out of two women older than 65 experience bladder leakage, according to the Urology Care Foundation.^[01] While there’s often a focus on identifying a treatment for urinary incontinence in elderly females, this condition affects both men and women roughly equally after they reach the age of 80.^[02]

What causes urinary incontinence in elderly adults?

From not drinking enough water to childbirth and health conditions such as diabetes, there are many different reasons behind urinary incontinence. Acute urinary incontinence in elderly adults often comes on suddenly, though sometimes different types of incontinence can develop over time.

The following health issues can cause urinary incontinence in both women and men:

• Multiple sclerosis
• Alzheimer’s disease
• Stroke
• Parkinson’s disease
• Constipation
• Obesity

Common urinary incontinence causes in women include:

• Prior pregnancies
• Childbirth
• Onset of menopause
• Pelvic floor atrophy

Urinary incontinence in elderly males is commonly caused by:

• Enlarged prostate

• Prostatitis or inflammation
• Nerve or muscle damage

There are six main 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.

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 they 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 to 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.

Total incontinence results in constant and uncontrollable bladder leakage, which indicates that your sphincter muscle is no longer working. This type of acute urinary incontinence in elderly individuals can be more challenging to treat.

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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 receiving medical help because they’re unsure what kind of doctor to see. A primary care doctor, geriatrician, nurse practitioner, or urinary specialist are viable options. Both men and women can visit a urologist, or women can find a dedicated urogynecologist. If your loved one feels comfortable with their primary care doctor, it’s generally good to start there.

What to expect at a doctor’s appointment for urinary incontinence

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 and current symptoms
• 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’ll likely record:

• Types of drinks they consume
• Times they urinate throughout the day and night
• 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, after which an X-ray is taken while the patient urinates, highlighting the urinary tract system. X-rays of the kidneys, 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 the capacity of the bladder, as well as what sensation the patient feels.
• Cystoscopy. The doctor views the patient’s bladder through a bladder scope, which acts like a telescope and checks for capacity, tumors, stones, or cancer.

After a diagnosis is made, behavioral therapy is often the first urinary incontinence treatment for the elderly. 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 it means someone else is in charge of taking you to the restroom.
• Bed-wetting alarms. To manage incontinence in the elderly at night, some people have bed-wetting alarms. When these alarms detect the presence of liquids, they sound an alert to wake seniors so they’re able to make it to the bathroom. Bed-wetting alarms can be placed beneath bed sheets or attached to a person’s pajamas.
• Pelvic floor muscle exercises. Called Kegels, these exercises strengthen the muscles that help regulate urination.^[03] Usually a person needs to practice Kegel exercises a few times a day, every day.
• 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 bladder stress. Even drinking coffee or tea while taking prescribed medication can aggravate incontinence. Additional bladder irritants to avoid include milk, tea, honey, soda, and acidic or very spicy foods.

Medications are frequently used in combination with behavioral therapies. Here are some commonly prescribed options, according to the National Association for Continence (NAFC):^[04]

• Anticholinergic or antispasmodic drugs 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 are prescribed when incontinence is caused by a urinary tract infection or an inflamed prostate gland.
• Tofranil® (imipramine) and Sudafed® (pseudoephedrine) are used to treat stress urinary incontinence, and they work by tightening muscles around the bladder.

The NAFC has even developed a full list of drugs used to treat elderly incontinence and other related conditions.

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Medical devices: Treatment 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.^[05] 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 that, similar to a diaphragm, 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.
• Electrical stimulation devices. These treatments can help address different types of incontinence by sending electric currents to nerves associated with urination. The stimulation probes aim to strengthen the bladder, lower back, and pelvic muscles. Electrical stimulation devices come with risks like tenderness, infection, and bleeding.

About 285,000 incontinence procedures are performed every year.^[06] If other treatment methods don’t work, surgery may help.

The following are common surgical procedures for urinary incontinence:^[07]

• 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 surgical incision is made into the lower stomach, and the bladder is lifted and stitched. The surgery can also be performed through one or more small incisions using specialized 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.

If your elderly loved one suffers from urinary incontinence, self-care can help avoid complications such as skin rashes, urine odors, and accidents.

Helpful incontinence care products. Having the right products on hand will provide you and your loved one some peace of mind in urgent moments and ease the stress of incontinence care. Common products include:

• Absorbent briefs
• Waterproof, vinyl briefs
• Absorbent booster pads and liners
• Disposable washcloths and wipes
• Penile clamp
• Washable, waterproof bed pads
• Absorbent bed pads

Cleaning. For cleaning, use a mild soap. Petroleum jelly or cocoa butter can protect the skin. Make sure to pat the skin dry.

Avoid falls. If your loved one frequently runs to the restroom, slip-and-fall accidents can happen more easily. Try to make the bathroom as accessible as possible.

If elderly 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.

Incontinence is among the many commons reasons that older adults choose to move to an assisted living facility or seek other long-term care options. Home care provided by professionals, such as certified nursing assistants, can help your loved one continue to live independently. Assisted living communities provide assistance with activities of daily living (ADLs) including toileting support. If you think an assisted living facility could be a positive shift for your loved one, reach out to one of our Senior Living Advisors today to learn more about the benefits of senior living.

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