Aging and Bladder Incontinence: Are They Related?

Older adults are suffering in silence. The prevalence of bladder incontinence is 1 in 3 women and 1 in 12 men. The risk of incontinence increases with age, but it is not part of normal aging. The stigma and embarrassment are often why older adults do not seek help for their bladder incontinence. Understanding bladder incontinence and the available treatments may encourage older adults or their family members to seek medical intervention.

What is bladder incontinence?

According to the International Continence Society (ICS), the definition of bladder incontinence is involuntary uncontrolled urine leakage due to bladder dysfunction. Incontinence affects 50% of post-menopausal women and occurs in twice as many women as compared to men. Women often view incontinence as a “normal part of aging,” so they rarely seek help. Only 45% of women and 22% of men affected seek medical attention. Of men aged 60 to 64, 11 percent live with urinary incontinence, increasing to 35% of men over age 85.

The price of products for people with incontinence accounts for only a small percentage of the overall cost. In 2007, the estimated cost to the healthcare system was $65.9 billion in the US.

Types of bladder incontinence

There are several types of bladder incontinence. You should consult your healthcare provider for an assessment to recommend the appropriate treatment for these symptoms.

• Urge. This type of incontinence happens when someone has a very sudden and urgent need to pass urine. Someone with urge incontinence can often end up with incontinence accidents on their way to the bathroom.
• Stress. This type of incontinence is a urine leakage due to pressure on the bladder from coughing, sneezing, laughing, or lifting a heavy object. This type of incontinence is often found in older women, especially if they have given birth.
• Overflow. This type of incontinence has a characteristic constant “dribbling.” This disruption is due to the bladder not completely emptying when someone goes to the bathroom. Another cause of overflow incontinence is an outlet obstruction in the bladder.
• Functional. This is also known as “disability incontinence,” this type is due to a mental or physical barrier to getting to the bathroom, such as severe arthritis or another disorder that affects a person’s mobility. People with advanced dementia also have “functional incontinence” as they do not possess the cognitive capacity to understand they need to go to the bathroom.
• Mixed. This type encompasses any mixture of two or more incontinence types.

10 causes of bladder incontinence in older adults

Your healthcare provider must first assess for any cause of bladder incontinence and recommend the most appropriate treatment. Some possible causes are treatable and thereby rectifying the incontinence. Other causes require lifestyle modifications, medications, or, in extreme cases, corrective surgery.

• Infection. Older adults may be prone to urinary tract infections (UTIs) due to decreased fluid intake and limited mobility. Symptoms of a UTI include burning during urination, confusion, and pain. Urinary frequency and urgency are also symptoms of a UTI and may be a reason for incontinence due to the inability to get to the bathroom in time.
• Constipation. The pressure of constipated stool in the bowel puts pressure on the bladder, which can cause incontinence. In addition, older adults are sometimes prone to constipation due to decreased mobility and gastric motility.
• Medication. Diuretics (water pills) can cause incontinence due to frequent bathroom visits to urinate. Other drugs contributing to incontinence include caffeine, alcohol, opioids, benzodiazepines, and some allergy preparations.
• Dementia. The later stages of dementia can be the underlying cause of incontinence, as the person with dementia may not know that they need to void or can’t find the bathroom. Additionally, incontinence in dementia increases a person’s risk of admission to a long-term care facility.
• Restricted mobility. As people age, many have multiple medical conditions like arthritis, Parkinson’s, and chronic pain issues. These conditions can make it more difficult to mobilize quickly enough to get to the bathroom quickly.
• Prolapse. In women, when the bladder, uterus, or rectum move into the vagina or anus due to weakened pelvic floor muscles, this results in a prolapse, causing urine to leak.
• Weakened or damaged muscles and nerves. Weakened muscles or nerve damage caused by spinal cord injury, Parkinson’s, diabetes, or stroke may result in incontinence symptoms.
• Prostate. When men have prostate surgery or have an enlarged prostate, they can have an increased incidence of incontinence.
• Obesity. Extra pressure on the bladder when someone is overweight can predispose them to incontinence.
• Smoking. While not completely understood, people who smoke are more likely to have incontinence than those who do not.

Possible treatments for incontinence

It is imperative to seek attention from your healthcare provider if you have any incontinence symptoms. Treating the source and the symptoms can make a difference in managing your daily activities. Some causes are reversible, while others may be manageable. Some of the more common treatments include:

• Pelvic floor exercises. These exercises, sometimes called Kegel’s, target strengthening the pelvic floor and can be helpful in urge and stress incontinence. (see instructions below.)
• Timed toileting. This is a type of bladder training initiated at home with someone who deals with incontinence. The simple step is developing a program by setting up voiding times, for example, “every two hours.” Begin by asking the individual if they need to go to the bathroom or reminding them that it is time to go to the bathroom.
• Pessary device. In women, a healthcare provider may insert a corrective device called a pessary ring into the vagina. This device repositions the urethra when prolapse is the cause of incontinence. The pessary needs monitoring and cleaning regularly by a healthcare provider.
• Medications. Medication may be necessary to treat conditions like urinary tract infections. Sometimes medication may be required as a long-term measure that targets the muscles of the urinary tract system. While a drug may not eliminate incontinence, it may reduce urinary frequency. You can discuss your options with your healthcare provider.
• Surgery. If any of the conservative treatments are unsuccessful, your healthcare provider may suggest corrective surgery to increase support of the urinary system.

How to do Kegels Exercises

1. Squeeze your pelvic muscles as if you are trying to stop urinating.
2. Don't flex any other muscle, like your abdomen.
3. Don't hold your breath.
4. Breathe normally.
5. Hold the “squeeze” for three seconds.
6. Repeat for a total of ten repetitions to start.
7. Work up to three sets of ten, three times daily.

Lifestyle modifications

You can reduce the risk or severity of incontinence with simple lifestyle modifications.

• Exercise and lose weight.
• Reduce coffee, tea, and soda consumption.
• Reduce or eliminate alcohol consumption.
• Increase water intake.
• Quit smoking.

Urinary incontinence affects older adults and is severely underreported. Stigma, embarrassment, and misinformation prevent both men and women from seeking medical intervention from their healthcare providers. While incontinence increases as we age, it is not a part of normal aging. There are many treatable causes, with the possible reversal of incontinence. Additionally, in other cases, incontinence may be manageable. Early intervention is imperative to have an optimal quality of life.