Urinary Incontinence in Older Adults

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Urinary incontinence means a person leaks urine by accident. While it can happen to anyone, urinary incontinence, also known as overactive bladder, is more common in older people, especially women. Bladder control issues can be embarrassing and cause people to avoid their normal activities. But incontinence can often be stopped or controlled.

What happens in the body to cause bladder control problems? Located in the lower abdomen, the bladder is a hollow organ that is part of the urinary system, which also includes the kidneys, ureters, and urethra. During urination, muscles in the bladder tighten to move urine into the tube-shaped urethra. At the same time, the muscles around the urethra relax and let the urine pass out of the body. When the muscles in and around the bladder don’t work the way they should, urine can leak, resulting in urinary incontinence.

Incontinence can happen for many reasons, including urinary tract infections, vaginal infection or irritation, or constipation. Some medications can cause bladder control problems that last a short time. When incontinence lasts longer, it may be due to:

• Weak bladder or pelvic floor muscles
• Overactive bladder muscles
• Damage to nerves that control the bladder from diseases such as multiple sclerosis, diabetes, or Parkinson’s disease
• Diseases such as arthritis that may make it difficult to get to the bathroom in time
• Pelvic organ prolapse, which is when pelvic organs (such as the bladder, rectum, or uterus) shift out of their normal place into the vagina or anus. When pelvic organs are out of place, the bladder and urethra are not able to work normally, which may cause urine to leak.

Most incontinence in men is related to the prostate gland. Male incontinence may be caused by:

• Prostatitis, a painful inflammation of the prostate gland
• Injury or damage to nerves or muscles from surgery
• An enlarged prostate gland, which can lead to benign prostate hyperplasia, a condition in which the prostate grows as men age

Types of urinary incontinence

There are different types of incontinence:

• Stress incontinence occurs when urine leaks as pressure is put on the bladder, such as during exercise, coughing, sneezing, laughing, or lifting heavy objects. It’s the most common type of bladder control problem in younger and middle-aged women. It also may begin later, around the time of menopause.
• Urge incontinence happens when people have a sudden need to urinate and cannot hold their urine long enough to get to the toilet. It may be a problem for people who have diabetes, Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, or stroke.
• Overflow incontinence happens when small amounts of urine leak from a bladder that is always full. A man can have trouble emptying his bladder if an enlarged prostate is blocking the urethra. Diabetes and spinal cord injuries can also cause this type of incontinence.
• Functional incontinence occurs in many older people who have normal bladder control. They just have a problem getting to the toilet because of arthritis or other disorders that make it hard to move quickly.

Treating and managing urinary incontinence

Today, there are more treatments and ways to manage urinary incontinence than ever be­fore. The choice of treatment depends on the type of bladder control problem you have, how serious it is, and what best fits your lifestyle. As a general rule, the simplest and safest treatments should be tried first.

A combination of treatments may help you get better control of your bladder. Your doctor may suggest you try the following:

Bladder control training

• Pelvic muscle exercises (also known as Kegel exercises) strengthen the muscles that support the bladder, which can help you hold urine in your bladder and avoid leaks. Learn more about pelvic floor exercises and how to do them.
• Urgency suppression helps control strong urges to urinate so you can make it to a toilet on time. For example, you can try distracting yourself to help keep your mind off needing to urinate, taking long relaxing breaths, holding still, and squeezing the pelvic floor muscles.
• Timed voiding is used to help control your bladder through scheduling time to urinate. For example, you can set a plan to urinate every hour. As time goes on, you can slowly extend the time between toilet breaks.

Medical treatments

• Medications that come in a pill, liquid, or patch may be prescribed to help with bladder control problems. However, some medications for overactive bladder have been associated with a higher risk of cognitive decline in adults over age 65. Talk with your doctor about what medications, if any, would work best for you.
• Vaginal estrogen cream may help relieve urge or stress incontinence. A low dose of estrogen cream is applied directly to the vaginal walls and urethral tissue.
• Bulking agents can be used to help close the bladder opening. Doctors can inject a bulking gel or paste that thickens the area around the urethra. This can reduce stress incontinence but may need to be repeated.
• Medical devices may also be used to manage urinary incontinence, such as a catheter that drains urine from your bladder; a urethral insert that helps prevent leakage; and a vaginal pessary ring that provides pressure to lessen leakage.
• Biofeedback uses sensors to make you aware of signals from your body. This may help you regain control over the muscles in your bladder and urethra.
• Electrical nerve stimulation sends mild electric currents to the nerves around the bladder that help control urination and your bladder’s reflexes.
• Surgery can sometimes improve or cure incontinence if it is caused by a change in the position of the bladder or blockage due to an enlarged prostate.

Behavioral and lifestyle changes

Changing your lifestyle may help with bladder problems. Losing weight, quitting smoking, saying “no” to alcohol, choosing water instead of other drinks, and limiting drinks before bedtime can help with some bladder problems. Preventing constipation and avoiding lifting heavy objects may also help with incontinence. Even after treatment, some people still leak urine from time to time. There are bladder control products and other solutions, including disposable briefs or underwear, furniture pads, and urine deodorizing pills that may help.

Visit the National Institute of Diabetes and Digestive and Kidney Diseases for more information on urinary incontinence in men and urinary incontinence in women.

When to see a health care provider and what to expect

Talk to your health care provider if you have urinary incontinence or any signs of a bladder problem, such as:

• Needing to urinate more frequently or suddenly
• Cloudy urine
• Blood in the urine
• Pain while urinating
• Urinating eight or more times in one day
• Passing only small amounts of urine after strong urges to urinate
• Trouble starting or having a weak stream while urinating

Get tips on talking to your doctor about sensitive subjects.

Your doctor may recommend urodynamic testing and perform the following to try to figure out what might be causing your bladder problem:

• Give you a physical exam and take your medical history.
• Ask about your symptoms and the medications you take.
• Take urine and blood samples.
• Examine the inside of your bladder using a cystoscope — a long, thin tube that slides up into the bladder through the urethra. This is usually done by a urinary specialist.
• Fill the bladder with warm fluid and use a cystoscope to check how much fluid your bladder can hold before leaking.
• Order or perform a bladder ultrasound to see if you are fully emptying your bladder with each void.
• Ask you to keep a daily diary of when you urinate and when you leak urine. Your primary care doctor may also send you to a urologist, a doctor who specializes in urinary tract problems.

For more tips to keep your bladder healthy, visit 15 Tips to Keep Your Bladder Healthy.

For more information on urinary incontinence and bladder health

National Association for Continence
800-252-3337
[email protected]
www.nafc.org

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
800-860-8747
866-569-1162 (TTY)
[email protected]
www.niddk.nih.gov

MedlinePlus
National Library of Medicine      
www.medlineplus.gov

Simon Foundation for Continence
800-237-4666
[email protected]
www.simonfoundation.org

This content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date.

Content reviewed:
January 24, 2022

Related Articles

Urinary incontinence – Causes – NHS

Urinary incontinence is when the normal process of storing and passing urine is disrupted. This can happen for several reasons.

Certain factors may also increase your chance of developing urinary incontinence.

Some of the possible causes lead to short-term urinary incontinence, while others may cause a long-term problem. If the cause can be treated, this may cure your incontinence.

Causes of stress incontinence

Stress incontinence is when the pressure inside your bladder as it fills with urine becomes greater than the strength of your urethra to stay closed. Your urethra is the tube that urine passes through to leave the body.

Any sudden extra pressure on your bladder, such as laughing or sneezing, can cause urine to leak out of your urethra if you have stress incontinence.

Your urethra may not be able to stay closed if the muscles in your pelvis (pelvic floor muscles) are weak or damaged, or if your urethral sphincter – the ring of muscle that keeps the urethra closed – is damaged.

Problems with these muscles may be caused by:

• damage during childbirth – particularly if your baby was born vaginally, rather than by caesarean section
• increased pressure on your tummy – for example, because you are pregnant or obese
• damage to the bladder or nearby area during surgery – such as the removal of the womb (hysterectomy), or removal of the prostate gland
• neurological conditions that affect the brain and spinal cord, such as Parkinson’s disease or multiple sclerosis
• certain connective tissue disorders such as Ehlers-Danlos syndrome
• certain medicines

Causes of urge incontinence

The urgent and frequent need to pass urine can be caused by a problem with the detrusor muscles in the walls of your bladder.

The detrusor muscles relax to allow the bladder to fill with urine, then contract when you go to the toilet to let the urine out.

Sometimes the detrusor muscles contract too often, creating an urgent need to go to the toilet. This is known as having an overactive bladder.

The reason your detrusor muscles contract too often may not be clear, but possible causes include:

• drinking too much alcohol or caffeine
• not drinking enough fluids – this can cause strong, concentrated urine to collect in your bladder, which can irritate the bladder and cause symptoms of overactivity
• constipation
• conditions affecting the lower urinary tract (urethra and bladder) – such as urinary tract infections (UTIs) or tumours in the bladder
• neurological conditions
• certain medicines

Causes of overflow incontinence

Overflow incontinence, also called chronic urinary retention, is often caused by a blockage or obstruction affecting your bladder.

Your bladder may fill up as usual, but because of an obstruction, you will not be able to empty it completely, even when you try.

At the same time, pressure from the urine that’s left in your bladder builds up behind the obstruction, causing frequent leaks.

Your bladder can be obstructed by:

• an enlarged prostate gland (if you have a penis)
• bladder stones
• constipation

Overflow incontinence may also be caused by your detrusor muscles not fully contracting, which means your bladder does not completely empty when you urinate. As a result, the bladder becomes stretched.

Your detrusor muscles may not fully contract if:

• there’s damage to your nerves – for example, as a result of surgery to part of your bowel or a spinal cord injury
• you’re taking certain medicines

Causes of total incontinence

Total incontinence is when your bladder cannot store any urine at all. It can mean you either pass large amounts of urine constantly, or you pass urine occasionally with frequent leaking in between.

Total incontinence can be caused by:

• a problem with your bladder from birth
• injury to your spinal cord – this can disrupt the nerve signals between your brain and your bladder
• a bladder fistula – a small, tunnel like hole that can form between the bladder and a nearby area, such as the vagina

Medicines that may cause incontinence

Some medicines can disrupt the normal process of storing and passing urine or increase the amount of urine you produce.

These include:

• angiotensin converting enzyme (ACE) inhibitors
• diuretics
• some antidepressants
• hormone replacement therapy (HRT)
• sedatives

Stopping these medicines, if advised to do so by a doctor, may help resolve your incontinence.

Risk factors

In addition to common causes, some things can increase your risk of developing urinary incontinence without directly being the cause of the problem. These are known as risk factors.

Risk factors for urinary incontinence include:

• increasing age – urinary incontinence becomes more common in middle age and is very common in people who are over 80 years old
• family history – there may be a genetic link to urinary incontinence, so you may be more at risk if other people in your family have the problem
• having lower urinary tract symptoms (LUTS) – a range of symptoms that affect the bladder and urethra

Page last reviewed: 15 June 2023
Next review due: 15 June 2026

Improved urinary retention | Memorial Sloan Kettering Cancer Center

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This information will help you improve your urinary retention.

Urinary retention is the ability to prevent involuntary leakage of urine from the bladder. The involuntary leakage of urine is called incontinence. Incontinence can be caused by surgery or radiotherapy to the pelvis, or an overactive bladder.

There are a number of ways to help you train your bladder and improve your ability to hold urine. Your doctor or nurse will discuss with you which options are best for you. It depends on the diagnosis and the treatment you received. If you have questions, please contact your doctor or nurse.

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Drink less liquid

• Limit your fluid intake if your doctor or nurse advises. There are no hard and fast rules about how much water you need. You must drink when you are thirsty.
• If you frequently urinate (small to the toilet) at night, do not drink any liquids after dinner.
• If you take medication in the evening, take it with just one sip of water.

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Empty your bladder on schedule

• Urinate every 1 to 2 hours if possible.
  • If you do leak urine during this time, urinate more frequently.
  • If no urine leakage occurs after 1–2 hours, increase the time between urination.
• Don’t wait until the last minute before you urinate.
• Empty your bladder as much as possible every time you go to the toilet.
• If you are having difficulty urinating, urinate once and then exit the toilet. Urinate again after 5-10 minutes. Use the muscles of the abdominal wall (abdomen) to empty your bladder.

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Keep a urinary journal

Your doctor or nurse will give you:

• urination journal for recording data on the amount of urine and the frequency of urination;
• a plastic container for collecting urine (women are given a collection bowl, men are given a urinal).

Select any 3 day period. During these three days, urinate only into a bowl or urinal. After each urination, measure the amount of urine. Write it down in your urination journal. Then pour the urine down the toilet and flush. If you leave home before the end of the collection period, take a urinal or collection bowl with you, as well as a urination journal.

If you have incontinence, write down this information as well. Please indicate how this happened:

• when you were tense;
• pressure on the bladder, such as when coughing, sneezing, bending over, lifting or changing position;
• with uncontrolled urge;
• on the way to the toilet;
• without your knowledge.

Tell your doctor or nurse if you forget to measure your urine or are unable to do so.

Take your urinary log with you to your next appointment. Your doctor or nurse will review and discuss the notes with you.

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Do Kegel exercises (pelvic floor exercises)

The main purpose of Kegel exercises is to strengthen the pelvic floor muscles. This will help prevent urinary incontinence.

To find your pelvic floor muscles, imagine that you are urinating. Tighten the muscles with which you would interrupt the stream of urine during urination. You can also contract the muscles you use to hold back gas when you don’t want to let it out.

For Kegel exercises:

1. Tighten your pelvic floor muscles for 2-3 seconds.
2. Relax your pelvic floor muscles completely for 10 seconds.
3. Repeat the exercise 10 times. This is one approach.

Start doing Kegel exercises with 3 sets daily. Increase the number of sets to 7-10 per day as recommended by your doctor.

When you feel the urge to urinate, do 4-5 Kegel exercises. Focus on stopping the urge to urinate. Before coughing, bending over, or lifting heavy things, you should also do Kegel exercises.

For more information, read the resource Pelvic Floor (Kegel) Exercises for Women or Pelvic Floor (Kegel) Exercises for Men. For more specific Kegel exercise tips, visit the National Association for Continence (NAFC) website at www.nafc.com.

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Limit or eliminate foods and drinks that irritate the bladder

Some foods and drinks can irritate the bladder. Examples include foods and drinks containing caffeine or chocolate. More examples are given in the table below.

You may need to change your diet, limiting the amount of these foods and drinks at one meal. For example, don’t include apple juice, cereal with milk, and a banana in your breakfast at the same time. If you drink coffee, try not to add milk or sweeteners to it. Changing your diet will help you feel the need to urinate less often.

*Caffeine is also a diuretic. This means that it will make you urinate more often.

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Date last updated

Tuesday, May 14, 2019

Urinary incontinence: causes and treatments

How rehabilitation can help with urological problems

The topic of urinary incontinence is considered taboo, many are ashamed of the problem and put off visiting a doctor. At the same time, incontinence negatively affects important aspects of life – from the emotional state to the ability to leave the house and travel.

There are various causes of incontinence, such as post-surgery stress, stroke, spinal cord injury, and other nervous system disorders. In this text, we will analyze in detail the causes of incontinence, as well as effective methods of treatment and rehabilitation.

Causes and risk factors for urinary incontinence

One of the most common risk factors for urinary incontinence is older age. Women over 60 report daily urinary incontinence in the range of 9% to 39%, men over 65 experience this problem half as often – from 2 to 11%. Urinary incontinence in the elderly is statistically associated with a decrease in strength and overall muscle tone, especially in the pelvic floor muscles.

Regardless of age and gender, the risk of urinary incontinence is increased in people with diabetes and overweight. For young women, childbirth, gynecological and infectious diseases can become an additional risk factor – from 7 to 37% of women aged 20 to 39have been reporting this issue for years.

Urinary incontinence may be due to a stroke. In 32-79% of patients, incontinence occurs upon admission to the hospital and in 25-28% remains at discharge.

Normally, in order to prevent leakage of urine, the sphincters (muscle valves) of the urethra should be closed during the accumulation of urine in the bladder, and the muscle of the bladder should be relaxed.

When the bladder is full, signals from the bladder are transmitted to the spinal cord and then to the brain, after which the response signals follow the same path, causing the bladder to contract and the sphincters to open. As a result, urine flows out of the bladder.

Frequent urination after a stroke is associated with overactive bladder muscle, which occurs due to impaired communication between the central nervous system and the bladder. Risk factors for urinary incontinence: paresis (decreased strength in any part of the body), depression, cognitive impairment, age over 75 years, dysphagia (impaired swallowing), loss of visual field and a large area of ​​\u200b\u200bbrain damage (lesion of the cortex and subcortical region) .

“Recently, a patient came to our clinic after a stroke with frequent false urge to urinate and episodes of urinary incontinence day and night,” says Ivan Kolbin, a neurourologist at the Three Sisters clinic. – Before each physical therapy session, the patient goes to the toilet because he is afraid that involuntary urination will occur during the exercises. At night, a man does not get enough sleep, as he wakes up at least four times because of the desire to go to the toilet. All this greatly affects his quality of life and emotional state. But this is solvable. If you choose the right therapy, then after 2-3 weeks the symptoms will go away or significantly decrease.

The main functions of the bladder – the accumulation and excretion of urine – are also impaired in spinal cord injuries. It is not uncommon for patients with spinal cord injury to stop feeling bladder fullness and the need to urinate. It is also likely that the person will not control the work of the sphincter of the urethra.

“If the patient has damage at the cervical or thoracic level, then frequent urination and urinary incontinence is associated with a spastic bladder that does not hold urine when filled. Although the signals between the bladder and the spinal cord are passing, the signals between the brain and the bladder have disappeared, so the person does not feel the fullness of the bladder and cannot control urination. The bladder muscle and urethral sphincter in this case are hyperactive, in addition, the joint work of these muscles is disrupted, says Ivan Kolbin. – In patients with lesions at the lumbar or sacral level, the situation is the opposite: the tone of the bladder is reduced, there are no contractions, the bladder gradually overflows and incontinence from overflow occurs. Failure to completely empty the bladder can lead to problems. Temporary placement of a urethral catheter is recommended in these patients to avoid overdistension of the bladder and prevent urinary tract and kidney complications. ”

Temporary placement of a urethral catheter is recommended in these patients to avoid overdistension of the bladder and complications of the urinary tract and kidneys

a number of other cases.

“Prolonged use of a catheter sometimes causes a nosocomial infection that can contribute to urinary incontinence. Hygiene and regular intermittent catheterizations are important to avoid inflammation of the urinary tract, because the longer urine remains in the bladder, the more likely bacteria will multiply and cause inflammation. It is also important that the bladder is completely emptied and that there is no residual urine left in it, which contributes not only to inflammation, but also to the formation of stones. An indwelling catheter should be changed regularly. During catheterization, it is important not to damage the urethra, as this also creates the prerequisites for inflammation.

Urinary incontinence, in both men and women, can be stressful. Stress incontinence in women is more often associated with birth injuries, hormonal disruptions, and surgeries. In men, stress incontinence in most cases occurs after a prostatectomy (surgery to remove all or part of the prostate for prostate cancer) and after a transurethral resection (surgery for a benign prostate tumor).

Incontinence after prostatectomy is also associated with the fact that when the prostate gland is cut off from the urethra, its back wall is partially damaged. The function is restored, as a rule, within 6 months after the operation. The number of patients with persistent urinary incontinence after surgery can reach 11.9%.

Treatment and rehabilitation

Pelvic floor training

Regular exercise is said to make the pelvic floor muscles stronger and stronger. Classes are held under the supervision of a doctor or with a smartphone, which tell the patient when to contract muscles and when to relax. It takes an average of 20 weeks to achieve results.

Kegel exercises help strengthen your pelvic floor muscles. But they are not shown to everyone. For example, in men after a stroke, mostly neurogenic damage occurs, in which drug therapy is sufficient. Muscle tone is more likely to decrease in women, especially with additional risk factors such as childbirth.

Electrical stimulation

This method is effective for men with urinary incontinence after prostatectomy.

Electrical stimulation (ES) activates the pudendal nerve. This causes the pelvic floor muscles to contract and also keeps the urethral sphincter closed and reduces the urge to urinate.

Electrical stimulation can be anal – when a special probe is inserted into the anal canal, as well as percutaneous – when overhead electrodes are placed (for example, on the hamstring or in the sacrum).

Extracorporeal magnetic innervation

This technique is effective in the complex treatment of urinary incontinence and works on the same principle as MRI: a device that is built into the seat of the chair creates a magnetic field. Next to the chair is a power supply unit with which the doctor can adjust the strength of this field. The doctor selects an individual dose of magnetic radiation for the patient, which improves the conduction of the nerve impulse and stimulates the contraction of the pelvic floor muscles. Unlike anal electrical stimulation, this method causes less discomfort for the patient.

General advice for patients with urinary incontinence

It makes sense to consult with your doctor about some aspects of your life. Perhaps he will advise:

• Limit fluid intake, drink in doses (no more than 200 ml of water at a time), drink less after 18:00, and also empty the bladder before bedtime so as not to get up at night and get better sleep.

“These are temporary restrictions,” says Ivan Kolbin. “Once the bladder again accumulates and holds a large portion of urine, you can return to the usual way of life.”

• Avoid excessive consumption of caffeinated, alcoholic and carbonated drinks.

“Caffeine stimulates urination even in patients without neurogenic disorders and stroke. Therefore, it is better for patients with urinary incontinence to limit coffee and, if there is such a need, drink it in the morning. If the patient himself notes the relationship between the intake of caffeinated drinks and incontinence, then it should be completely excluded, ”Ivan Kolbin.

• Exercise to strengthen the pelvic floor muscles.

“The intensity of exercise depends on the condition of the patient. In most cases, Kegel exercises are enough to do 30 sets 3 times a day, ”- Ivan Kolbin.

• Watch your weight – being overweight can put pressure on your bladder and make you want to urinate.

The experience of the Three Sisters clinic in helping people with urinary difficulty

Patients with urinary incontinence are most often admitted to the Three Sisters Clinic after stroke and spinal cord injury. In these cases, rehabilitation specialists work with them to strengthen the muscles of the pelvic floor. For example, Kegel exercises are recommended. The doctor supervises the exercises and teaches the patient to do them on their own so that they can continue exercising at home after discharge.

The main goal of rehabilitation is to regain control of urination and urinary retention. It is important that urination is voluntary and the patient, depending on the severity of the violation, has time to get to the toilet or other auxiliary means of rehabilitation.

If a person holds urine, then the next goal is to increase the intervals between urination and work on control. For example, if an urge appears, the patient needs to learn how to hold urine so as not to interrupt the session and not immediately run to the toilet. The quality of rehabilitation and life in general depends on this.

Physicians also prescribe medication individually:

• Alpha-blockers, which are recommended for men because they help relax the sphincters and the prostate gland. This allows urine to pass freely, and alpha-blockers also help reduce the pressure in the bladder that occurs when urine passes.