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

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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

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causes, symptoms and effective treatments for dysfunction

Contents

• 1 Neurogenic bladder: causes, symptoms and effective treatments for dysfunction
  • 1. 1 Neurogenic bladder: main causes and symptoms
  • 1.2 What is a neurogenic bladder?
  • 1.3 Causes of neurogenic bladder dysfunction
  • 1.4 What are the symptoms of bladder dysfunction?
  • 1.5 Diagnosis of bladder dysfunction
    • 1.5.1 Symptoms
    • 1.5.2 Diagnosis
    • 1.5.3 Variants of dysfunction
  • 1.6 Methods of treatment bladder dysfunction
    • 1.6.1 1. Medical treatment
    • 1.6.2 2. Physiotherapy
    • 1.6.3 3. Surgical treatment
    • 1.6.4 4. Alternative treatments
  • 1 .7 Treatment of neurogenic bladder dysfunction
    • 1.7.1 Pharmacotherapy
  • 1.8 Bladder rehabilitation
    • 1.8.1 Physical therapy
    • 1.8.2 Drug treatment
    • 1.8.3 Lifestyle modification
    • 1.8.3 8.4 Surgical treatment
  • 1.9 Folk remedies for bladder dysfunction
  • 1.10 Improving the effectiveness of the treatment of bladder dysfunction
  • 1. 11 Complications of bladder dysfunction
  • 1.12 Conclusions

  90 058 1.13 Related videos:

  • 1.14 Q&A:
    • • 1.14 .0.1 What is a neurogenic bladder?
      • 1.14.0.2 What causes a neurogenic bladder?
      • 1.14.0.3 What are the symptoms of a neurogenic bladder?
      • 1.14.0.4 How is neurogenic bladder diagnosed?
      • 1.14.0.5 How to deal with a neurogenic bladder?
      • 1.14.0.6 What are the complications of neurogenic bladder?

Find out the causes, symptoms, and effective treatments for neurogenic bladder dysfunction. Detailed information about the disorders that cause dysfunction and how to correct it.

Bladder dysfunction is a common disorder in people of all ages. Neurogenic bladder, on the other hand, is a more complex and less common form of bladder dysfunction that is produced by the nervous system.

This type of dysfunction can occur in both adults and children and can cause pain and discomfort, an increased risk of urinary tract infections, and even treatment-related side effects. This article provides information about the causes, symptoms, and recent developments in the effective treatment of neurogenic bladder.

In addition, this article also contains tips and advice on preventive measures to help reduce the risk of this disorder and maintain an overall healthy bladder.

Neurogenic bladder: main causes and symptoms

Neurogenic bladder is a condition in which the nervous system loses control of the urinary function and the patient loses the ability to control their bladder. This condition can be caused by various reasons, including damage to the nervous system, infectious diseases, diabetes, and others.

In order to effectively treat a neurogenic bladder, it is important to identify the causes of this condition. In some cases, treatment may include drug therapy to improve urinary control, and in more severe cases, surgery may be required. Regular medical monitoring and appropriate treatment will help patients with neurogenic bladder maintain their urinary function and improve their quality of life.

What is a neurogenic bladder?

Neurogenic bladder is a condition in which the nervous system cannot control urination, causing urine to be held in the bladder. This inability may be the result of damage to the nerves that are connected to the bladder and control its functioning.

Neurogenic bladder dysfunction can occur as a result of spinal cord injury, diseases such as multiple sclerosis, infections of the nervous system, rare genetic diseases such as Rett syndrome, and other causes.

Symptoms of a neurogenic bladder include: inability to hold back urine, involuntary urination, poor urine output, painful urination, frequent urination, bladder fungus, and urinary tract infections.

Causes of neurogenic bladder dysfunction

Neurogenic bladder occurs as a result of damage to the nervous system that controls the functioning of this organ. The causes can be diseases such as multiple sclerosis, Parkinson’s disease, spinal muscular atrophy, spinal cord injury and others.

One of the main causes of is diabetic neuropathy, where the bladder is unable to store and excrete urine properly. Also, bladder dysfunction can develop with cerebrovascular accidents, diseases of the peripheral nervous system, urinary tract infections, as well as in stressful situations and other pathologies associated with the function of urination.

Often neurogenic bladder occurs with disorders of the spinal cord, when the nerves that are responsible for controlling urination do not function normally. Tumors, stenosis of the ureters, prostate adenoma, bladder stones and other pathologies that prevent the normal excretion of urine can also be causes.

In some cases unexplained causes may also be associated with the development of a neurogenic bladder. It is important to regularly monitor the health of the bladder and seek timely help from specialists if symptoms of dysfunction occur.

What are the symptoms of bladder dysfunction?

Bladder dysfunction is a violation of functional activity. It can manifest itself in the form of various symptoms, such as:

• Frequent urination more than 8 times a day;
• Insufficient bladder emptying Feeling of a full bladder after urination;
• Unreasonable urge to urinate – a strong desire to urinate with an empty bladder;
• Erasing the boundaries between the urge to urinate – no break between the urge to urinate;
• Bedwetting – inability to hold urine during the night, which leads to nocturnal awakenings to urinate;
• Diurnal incontinence is the inability to hold urine during the day, which may result in urine spilling into underpants.

Bladder dysfunction symptoms can be indicative of various forms of dysfunction and should be evaluated by a qualified urologist. Only he can determine the cause of the violation and choose an effective treatment.

Diagnosis of bladder dysfunction

Symptoms

The main symptoms of bladder dysfunction are: frequent urination (more than 8 times a day), insufficient emptying of the bladder, inability to control urination, pain during urination or obstruction, and bedwetting.

Diagnosis

Diagnosis of bladder dysfunction requires urine and blood samples and an ultrasound of the bladder. In some cases, cystometry and urometry may be required, tests that can help determine bladder volume and muscle strength.

Types of dysfunction

There are several types of bladder dysfunction: overactive, underactive and mixed types. The hyperactive type is characterized by frequent urination and inability to control urination. The hypoactive type, on the contrary, is associated with insufficient emptying of the bladder and difficulty urinating. The mixed type includes features of both variants and may present differently in each patient.

Treatments for bladder dysfunction

1. Medication

If your bladder is dysfunctional, your doctor may prescribe medications that increase bladder contractions, which helps the sphincter interact with the bladder. Medications to reduce spasticity and sensitivity, antibiotics for infections, and alpha-blockers to improve urine output may also be used.

2. Physiotherapy

A combination of physiotherapy exercises, which may include gymnastics, abdominal massage, and electrical stimulation, can help improve bladder and sphincter muscle tone. They also perform a bladder transfusion, which helps to improve its functioning.

3. Surgery

In some cases, the treatment of bladder dysfunction may require surgery. Most often, operations are performed that are aimed at increasing the capacity of the bladder, eliminating a narrow ureter, or installing a special stimulator that will control the functioning of the bladder and sphincter.

4. Alternative Therapies

Some people choose to treat bladder dysfunction with alternative therapies such as yoga, acupuncture, or meditation. However, the effectiveness of these methods has not been proven and their use should be in consultation with the doctor.

Treatment of neurogenic bladder dysfunction

Pharmacotherapy

Pharmacotherapy is one of the main treatments for neurogenic bladder dysfunction. The medications that are used in this case may vary depending on the cause of the bladder problem and the severity of the symptoms.

Anticholinergic drugs, which block acetylcholine receptors and reduce bladder flexor muscle activity, may be used to reduce bladder spasms. This can reduce the feeling of urinary urgency and reduce the frequency of insufficient urination.

In addition, in cases where neurogenic bladder dysfunction is caused by an infection, antibiotics may be given to treat the infection and prevent recurrence.

It is important to remember that prescribing medicines should only be carried out by a doctor and strictly follow the recommendations and instructions for use. Uncontrolled use of drugs can lead to negative consequences and deterioration of the patient’s condition.

Bladder rehabilitation

Physical therapy

Physical therapy is an important part of neurogenic bladder rehabilitation. It includes Kegel exercises, which are aimed at strengthening the muscles of the bladder and help increase its capacity. Bladder muscle electrical stimulation can also be performed, which reduces convulsions and increases muscle strength.

Medications

Medications may include medications to reduce the urge to urinate, improve communication between the brain and the bladder, and reduce bladder muscle spasms. Medicines should be taken only under the supervision of a doctor and follow his recommendations.

Lifestyle changes

With neurogenic bladder dysfunction, it is important to monitor your drinking regimen and urological hygiene. Patients are advised to reduce fluid intake in the evening and at night, and to go to the toilet on a schedule to prevent bladder overflow. Alcohol and coffee should also be avoided, as they can worsen symptoms of dysfunction.

Surgery

In some cases where bladder dysfunction is accompanied by urinary stones or other problems, surgery may be required. However, surgical treatment is a last resort and is prescribed only in the absence of the effectiveness of conservative methods.

Benefits of Bladder Rehabilitation

Folk remedies for bladder dysfunction

Bladder dysfunction is a serious disorder that requires qualified medical attention. But in addition to medical and surgical treatment, there are many alternative methods that can help cope with the problem.

Another way to treat bladder dysfunction is to use heat. For example, a warm compress can be applied to the abdomen using herbal decoctions or bear bile. It is also effective to use rubbing warming ointments and creams.

1. Traditional medicine based on the beneficial properties of natural ingredients, can be an effective addition to the main treatment of bladder dysfunction;
2. However, it must be remembered that before using any folk remedy, it is necessary to consult a doctor to avoid possible side effects;
3. It is important to note that folk remedies can only help in cases of mild bladder dysfunction and are not an alternative to qualified medical treatment.

Increasing the effectiveness of the treatment of bladder dysfunction

Bladder dysfunction is a serious disease requiring complex treatment. Below are recommendations that will help improve the effectiveness of treatment:

• Compliance with the drinking regimen. It is recommended to drink enough water and avoid alcoholic and sugary drinks, which can depress the functionality of the bladder.
• Dieting. Foods that can irritate the bladder, such as coffee, spicy and fatty foods, should be avoided.
• Physical exercise. It is important to engage in special exercises aimed at strengthening the muscles of the bladder and reducing stress.
• Regular monitoring. After the start of treatment, regular monitoring by a physician is required, who will monitor the effectiveness of treatment and prescribe the necessary adjustments.

It is important to remember that each case of the disease is individual, so the treatment should be selected individually, taking into account the characteristics of the patient and the form of the disease.

Complications of bladder dysfunction

Bladder dysfunction can lead to serious complications that manifest themselves in various areas of a person’s life.

• Urinary system. Failure to pass urine can cause urinary retention in the bladder and lead to severe pressure on the bladder walls. This in turn can cause bladder enlargement and increased pressure on the kidneys, which can be damaged.
• Life. Bladder dysfunction can negatively affect a person’s quality of life. Excessive pressure on the abdominal cavity can cause pain and discomfort. It can also lead to other problems such as muscle spasms and pain syndromes.
• Sex life. Violation of urination may adversely affect sexual life. Bladder dysfunction can affect the ability to have an erection in men, as well as the ability to achieve orgasm in both sexes.

All of these complications can, over time, impair the quality of life and harm a person’s health. Therefore, seeking medical help and successfully treating bladder dysfunction is very important.

Conclusions

Neurogenic bladder is a serious disorder that requires a complex approach to treatment and is often a symptom of other diseases.

Treatment may be conservative or surgical, depending on the extent and cause of the dysfunction. It is also important to use rehabilitation methods and methods to reduce pain symptoms.

Patients should receive psychological support and education about the possibilities on the path to full recovery.

Despite the fact that the neurogenic bladder requires a long and complex treatment, modern techniques and advanced technologies can provide high rates of efficiency and quality of life for patients.

Related videos:

Q&A:

What is a neurogenic bladder?

Neurogenic bladder is a condition in which it is painful to control your urinary function. The nervous system that controls urination does not work properly, which can lead to malfunctioning of the bladder and urinary tract.

What causes a neurogenic bladder?

The causes of neurogenic bladder may be different, but most often it is associated with diseases and injuries of the nervous system, such as multiple sclerosis, spinal cord lesions, diabetic neuropathy, cervical sciatica and others. It may also be associated with certain medications and other medical procedures.

What are the symptoms of a neurogenic bladder?

The main symptoms of a neurogenic bladder are urination disorders, frequent urination, inability to hold urine, sudden and unpredictable urination, painful urination, urinary tract infections.

How is neurogenic bladder diagnosed?

To diagnose a neurogenic bladder, the doctor performs a detailed examination and diagnosis of symptoms, measures the volume of the bladder and the speed of urination. Uroflowmetry, ultrasound, cystoscopy and other studies may also be prescribed.

How to cope with a neurogenic bladder?

Neurogenic bladder can be managed with bladder muscle exercises, medications, botulinum toxin injections, and surgical treatments. It is necessary to consult a doctor who will prescribe the most effective method of treatment, depending on the severity of the symptoms and the cause of the neurogenic bladder.