What Is Incontinence?

Basic facts about a common health issue for older adults
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Incontinence -- loss of bladder or bowel control -- affects as many as half of older adults at some point, affecting both women and men. Incontinence can complicate caregiving and cause needless embarrassment.

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Types of incontinence

Urinary incontinence, also called bladder incontinence, refers to the involuntary loss of urine from the bladder. It's more common in older adults than bowel incontinence (also called fecal incontinence), the loss of bowel control.

The main types of chronic urinary incontinence are:

  • Overactive bladder, (which is also called urge incontinence), in which the person continually feels the need to urinate

  • Stress incontinence, or leaking small amounts of urine when sneezing, coughing, lifting, or even having sex

  • Overflow incontinence, in which the bladder never completely empties

  • Functional incontinence, caused by physical impairments that prevent efficient toileting

  • Prostate incontinence, which affects men who have prostate enlargement, infection, or surgery

It's common to have a mix of different types of incontinence.

Causes of incontinence

Incontinence is not a normal part of aging. It's more common in older adults, though, because many of the conditions that can cause incontinence are associated with increasing age. These include wear and tear on supporting musculature, a history of pelvic-floor problems in women, and prostate problems in older men.

Those at risk for chronic incontinence problems include diabetics, the overweight and obese, arthritics, people with multiple sclerosis or Parkinson's disease, those with dementia, and men with prostate problems.

New or worse-than-usual incontinence can also easily be caused by an acute problem, such as a urinary tract infection, medication side effects, or delirium. For this reason, it's always important to see a doctor about new or suddenly worse incontinence symptoms.

Incontinence symptoms

Clues that the elimination system isn't working right can take many forms. Signs of overactive bladder, for example, include frequent urination and waking at night to use the bathroom. Your bladder may also be trying to tell you something if you're experiencing burning upon urination or leak small amounts when you cough, sneeze, or have sex.

Other signs you may need to see a urologist can be surprising, such as a shrinking social life (because of fears of being unable to find bathrooms on time), or lying down to relieve a sensation of heaviness. Changes in bladder habits can reflect your broader health. Beyond the bladder itself, a problem may lie with the pelvic organs or in something more systemic, such as sleep apnea or diabetes.

A thorough medical exam can usually establish the cause or causes of incontinence.

Women's common incontinence problems

Women over 40 experience the highest rates of incontinence. Women are especially affected by two types of incontinence: overactive bladder and stress incontinence, which can happen when pregnancy, childbirth, obesity, or menopausal changes weaken the structures involved in urination. Menopause is a common cause of overactive bladder.

Other types of incontinence in older women include:

  • Functional incontinence

  • Overflow incontinence

  • Mixed incontinence

Men's common incontinence problems

The most common causes of incontinence problems in older men are:

  • Urge incontinence (overactive bladder)

  • Overflow incontinence

  • Prostate incontinence or incontinence after prostate surgery

  • Functional incontinence

  • Stress incontinence

  • Mixed incontinence

Treatments for incontinence

Most forms of incontinence are considered highly treatable. Treatments for incontinence include:

It's possible for incontinence to clear up on its own, but this depends on the cause; most types affecting older adults are chronic (long-term). New or worse-than-usual incontinence should always prompt a workup for an acute cause, such as a urinary tract infection or a medication side effect.

Surgery is a last-resort option, although it's also possible to fix a leaky bladder without surgery with physical therapy and some of measures described above.

Living with incontinence

It's possible to live normally with a leaky bladder. In addition to the treatments recommended above, it helps to:

Caring for someone who's incontinent

Many family members find talking to someone who's incontinent to be difficult. Yet it's just as useful to understand how to cope with the emotional side of incontinence as it is to know how to manage the practical care for someone who's incontinent. Compassionate understanding can add to quality of life and keep someone living independently longer. Incontinence is a leading cause of out-of-home placement.

It also helps for a caregiver to know:

Paula Spencer Scott

Paula Spencer Scott is the author of Surviving Alzheimer's: Practical Tips and Soul-Saving Wisdom for Caregivers and much of the Alzheimer's and caregiving content on Caring. See full bio