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:
Bladder training (also called bladder retraining)
Physical therapy, including Kegel exercises
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:
Familiarize yourself with your personal bladder triggers and know how to turn them off.
Know how to stop incontinence from sabotaging your sex life.
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:
How to make helping with toileting safe and easy, whether the person is bedridden, mobile, or has a catheter.
How to clean the skin after someone with incontinence has an accident.
How to prevent and recognize signs of urinary tract infections.
What to say and what never to say to an incontinent person. Empathy and humor can go a long way toward improving the quality of life for a loved one with incontinence.