What Are the Most Common Causes of Bladder Incontinence in Older Women?

5 answers | Last updated: Feb 06, 2018
A fellow caregiver asked...

What are the most common causes of bladder incontinence in older women?

Expert Answers

Dr. Leslie Kernisan is the author of a popular blog and podcast at BetterHealthWhileAging.net. She is also a clinical instructor in the University of California, San Francisco, Division of Geriatrics.

The answer depends on whether the incontinence is temporary (short-term) or chronic (ongoing). Common reasons for temporary incontinence include urinary tract infection, a medication side effect, drinking too much caffeine or alcohol, and delirium. When the situation changes or is treated, the incontinence tends to end quickly. These same situations can also exacerbate chronic incontinence.

The five most common causes of bladder incontinence in women over age 50 are:

Stress incontinence

This kind of incontinence -- by far the most common type affecting women -- occurs when pressure (the "stress" in its name) is put on the abdomen, such as when sneezing, coughing, getting out of bed or a chair, laughing, or doing some kinds of exercise. The neck of the bladder and the urethra fail to close properly, due to some kind of structural weakness, and the pressure pushes urine out of the bladder. (People with strong muscles can withstand the extra pressure and therefore aren't incontinent.)

Many women first experience stress incontinence after childbirth, when the pelvic floor muscles that support the bladder neck and urethra are stretched and weakened. If it doesn't clear up on its own and is left unaddressed, the problem can persist for years.

Then at menopause, the tissues that line the urethra can thin due to a loss of estrogen, and bladder and urethral sphincter muscles weaken. Someone who's had colorectal surgery or a full or partial hysterectomy is also at higher risk.

Urge incontinence

Urge incontinence (also called overactive bladder) is a sudden, strong need to urinate before the leakage.

Nerve damage (from injury or a nerve disorder such as Parkinson's disease) is a common cause. The nerves may send wrong information to the brain about when the bladder needs to "go." Urge incontinence may also be the result of some other medical condition, such as stroke, diabetes, infection, or a tumor blocking nerve signals. However, in most chronic cases, no specific cause for the urge incontinence can be found.

Functional incontinence

In this situation, the person has normal bladder control, but physical limitations impair the ability to use a toilet promptly. For example, the person may have arthritis or Parkinson's disease, which makes it difficult for them to move quickly and efficiently. People suffering from dementia (such as Alzheimer's disease) may have incontinence if they forget or don't notice their need to go to the bathroom.

Overflow incontinence

In overflow incontinence, the person never feels the urge to urinate and the bladder simply keeps filling, until small amounts literally overflow the bladder and leak out.

In some cases caused by nerve damage, the brain receives no messages that bladder is full until it's too late. In other cases, the cause is an obstruction of the bladder outlet due to a prior surgery or prolapse.

Mixed incontinence

Many older people have a combination of types of incontinence, such as stress incontinence with urge incontinence, or urge incontinence with functional incontinence.

Community Answers

Dengue answered...

what to do about incontinence

Charlyd+83 answered...

Senior dementia, is an answer but getting a doctor, even a neurologist to diagnose is near impossible. When loss of memory begins to be a serious problem, a diagnosis is still a flippant, Oh that's just part of getting old.

Doctors need to be educated on senior dementia.

Daffi answered...

This worked for me at the beginning of a new job...I was fortunate to find a solution quickly, and to solve a sudden incontinence that was baffling.

I was in construction and put my dust mask in my pocket with my kleenex/tp...for running in to use restrooms I prepared for final inspection. It turns out that the tissue was being contaminated by the dust mask, and this may be helpful for someone because in any travels or errands you may have exposure to tissues that are accidently sprayed by any contaminants etc.

A fellow caregiver answered...

And sometimes it's just due (at least partly) to laziness.

My mom was having trouble getting to the bathroom in time due to physical infirmities; after a bad fall in the shower, she hurt so bad and moved even slower, so I suggested she wear an incontinent pant for a few days, until she started feeling better. She now claims that she doesn't know she has to go until she starts going.

Her doctor has prescribed Ditropan (she's up to 4 times daily now), but she says there's no improvement.

This is the main reason I've held off getting a hospital bed for her to sleep in - I KNOW that within a month she will start making excuses (I'm tired; I hurt a lot today) to stay in bed for the day, and within a month of that she will be wanting to stay in the bed full time. At that point, I'll no longer be able to care for her properly - she's large, and there's no room for her to roll to her side in a hospital bed so I won't be able to clean her after a BM.

I've told her this, but since it's something she doesn't want to hear, she's not hearing it. Most everyone else just thinks I'm being mean by making her sleep in her recliner (she can't lay flat in a regular bed and hasn't slept in one for several years). The ONLY good thing about her staying full time in a bed is that it would be in her bedroom and I wouldn't have to hear the TV going 24/7 in the living room!