Aging & incontinence

If you’ve watched a loved one get older, you’ve probably noticed changes in their physical condition. Maybe they’re not as fit or trim as they once were. Maybe their eyesight and hearing aren’t as good as they used to be. It’s natural. 

And they might have a similar problem with their urinary system. With age, it works less effectively than when they were younger. As a result, they lose some or all control over their bladder and bowels. It’s a common condition called incontinence. 

Bowel and urinary incontinence are conditions where a person accidentally passes stool or urine.1 This happens when there’s a problem with how the bladder, rectum, or anus function.¹

Incontinence could occur due to several factors, such as: ¹

• Side effects from certain medications
• Stress
• Weak pelvic floor
• Infections
• Chronic health conditions, such as a stroke

While incontinence is common among older adults, it’s not always a natural part of aging.2,3 With the right care and understanding, many seniors could feel more comfortable and supported.

Several types of incontinence could affect older adults. Each type has different causes and symptoms: ^5,6

Stress incontinence happens when pressure is placed on the bladder, often during everyday actions like sneezing, laughing, coughing, or lifting something heavy. This can lead to small leaks and causes might include:

• Obesity or carrying extra weight
• Hormonal changes, such as menopause
• Prostate cancer
• Muscle damage around the bladder
• Certain medications

Urge incontinence (also called overactive bladder) involves a sudden, intense urge to urinate before reaching the toilet. Causes can include:

• Nerve damage in the bladder
• Age-related changes
• Menopause
• Neurological conditions (like having a stroke)
• Health conditions like diabetes

Overflow incontinence occurs when the bladder doesn't fully empty when using the toilet. Common causes include:

• Constipation
• Nerve damage
• An enlarged prostate
• Certain medications

Functional incontinence is when a person is physically or mentally unable to reach the bathroom in time. This could often happen with conditions like dementia or arthritis.

Mixed incontinence is a combination of both stress and urge incontinence. It's especially common in women. Causes may include:

• Childbirth
• Pregnancy
• Nerve damage
• Past surgeries to the rectum, vagina, or prostate
• Chronic health conditions like multiple sclerosis

Incontinence can be embarrassing and frustrating for your loved one. Going to the bathroom, a private function they once took for granted, could suddenly become beyond their control.  

What’s the first thing to do if your elderly loved one loses control of their bladder and/or bowels? Try not to panic. It may be awkward and embarrassing for both of you at first. But be assured: incontinence is an often-faced problem and there are ways you can help them to deal with it.

You can help by being understanding. By trying not to be embarrassed or judgmental about their situation. Learn more about incontinence, and the practical things you can do for your loved one. Care for them in a loving manner, and it could bring the two of you closer together. 

To understand your loved one’s condition better, consider what’s happening in their aging body.

As they’ve grown older, their organs, muscles and nerves might stop working effectively together. 

To be able to keep continent we need support from the pelvic floor muscles and sphincter muscles. These important muscles assist in urinary and fecal continence. When we get older, these muscles might weaken for different reasons and therefore cause urinary leakage. It can also be that nerves connecting the brain and bladder could be sending the wrong signals. 

In addition, also as a result of age, our kidneys and bladder might not work as effectively as when we were younger. (Generally, in a healthy aging person, kidney function remains normal. But illness, medicines, and other conditions can impair kidney function.) 

While aging could affect the bladder, not all seniors will experience incontinence.3 Aging is just one of many factors that could play a role. Other factors include:^3,4

• Certain medications
• Past surgeries to the pelvis or lower abdomen
• Dietary changes
• Memory loss or trouble thinking clearly
• Ongoing health conditions, such as multiple sclerosis, stroke, or prostate problems
• Trouble moving around

While incontinence can be a sensitive topic, it is manageable.4 It’s also important to know what happens to our kidneys and bladder as we age to be able to help as caregivers.

The renal function is at increased risk of declining as we age. This is seen as a reduced blood flow to the kidneys and reduced production of anti-diuretic hormone (ADH).

This hormone concentrates the urine (recovering water into the body). When this hormone level is reduced, more urine is produced, especially at night. This is also a reason why it is normal for an elderly person to need to use the bathroom a few times per night.

The bladder is a muscle sac. With aging, the bladder muscles are at increased risk of starting to lose tone and function. This leads to a reduced ability to contract and squeeze. As a result, the bladder takes a longer time to empty and might not totally empty, leaving some urine in the bladder.

The bladder also becomes less stretchy and cannot hold as much urine as before. The emptying reflex is triggered later when the bladder is almost full. This gives an elderly person less warning time to get to the bathroom to empty their bladder.

The urethra can become blocked. In women, this can be due to weakened muscles that cause the bladder or vagina to fall out of position (prolapse). In men, the urethra can become blocked by an enlarged prostate gland. These conditions are important to detect early in order to get the right treatment.

Symptoms can include:

• difficulty in starting to urinate
• feeling that the bladder is not emptied after urinating
• an interrupted or weak urine stream
• a frequent urge to urinate and frequent nighttime urination.

Not being able to empty the bladder completely can cause the bladder to be filled with residual urine which causes overflow urinary incontinence and is also a risk for urinary tract infections.

If your loved one has become less mobile with age, they might not find it easy to reach the bathroom. The result is, when they need to go, they can’t get there in time. Then they depend on a caregiver like you to help them with their incontinence.

Treatment Options from Doctors

Treatment depends on the type and cause of incontinence, so getting a professional assessment is an important first step.4 A healthcare provider can help identify the best option for your loved one.

Common treatment approaches could include:⁴

• Incontinence pads: Special products offer comfort and protection from leaks throughout the day.
• Electrical stimulation: A mild current is sent to the pelvis to help with bladder control.
• Pessary: It is a medical device that helps reposition the urethra to avoid leaks.
• Medications: Botox and alpha-blockers are options that can help ease symptoms.
• Catheters: A tube that helps drain the bladder. It’s helpful when the bladder doesn’t empty properly.
• Surgery: In extreme cases, or if a blockage is causing incontinence.

Techniques to Improve Bladder Control

Simple techniques could make a big difference in managing bladder leaks in seniors. Two helpful methods are bladder training and pelvic floor exercises (also called Kegels).⁴

Bladder Training

Bladder training could help your loved one wait longer between bathroom trips.6 It teaches the bladder to hold more urine before the urge strikes.6 As a caregiver, you can support this process by: ⁶

• Tracking bathroom trips: Help them keep a “bladder diary” that records when they urinate and any leaks.
• Creating a schedule: Use the diary to set regular bathroom times, even before they feel the urge.
• Setting small goals: Encourage them to wait 15 minutes longer between trips over time.
• Celebrating progress: Acknowledge their efforts, it helps them stay motivated.

Pelvic Floor Exercises

These exercises strengthen the muscles that help your loved one control their urine flow.4 With time, they can improve bladder control and reduce leaks. Here's how you can help:⁴

• Help them find the right muscles: These are the same muscles used to stop urinating mid-stream (note: only use this as a one-time guide).
• Guide the rhythm: Encourage holding the muscle for about 10 seconds, then relaxing for 10 seconds.
• Add to their routine: Aim for 3 to 4 sets each day, during quiet times like sitting or lying down.

Everyday Habits That Can Help

Gentle daily habits can go a long way in helping senior’s bladder health.7 You could try these simple adjustments:⁷

• Encourage regular bathroom visits, every 3 to 4 hours.
• Support slow, relaxed bathroom trips so they can fully empty their bladder without rushing.
• Promote gentle physical activity, like walking or light stretching, to support bladder function.
• Limit bladder irritants such as caffeine and alcohol, which can make incontinence worse.
• Support healthy hydration; drinking enough water helps prevent bladder irritation - unless a doctor advises otherwise.
• Help prevent constipation by offering high-fiber foods like grains and vegetables.

Talk to Their Doctor First

It's always a good idea to speak with a healthcare provider first. They can help rule out treatable health issues that might be causing incontinence.

A visit to the doctor's office also ensures that your loved one receives a personalized care plan based on their specific needs and the type of incontinence they're experiencing.

Be Ready for Anything

Instead of waiting for accidents to happen, prepare for them. Preparation helps you and your loved ones stay calm and reduces stressful situations.

When going on outings, you could prepare a care kit; it could be a bag filled with essentials like:

• Spare clothes
• Gloves
• Incontinence pads or adult diapers

Just as you prepare for the day, go ahead and prepare for nighttime leaks by:

• Making use of protective bedding
• Have incontinence diaper briefs on hand: tape-on or tab-style
• Keeping spare, clean sheets nearby

Choose Easy-to-Wear Clothing

Choose clothing with Velcro or elastic waistbands. These adaptive clothes could support both you and your loved one by:

• Reducing stress during urgent bathroom trips
• Making it easier to change soiled garments
• Supporting your loved one’s comfort and independence

Keep an Eye on Their Diet

Help your loved ones by limiting bladder irritants like caffeine and alcohol.7 Also, include more fiber-rich foods, like whole grains, fruits, and vegetables.7 Both diet changes will help with bladder leaks.⁷

Show Patience and Compassion

Incontinence can bring up emotions like embarrassment, frustration, or even denial; especially for older adults. Offering emotional support means treating your loved one with empathy, dignity, and respect every step of the way.

Hygiene Tips for Caregivers Supporting Someone with Incontinence

A proper hygiene routine can help prevent skin breakdown, infections, and discomfort. 8 Here are a few practical tips: ⁸

• Clean the skin thoroughly with a gentle, pH-balanced cleanser after accidents.
• Use barrier creams to protect intimate areas.
• Change pads or briefs regularly to reduce the risk of skin breakdown and incontinence-associated dermatitis.
• Stay on top of laundry routines to ensure fresh, clean clothes and bedding.
• Create a discreet disposal system for used incontinence products

Helping Someone Use the Toilet: Practical Tips for Caregivers

Using the toilet is a daily need, but with the right guide, you can make it safer and more comfortable for your loved one.⁸

• Make sure of supportive tools like:
  • Mobility aids for walking support
  • Commodes for easier access, especially at night
  • Grab bars to help with balance.
  • Raised toilet seats to reduce strain
• Create a regular bathroom schedule. This helps reduce accidents and offers structure, especially for those with dementia who may feel rushed or confused.
• Keep the path to the bathroom clear by removing rugs or furniture that may cause a fall.
• Always protect their privacy, but stay nearby in case they need help.
• Use a calm, gentle tone and respect their pace and preferences.

Learn more

To be a good caregiver, it’s important to understand the aging process and how it affects mobility and cognitive ability. Learn more about age-related changes and how you can help your loved one in the following articles:

> Home safety

> What is incontinence?