What Causes Incontinence in the Elderly?
Introduction: What Is Incontinence?
Incontinence is the term used to describe a condition where a person is unable to self-restrain the act of elimination. In healthy adults, the urge to urinate and defecate can be controlled until such time as a toilet is available for use. In a person with incontinence, that individual is unable to hold the waste until an appropriate situation.
Incontinence can be further distinguished between urinary incontinence and fecal incontinence. While this is helpful in terms of discussing the problem with caregivers, it’s important to know that both conditions can exist simultaneously or separately in the same person. One is neither exclusive nor reliant on the other.
Babies and youngsters naturally have incontinence. They possess not the physical, emotional, or verbal development to be aware of, control, or verbalize the need to vacate bowels or bladder. As humans grow, these conditions change and a child becomes ready to “potty train” so they know when and where to eliminate.
In terms of management and treatment of incontinence, it’s helpful to understand more about incontinence in the elderly and other adults.
Types of Incontinence
Urinary incontinence and fecal incontinence are only used to describe what is actually happening. Medical professionals use more precise wording for the different types of incontinence that reference the underlying cause of the condition.
Stress Incontinence
As the name implies, this is induced by stress, but not emotional stress. When doctors use this term, refer to actual physical stress on the organ. Most everyone has experienced the odd leak of urine on laughing, sudden surprise, coughing, sneezing, lifting something heavy, and similar activities. Even certain exercises might exert pressure on the bladder and cause a little leakage. A random event like this doesn’t mean that a person suffers with stress incontinence as a condition.
Urge Incontinence
This type defines the condition where a person feels a sudden and urgent need to evacuate their bowels or urinate, with little pre-warning. The urge might be so strong that they’re unable to reach a toilet in time. The bladder muscles or colon muscles contract uncontrollably, which may result in an accident.
Overflow Incontinence
This type refers to a condition where the bladder doesn’t empty all the way, leaving a person feeling like they still have to urinate even though they’ve already gone. Only small amounts of urine escape at a time, creating a chronic condition of uncomfortableness in the person.
Functional Incontinence
This term applies when there’s not so much an internal problem as an external one, creating obstacles to a person being able to get themselves to a toilet in time. Functional incontinence is a function of elderly-related problems, specifically.
To make matters more complicated, a person may experience more than one type of incontinence as they age. As such, the causes of various types of incontinence deserve to be examined, as well.
Underlying Medical Causes
A physician can assess potential causes to diagnose incontinence to determine if the cause is medical.
Enlarged Prostrate
The prostate gland in men grows larger with age. Known as benign prostatic hyperplasia, it’s not understood why the prostate gets bigger, but almost every male will experience this enlargement if they live long enough. An incontinence problem may occur because of it, since the prostate presses against the urethra, the channel whereby urine is extricated from males. Think of it like trying to make liquid pass through a straw while pinching it.
Urinary Tract Infection
Temporarily, a urinary tract infection can cause irritation in the lining of the bladder, leading to incontinence and sudden urgency to urinate.
Diabetes
Diabetes can cause all kinds of trouble and incontinence is another. When blood sugar is high, urine production may be elevated, too. This is why one symptom of diabetes is frequent urination. But diabetes also damages nerves, and when signals between the brain and the bladder aren’t transmitted as they should, incontinence may develop.
Neurological Conditions
A number of neurological conditions can contribute to incontinence in the elderly and in others. These include Parkinson’s, multiple sclerosis, stroke, spinal cord injuries, and more. This is because nerve damage interrupts the transmission of brain signals to the bladder and colon.
Digestive Issues
Fecal incontinence in particular can be caused by inflamed bowels, chronic diarrhea, and even the overuse of laxatives, which can damage the natural action of the bowels.
Medication and Incontinence
Incontinence can also be instigated by certain medications. When this happens, it’s important for the caregiver or patient to express the problem to the prescriber, since an alternative medication without such side-effects may be available.
The list of names of specific medications with incontinence as a possible side-effect would be exhaustive, but there are general categories of such medications.
Diuretics
These are common culprits, as their very job is to induce urination. They may also cause a lack of bladder control, since they do intercept muscle and/or nerve functions that are involved in the urination process.
Sedatives and Sleep Aids
Most people are roused awake when the body needs to evacuate. But sedatives and sleep aids might hinder this natural reaction, resulting in soiled sheets.
Antidepressants, Muscle Relaxants, Blood Pressure Drugs
These have all been known to influence bladder muscle contractions, leading to some form of incontinence.
Cold/Allergy Medications
These types of drugs might make it more difficult to empty the bladder completely, as they tend to tighten the muscles around the bladder.
When consulting with a medical practitioner, it’s essential to provide a comprehensive list of all medications being taken, as these common types of drugs can cause or make incontinence worse.
Lifestyle & Dietary Contributors
Lifestyle and dietary factors can both cause incontinence and be used to lessen or get rid of the problem of incontinence. Of note are foods and drinks, many of which are commonly known to exacerbate or cause it.
For example, caffeine stimulates the bladder and colon. Many people use coffee or tea in the morning to stimulate bowel movement. This isn’t inherently problematic, but if it does become a problem, a closer look at the quantity of caffeine ingestion is likely warranted.
Excess alcohol consumption isn’t good for many reasons, but incontinence is one worth consideration. It can inhibit a person waking when they need to urinate, cause excess urine production, and damage nerves from the brain to the bladder.
Water is, of course, needed for human life, but too much is just as bad as too little. It’s worth ensuring that water is taken in balance so as to avoid constipation from dehydration without overloading the bladder with too much water.
Bowel and bladder health is supported by adequate consumption of fiber, balanced hydration and an avoidance of excess of caffeine and alcohol.
Finally, consistent exercise in accordance with one’s physical limitations and abilities helps to keep internal muscles – those associated with proper colon and bladder function – toned and able to perform as intended, just as it helps those visible muscles in the arms, legs, and torso.
Physical Changes in Aging
In the elderly, physical changes can negatively affect the ability to properly evacuate the bowels and bladder, leading to a higher likelihood of developing incontinence in later years.
For example, the pelvic floor muscles may weaken after pregnancy and childbirth. These muscles are integral to the support of the bladder. This explains why so many pregnant women have temporary or lasting incontinence.
Hormonal changes, such as those that happen after menopause, can increase sensitivity and urgency for urination, too.
In men, the growth of the prostrate, as explained earlier, can narrow the urethra and inhibit the capability of the bladder to empty completely. Benign prostatic hyperplasia also makes the male body accumulate more of the hormone dihydrotestosterone (DHT), which exacerbates the problem on incontinence.
Nerves age similar to organs and other bodily tissue. This natural aging may mean nerve signals are less strong and able to correctly transmit between the brain and the bladder.
Typically, these changes occur over time but may become problematic and more obvious only in elder folks.
When to Seek Medical Help
For the general public, incontinence is often considered embarrassing, something to be hidden. Its prevalence is often underrated for just such reasons, but it’s a lot more common than most people realize.
That doesn’t, however, mean that incontinence issues should be ignored. They should always be reported to a medical professional, for one reason, because treatment might be available, and for another, because the underlying cause might be more dangerous than expected.
Certain red flags mean that incontinence should be addressed sooner rather than later.
Frequent leakage, sudden urgency, or a noticeable change in bladder habits should prompt a medical consultation. These symptoms may indicate an underlying condition that requires treatment.
Pain during urination, blood in the urine, or repeated urinary tract infections also require medical attention. These signs may indicate infection or other problems within the urinary system.
Fecal incontinence that happens regularly or worsens over time should also be evaluated. Digestive disorders or nerve problems may be involved.
During an evaluation, a healthcare provider may review medical history, medications, and lifestyle habits. Diagnostic tests sometimes include urine analysis, imaging studies, or bladder function testing.
Specialists such as a urologist may become involved when symptoms are complex or persistent.
Early evaluation often leads to better symptom control and more effective treatment plans.
Management Strategies & Treatment Options
Treatment is dependent upon the underlying cause of incontinence and the severity of symptoms. Many people are encouraged to try a combination of management strategies and treatment options such as those noted herein.
Pelvic floor exercises strengthen muscles that support bladder control and can improve urinary function over time.
Bladder training is a technique where the person follows a schedule for toilet time, increasing the time between trips little by little, so the bladder gets trained to go longer without the urge to urinate.
There are prescription medications, too, more suitable for men with prostate enlargement.
Some doctors recommend physical therapy programs focused on pelvic muscle strengthening. These programs are often part of broader pelvic health resources offered through clinics or rehabilitation centers.
In more severe cases, surgical procedures might be appropriate, especially in cases where an internal cause has been found, or where other treatments have not been successful.
At-Home Coping Tips
Coping with incontinence is a challenge unto itself, not least because of the social embarrassment it causes. Daily management strategies can help elderly adults maintain comfort and independence while dealing with incontinence.
Absorbent pads and protective garments are widely available now and can be ordered online for discreet delivery. These products help protect clothing and bedding from soils and stains.
Scheduled bathroom trips can also reduce accidents. Visiting the restroom at regular intervals during the day – even when there is no felt need – may help prevent accidents.
Making the bathroom easier to access can also help. Good lighting, clear walkways, and safety rails may reduce the time needed to reach the toilet. Some homes benefit from raised toilet seats or bedside commodes.
Clothing choices can make a difference as well. Loose garments or elastic waistbands allow faster removal when the urge strikes suddenly.
Caregivers often help organize daily routines that support regular restroom use. These adjustments can reduce stress and improve quality of life for both seniors and those assisting them.
Conclusion & Support Resources
Incontinence affects many older adults, but it does not have a single cause. Understanding what causes incontinence in the elderly involves looking at physical changes, medical conditions, medications, and daily habits. Identifying these factors can help guide effective care.
Healthcare professionals can evaluate symptoms of elderly incontinence and recommend treatment options that address specific causes. Support from caregivers, clinicians, and pelvic health resources can make daily management easier.
When symptoms appear, discussing them with a healthcare provider can lead to better strategies for maintaining comfort, independence, and overall health.