What can be done for incontinence in the elderly? A Guide to Treatment and Management

An estimated one in five senior adults experiences a form of bladder control problem, making it a common but often concealed issue. Learning what can be done for incontinence in the elderly offers a pathway toward restored confidence and a better quality of life for those affected and their caregivers.

Quick Summary

Incontinence in older adults can often be managed or cured through various approaches, including lifestyle changes, bladder training, pelvic floor exercises, medication, and the use of modern, discreet incontinence products. Consultation with a healthcare provider is essential to determine the right combination of strategies for each individual's needs.

Key Points

• Incontinence is treatable, not inevitable: While more common in older age, incontinence is not a normal part of aging and can be effectively managed or cured with the right treatment plan.

• Diagnosis is the first step: Consulting a healthcare provider is crucial to determine the type of incontinence (stress, urge, overflow, or functional) and its underlying causes before starting any treatment.

• Behavioral changes are foundational: Simple, non-invasive strategies like bladder training, timed voiding, and dietary modifications often form the first line of defense and can yield significant improvements.

• Kegel exercises strengthen control: Pelvic floor muscle exercises, or Kegels, are a proven method for strengthening the muscles that support the bladder and can help reduce leakage for both men and women.

• Medical and surgical options are available: For more severe cases, or when other treatments fail, medications, medical devices like pessaries or catheters, and even surgery can provide effective relief.

• Empathetic care is essential: Incontinence can affect mental and emotional well-being, leading to embarrassment and depression. Caregivers should be supportive and patient, helping to create a comfortable and dignified environment.

• Modern products offer discretion: A wide variety of modern incontinence products, from discreet pads and liners to high-absorbency briefs, can provide reliable protection and peace of mind.

Understanding the Types and Causes of Incontinence

Before exploring treatment options, it is crucial to understand that incontinence is not a normal or unavoidable part of aging, but rather a treatable condition with several different types and causes. Age-related changes, such as weaker bladder muscles or stiffening tissue, can contribute, but other factors are often at play. A proper diagnosis from a healthcare provider is the first step toward effective management.

Types of Urinary Incontinence

• Stress Incontinence: Involuntary leakage of small amounts of urine when pressure is put on the bladder, such as during a sneeze, cough, or physical activity.
• Urge Incontinence: The sudden, intense need to urinate followed by a large leakage. It is often caused by an overactive bladder muscle.
• Overflow Incontinence: The frequent or constant dribbling of urine due to a bladder that doesn't empty completely. This is common in men with an enlarged prostate.
• Functional Incontinence: Leakage that occurs when a person is unable to get to the toilet in time due to physical or cognitive limitations, even though their urinary system is functioning normally.
• Mixed Incontinence: A combination of stress and urge incontinence, which is especially common in older women.

Common Contributing Factors

• Weakened Pelvic Muscles: Pregnancy and childbirth, along with the natural aging process, can weaken the muscles supporting the bladder.
• Enlarged Prostate: In men, an enlarged prostate can block the urethra, leading to overflow incontinence.
• Neurological Conditions: Diseases such as Parkinson's, Alzheimer's, or multiple sclerosis can damage the nerves that control the bladder.
• Chronic Health Issues: Conditions like diabetes can cause nerve damage that affects bladder control.
• Medications: Diuretics, sedatives, and certain antidepressants can increase urine production or relax bladder muscles, contributing to the problem.
• Other Factors: Constipation, urinary tract infections, and obesity can also worsen incontinence symptoms.

First-Line Behavioral and Lifestyle Strategies

For many seniors, initial treatment focuses on non-invasive changes that can significantly improve or resolve symptoms. These foundational strategies empower individuals to regain control and dignity.

Bladder Training and Timing

Bladder training helps re-establish a regular urinary schedule and control urgency.

• Timed Voiding: Establishing a fixed bathroom schedule, such as every two hours while awake, can help train the bladder.
• Delayed Urination: When the urge to urinate strikes, consciously try to delay going to the bathroom for a few minutes. Gradually increase this delay to strengthen control.
• Urgency Suppression Techniques: Techniques like distraction, long, relaxing breaths, and squeezing the pelvic floor muscles can help manage a sudden urge.

Dietary and Fluid Management

• Monitor Fluid Intake: While it's important to stay hydrated, consuming large amounts of fluid at once, or near bedtime, can aggravate symptoms. Aim for small, frequent amounts throughout the day and limit intake a couple of hours before sleep.
• Identify Bladder Irritants: Certain foods and drinks can irritate the bladder. These include caffeine (coffee, tea, soda), alcohol, carbonated beverages, spicy foods, and artificial sweeteners. Keeping a journal can help identify personal triggers.
• Manage Constipation: A high-fiber diet can help prevent constipation, which puts pressure on the bladder and can worsen incontinence.

Pelvic Floor Muscle Exercises (Kegels)

Kegel exercises strengthen the pelvic floor muscles that support the bladder. It is essential to perform them correctly for maximum benefit.

1. Find the right muscles: To identify your pelvic floor muscles, try to stop the flow of urine mid-stream. The muscles you use to do this are the ones to target.
2. Practice technique: Squeeze these muscles and hold for a count of three to five seconds. The muscles in your abdomen, buttocks, and thighs should remain relaxed.
3. Relax and repeat: Relax the muscles for the same amount of time. Repeat this 10 to 15 times, three times a day.

Medical Treatments and Interventions

If lifestyle changes and exercises are not enough, or for more severe cases, medical professionals may recommend other treatments.

Medication

• Anticholinergics: These drugs can help calm an overactive bladder, reducing the urgent need to urinate. However, they may cause side effects like dry mouth and constipation.
• Beta-agonists: These medications work by relaxing the bladder muscle, allowing it to hold more urine. An example is mirabegron.
• Topical Estrogen: Low-dose vaginal estrogen cream can help women with urge or stress incontinence by rejuvenating and toning urethral tissues.

Medical Devices

• Pessaries: For women, a small, removable device inserted into the vagina can help support the urethra and reduce stress incontinence.
• Nerve Stimulators: Devices that send mild electrical pulses to the nerves controlling the bladder can help with urge incontinence. This can be done minimally invasively or through a procedure.
• Urethral Inserts: A small, disposable device can be inserted into the urethra to act as a plug, which is removed before urination.
• Catheters: For overflow incontinence, intermittent or chronic catheters may be used to empty the bladder. This is typically a last resort due to infection risks.

Surgery

Surgery is typically considered when other treatments have failed or in cases of severe incontinence caused by structural issues.

• Sling Procedures: A surgeon places a sling, often a mesh strip, under the urethra to provide support and keep it closed during physical activity.
• Bulking Agent Injections: A gel or paste is injected to thicken the area around the urethra, helping to close the bladder opening.
• Prostate Reduction: For men with incontinence from an enlarged prostate, surgery can remove or shrink the blockage.

Incontinence Products for Management

For many, a combination of lifestyle changes and absorbent products is the most effective approach. Products are constantly improving, offering discreet and comfortable options.

Product Type	Use Case	Key Features	Considerations
Pads & Liners	Light to moderate leakage; daily wear	Thin, discreet, adhesive backing, odor protection	Best for stress or minor urge incontinence; requires frequent changing
Protective Underwear (Pull-ups)	Moderate to heavy leakage; active wear	Resemble regular underwear, comfortable, easy to use	Good for those who are mobile and want discretion; easier for self-toileting
Adult Diapers (Briefs)	Heavy to severe leakage; overnight wear	High absorbency, tab-style closures for easy changes	Ideal for immobile individuals or overnight protection
Booster Pads	Added absorbency for briefs or pull-ups	Thin inserts placed inside another product to extend wear time	Cost-effective way to increase absorbency without changing the whole garment
Bed & Chair Pads	Furniture protection	Absorbent, waterproof, disposable or reusable	Essential for protecting bedding and furniture, especially at night

Creating a Supportive Environment

Caregivers and family members play a vital role in managing incontinence while preserving dignity. Simple adjustments at home can make a significant difference.

• Ensure easy bathroom access: Keep pathways clear, use nightlights, and consider installing grab bars or a raised toilet seat.
• Choose appropriate clothing: Easy-to-remove clothing with elastic waistbands, snaps, or Velcro can speed up bathroom trips.
• Maintain emotional support: Approach the topic with empathy and patience. Incontinence can be embarrassing and lead to depression and social withdrawal. A supportive attitude fosters better communication and adherence to a treatment plan.

Conclusion

Incontinence in the elderly, while common, is not a condition to be endured in silence. With a proactive approach, including behavioral strategies, lifestyle modifications, medical interventions, and the right products, a person's quality of life can be dramatically improved. The first step toward finding a personalized and effective solution is an open conversation with a healthcare provider. Effective management allows seniors to continue living full, active, and independent lives without the constant worry of leaks. To learn more about treatment options, visit the Health in Aging website for a wealth of resources from the American Geriatrics Society.

Frequently Asked Questions

Is incontinence a normal part of getting old?

No, incontinence is not a normal or expected part of the aging process, but rather a medical condition. While it is more common in older adults, it is often treatable. Many seniors live their entire lives without experiencing it, and for those who do, there are many effective management and treatment strategies available.

What is the fastest way to stop incontinence?

There is no single "fastest" solution, as the most effective approach depends on the underlying cause. A medical evaluation is necessary to determine the correct path. For some, simple lifestyle changes and bladder training may provide quick relief, while others may require medication or other interventions for a more lasting solution.

How do you treat age-related bladder weakness?

Treatment for age-related bladder weakness often starts with strengthening the pelvic floor muscles through Kegel exercises and implementing bladder training. Lifestyle changes, such as modifying fluid intake and avoiding irritants like caffeine, can also help. If these methods are insufficient, a doctor might recommend medications or medical devices.

When should an elderly person be put in diapers?

Absorbent garments, including diapers, are an effective management tool but should not be the first or only solution. They are most appropriate for heavy leakage, overnight use, or for individuals with cognitive or mobility impairments. A medical evaluation should always precede the decision to rely solely on absorbent products, as incontinence often has an underlying cause that can be treated.

How can caregivers help manage incontinence with dignity?

Caregivers can help manage incontinence with dignity by approaching the subject with empathy, avoiding shame, and focusing on solutions. Providing emotional support, ensuring easy access to the bathroom, and having appropriate, comfortable products readily available are key. Choosing easy-to-manage clothing and focusing on hygiene are also crucial for maintaining a senior's independence and self-esteem.

Can diet affect incontinence in older adults?

Yes, diet can significantly affect incontinence. Certain foods and drinks, including caffeine, alcohol, and spicy foods, are known bladder irritants that can worsen symptoms. Staying properly hydrated with non-irritating fluids and maintaining a high-fiber diet to prevent constipation are also important factors.

What should I tell a doctor about incontinence?

When speaking with a doctor, it's helpful to come prepared. Keep a bladder diary for a few days, noting when and how often leaks occur, as well as fluid intake. Be ready to discuss your medical history, any medications or supplements you take, and how incontinence affects your quality of life.