Incontinence in the elderly.

• Is incontinence normal in elderly? NO it is NOT!

• Urinary or faecal incontinence is NOT a part of “old age” or “normal ageing”. 

• Incontinence problems in the elderly occur in 1/3 of people over 80 years of age.

• Incontinence in older adults is twice as common in elderly women.

• The figure is much higher is nursing home elderly.

• As you get older the bladder volume at which it signals that you want to void is lower.  You can't hold as much volume of urine and you may want to go a little more often than a younger person. 

• An unstable bladder is a sudden urge to void small volumes of urine without warning which can contribute to urinary incontinence.

• Unstable irritable bladders in males and females can be very distressing and disabling and is a major contributor to falls risk particularly a night.

• Nocturia (getting up frequently at night to pass urine) and incontinence should be actively investigated, diagnosed and treated in the elderly to improve quality of life and reduce falls risk.

• In females the common causes of an unstable bladder include a neurological condition such as Parkinson's disease, stroke and dementia.

• In males they have similar problems, but it also can be caused by the prostate which can enlarge, reducing urine flow and causing an irritable bladder.

• In any older patient with an unstable bladder it is important to measure the bladder residual urine volume (how much is left after a good wee) to make sure the bladder is emptying and not in acute or chronic urinary retention.  This can be done with an ultrasound examination. 

• If the bladder won't empty and develops chronic retention, the patient could develop back flow pressure which could cause swelling of the kidneys (hydronephrosis) and eventually chronic renal failure.

• What causes sudden incontinence in elderly? This is a warning sign that the elderly person is unwell.

• New urinary incontinence in an older patient may be the first sign of delirium. 

• A urine infection in the elderly does not usually result in incontinence, but rather causes confusion and falls.

• Lower urinary tract symptoms in older men is usually due to an over active bladder or prostate enlargement. In older women it is usually due to weak muscles of the pelvic floor or overactive bladder.

• How to stop incontinence in older adults-

  ·      renal bladder ultrasound to assess kidney/prostate size and bladder emptying

  ·       blood test of kidney function

  ·       urine culture to exclude infection

  ·       bladder diary to establish pattern

  ·       restriction of fluid intake at night

  ·       pelvic floor exercises

  ·       bladder retraining/prompted voiding routines

  ·       urodynamic studies to measure bladder pressure/volume/emptying and urine flow

  ·       drug treatment

  ·       assessing the safety of toilet access at home

  ·       providing extra support services at home/Carers

  Non-drug treatment is the first and preferred option. However, anti-cholinergic drugs are commonly used to treat over active bladder in the elderly, but they have a very high side effect profile including-

  ·       confusion

  ·       dry eyes and mouth

  ·       constipation

  ·       blurred vision

  ·       worsening glaucoma

  ·       acute urinary retention- this is an emergency requiring an indwelling catheter to drain/decompress the bladder.

  Constipation in the elderly is a common and must be treated as it can cause urinary incontinence and acute urinary retention.

• Overall urinary incontinence can be managed and improved in a significant number of  elderly patients, particularly if they receive multi-disciplinary care to improve their nutrition, mobility and reduce the number of medications that they are taking.

Very helpful information for families and carers on this important topic coming soon!

For more information read Dr Peter Lipski’s book “Your Elderly Parents Failing Health. Is It Ageing Or A Treatable Condition”.