Is incontinence an inevitable part of ageing?

Why is urinary incontinence commonly accepted as a normal part of ageing?

There is a tendency among health professionals, as well as the general public, to accept urinary incontinence as a part of the ageing process and it is true to say that the prevalence of urinary incontinence increases with age.

Women and men are affected in different ways by the ageing process:

• Many of a woman’s urinary problems are associated with the effects of childbirth and/or the loss of the hormone oestrogen with the onset of the menopause.
• Men have relatively few continence problems in their younger years, unless through injury or disease, but enlargement of the prostate in later life can bring a variety of unpleasant symptoms and it can be a struggle at times to remain continent.
• Changes in ‘body clocks’ (known as circadian rhythms) cause urine production to increase overnight. Because the person is lying down, there is movement of body fluid from their extracellular spaces to their blood vessels (sometimes called a third space shift) causing an increase in amounts of urine. Therefore, older adults will report nocturia (wakening to use the toilet) and sometime nocturnal enuresis (urine loss during sleep).
• Sensory nerves from the bladder to the brain often ‘wear out’, creating breaks in the nerve pathway. ‘Short-circuiting’ of nerve-firing occurs and messages to the brain may be incomplete.

Changes caused by ageing

A delayed response to sensory stimulation is common, which causes a delay in perceiving the urge sensation to void. There is decreased warning time between feeling the urge sensation and actual voiding (urgency).

This sudden and strong feeling of urgency may cause an older person to panic and increase their risk of falling when they try to reach the toilet in time.

Damaged nerve pathways or cortical brain damage can also lead to an increase in bladder contractions (overactive bladder) at small urine volumes. An older person may have little or no bladder control and experience urgency incontinence.

The detrusor muscle lining the bladder stiffens and atrophies which reduces bladder capacity, as it cannot stretch to accommodate large urine volumes.

Increased infection risk

The bladder is not as ‘elastic’ as people age, which means it is less likely to fully empty (urinary retention). This is the reason why older people often need to void more frequently in small amounts.

Urine that remains in the bladder (post-void residual [PVR]) increases the risk of urinary tract infection.

After menopause, the lining of the vagina and urethra become thin and less vascular leading to urogenital atrophy/atrophic vaginitis and urinary symptoms, such as urgency and frequency.

In men, the prostate gland enlarges and can ‘squeeze’ the urethra like a collar causing ‘bladder outlet obstruction’ and symptoms such as frequency and feelings of incomplete emptying.

Is it treatable?

All of the above symptoms are treatable if the older person affected seeks help.

Older people with a dysfunctional bladder and/or bowel, and the health professionals supporting them, must stop accepting incontinence as an inevitable part of ageing.

Promoting continence promotes dignity, and a sense of personhood and well-being that enables individuals to live full, active lives with a better quality of life