Facts and myths about effects of ageing on continence
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 - refer back to the facts in Step 1.7 Incontinence is a ‘Big Issue’!!!.
Women and men are affected in different ways by the ageing process:
- Many of women’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 create a struggle, at times, to remain continent
- Changes in the ‘body clocks’ (known as circadian rhythms) cause increases in urine production 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.
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. The older person may have little or no bladder control and experience urgency incontinence.
The detrusor muscle lining the bladder stiffens and atrophies which reduces the bladder capacity, as it cannot stretch to accommodate large urine volumes.
The bladder is also not as ‘elastic’, 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.
The 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
Did you know? All of the above are treatable symptoms if the older person 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
Share your ideas on how to raise awareness of treatment and self-help options for older people living with bladder urgency and/or leakage.
Search for information leaflets or flyers that set out self-help advice to people living with urinary symptoms – share your findings with fellow learners. Can you use or adapt any of these to use in your own practice?
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