When someone is unable to control the ability to urinate and there's an involuntary loss of urine, this person is said to have urinary incontinence. This condition is also called "leaky bladder."
It's a very common problem, especially among older adults. As many as 30% of seniors living in the community and up to 50% of seniors living in nursing homes experience this condition. It generally affects more women than men until the age of 80.
Many people believe that urinary incontinence is a normal part of aging when in fact it's not. Others may be embarrassed to talk about incontinence with a health care professional. For these reasons, many people don't seek medical help and never get properly diagnosed or treated. In many cases, urinary incontinence can be cured, or at least significantly relieved.
Loss of urine can occur for a number of reasons that are related to the bladder (where urine is stored in the body) or the bladder sphincter (a thick muscle that controls the flow of urine out of the bladder).
Although aging itself doesn't cause incontinence, normal changes that occur in the urinary and genital systems as people age make this condition more common in the elderly.
For example, the bladder and the muscles that support it tend to sag with age, making it more difficult to store urine. Many medications taken by seniors for various medical conditions (e.g., high blood pressure, depression) can also increase bladder problems and lead to incontinence.
A common cause of temporary urinary incontinence is a urinary tract infection. Other causes of incontinence include severe constipation, delirium, depression, reduced mobility, and diabetes.
There are four types of urinary incontinence:
Stress urinary incontinence: Urine will leak out in sudden spurts when someone coughs, sneezes, strains, or laughs. All these activities increase the pressure on the abdomen and bladder, causing urine to abruptly flow out. It's most commonly the result of weakened or stretched muscles that support the uterus and bladder. Childbirth via vaginal delivery, prolonged or difficult labor, previous pelvic surgery,being overweight, and having a family history of stress urinary incontinence (mother or sister with SUI) can all increase the risk of stress urinary incontinence.. The loss of estrogen associated with menopause can lead to weakness of the pelvic muscle support and contribute to stress urinary incontinence.
SUI typically does not occur in men and may be seen only after some type of prostate surgery.
Overflow incontinence: This occurs when the bladder stores more urine than it can handle. It can have two causes: An enlarged prostate, typically in men aged 55 or greater (called benign prostatic hyperplasia) or in women and men with a weak bladder muscle. In BPH, the large prostate squeezes or compresses the urethra (the tube that empties urine from the bladder) and prevents normal flow of urine. If the bladder muscle is weak, the urine cannot be squeezed out of the bladder. With BPH or a weak bladder muscle, urine starts to collect in the bladder until there's so much excess that the bladder becomes distended (overstretched) and urine leaks out.
Conditions that can cause a weak bladder muscle and overflow incontinence include diabetic neuropathy and spine problems. Chronic untreated BPH can eventually lead to bladder muscle weakening.
Urge incontinence: As one of the symptoms of "overactive bladder," this condition causes people to feel an urgent need to urinate that is difficult to delay due to muscle spasms in the bladder. It is the most common type of incontinence in older people. As a result of infection, stones, strokes, and dementia, the bladder spasms and causes urine loss.
Functional incontinence: This type of incontinence occurs when people have urge incontinence but are unable to get to the toilet because of conditions such as dementia, stroke, or immobility.
Some people may have mixed incontinence, which is a combination of the four types. The most common combination is urge and stress incontinence. Incontinence can either be temporary (e.g., caused by infections or medications) or persistent (e.g., due to a stroke or other neurological condition).