Prevalence and Background
It is important that family caregivers have an understanding about the etiology (i.e., source and causal factors) of the symptoms of bladder control problems so as to avoid assumptions, guilt, and commonly held myths.
If you are not familiar with incontinence, find a wealth of information on this topic in the Bladder & Bowel Health section. Within this section there is information about women's health and men's health, the different types of incontinence, and FAQ. There is also information about bedwetting and nocturia.
Assessment and Diagnosis
The first thing you need to do as a caregiver is get your loved one assessed and diagnosed by a healthcare provider. In some cases, it can be hard to get someone to admit they have bladder or bowel control issues. Often they may be shy or embarrassed about their condition, so the doctor or nurse may rely on you to answer some necessary assessment questions. Here are some questions a healthcare provider may ask you as the caregiver:
- Is the problem less evident or worse at night?
- Does your loved one frequently feel the urge to urinate? Can they make it to the bathroom before leaking urine?
- Is urine leakage provoked by coughing, sneezing, or laughing?
- Is bladder control lost only at certain times, such as when an individual hears water running or when they get up out of a chair or the bed?
For further information on questions the provider may ask, physical examinations, and other assessment tests for diagnosis, check out the diagnostic test. Also, NAFC provides a diagnostic quiz that your loved one can take and a medical history form to take with you to your loved one's appointment. Aside from consultation with a primary care physician such as a family practice doctor, an internist, or geriatrician, referrals can be made to different specialists such as a urologist, gynecologist, advanced nurse practitioner, or a urogynecologist. Use NAFC's Find an Expert search to find a provider near you.
Age Related Changes that Affect the Bladder and Continence
Most urinary dysfunction in the elderly is attributable to lower urinary tract disorders, with incontinence being the predominant symptom. The prevalence of overactive bladder (OAB) with incontinence increases sharply in postmenopausal women, while it increases gradually with age in men, often times due to an enlarged prostate. The exception to this is nocturia. In men, the prevalence of nocturia increases more rapidly with age than in women, although it is more common among women at a younger age.53 Also, disorders associated with fluid overload (eg; congestive heart failure, hypoalbuminemia, drug-induced peripheral edema) and calcium channel blockers can cause incontinence in elderly individuals.52 As we age, there are a number of changes that can occur in our bodies and our bladders that can have an effect on bladder function.
General Changes in Bladder Function
- Reduced bladder capacity
- Increased tendency of bladder to contract in response to filling and to “triggers” such as running water
- Reduced strength of bladder contractions
- Decreased awareness of bladder filling
- Increased nighttime urine production
The effects of these changes may be:
- Increased frequency of urination
- Increased urgency; more difficulty with bladder control (increased risk of leakage)
- Increased potential for incomplete emptying
- Reduced “response time” –i.e., less time between awareness of need to urinate and urination during nighttime hours
General Changes Outside the Bladder
- Reduced Mobility
- Other health problems requiring medications
- Neurological obstacles that interfere with the signals from the brain to the bladder (for example, in stroke survivors)
The effects of these changes may be:
- More time required to get to the bathroom
- Prescribed medications may affect bladder function (ability to stretch and to empty) or sphincter function (ability to hold urine in bladder)
Lifestyle Changes
- Changes in diet: Bladder irritants
- Lack of hydration
- Lack of physical exercise
The effects of these changes may be:
- Exacerbating problems with frequency or urgency of urination
- Constipation, which can also lead to urinary symptoms of frequency and urgency
Gender Specific Changes: Male
- Enlarged prostate
The effects of these changes may be:
- Difficulty emptying the bladder completely; may cause frequent and urgent urination and feelings of incomplete emptying
Gender Specific Changes: Female
- Reduced estrogen production resulting in increased tendency of bladder to contract and reduced ability of sphincter to provide enough resistance
The effects of these changes may be:
- Increased frequency of urination; sense of “urgency” to urinate; may have reduced ability to control the bladder
- Increased risk of leakage with activity (e.g., coughing, laughing, or sneezing)
Emotional Factors of Incontinence
The effect of urinary incontinence (UI) on a person’s quality of life can vary considerably. UI can contribute to sleep deprivation, embarrassment, social withdrawal, depression, stress, and sexual dysfuction. A recent study concluded that elderly people who suffer from UI are more likely to have symptoms of depression than those without UI. Moreover, if nocturia is present, sleep deprivation can contribute to symptoms that may be associated with depression when the underlying cause is an overactive bladder.
The degree of depression is linked to the severity of incontinence, or the amount of urine lost with each “accident.” Researchers have found that the depression associated with UI makes it more difficult to persuade the individual to perform pelvic muscle exercises and bladder retraining, which have been shown in research to reduce UI episodes.
The emotional distress caused by UI can also affect family members who are invovled in caregiving. UI is known to lead to the decision to place an individual in a long-term care nursing facility, and it can cause guilt and confusion for the family members involved in a relative’s care.
