What happens when they get older?
What’s the first thing to do if a loved one loses control of their bladder and/or bowels? Try not to panic. It may be awkward and embarrassing for both of you at first. But be assured: is a common problem and there many are ways you can help them to deal with it.
If you’ve watched a loved one get older, you’ve probably noticed changes to their physical condition. Maybe they’re not as fit or trim as they once were. Possibly their eyesight and hearing aren’t so good these days.
And it’s very common for people to develop symptoms that affect how they store or pass urine – so called ‘urinary symptoms’ – including incontinence.
Incontinence can be embarrassing and frustrating for your loved one. Going to the toilet, a private function they once took for granted, is suddenly beyond their control.
You can help by being understanding, and by trying not to be embarrassed or judgmental about their situation. Learn more about incontinence, and the practical things you can do for your loved one. Care for them in a loving manner and it could bring the two of you closer together.
To understand your loved one’s condition better, consider what’s happening to their body and what might be causing their symptoms.
Why is your loved one becoming incontinent?
There are many causes as to why someone would develop urinary symptoms, including diseases and conditions – many of which become more common with advancing age. Examples of these diseases and conditions include:
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Overactive bladder
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Stress urinary – caused by weakened pelvic floor muscles
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An enlarged . Benign prostate enlargement is common in men aged over 50. It's not a cancer and it's not usually a serious threat to health.
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Infections – to any part of the urinary system
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Diabetes
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Sleep apnea
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Damage to nerves that control the bladder – caused by multiple sclerosis, diabetes, Parkinson’s disease
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Diseases or conditions that make it difficult to get to the bathroom in time or make it difficult to remove clothing in time
There are also a number of changes that occur in the body as it ages, meaning organs, muscles and nerves might stop working effectively together.
To be able to maintain control of when and where we pass urine (‘continence’ – the opposite of ‘incontinence’), we need support from the pelvic floor muscles and sphincter muscles to contain urine within the bladder. These important muscles assist to maintain urinary and faecal continence. When we get older pelvic floor muscles and sphincter muscles can become altered in their ability, leading to incontinence.
But it can also be that nerves connecting the brain and bladder could be sending the wrong signals.
Finally, changes in hormones mean that our kidneys produce more urine later in the day / evening, which partly explains waking during the night to pass urine.
The following changes could be contributing to incontinence:
What happens with kidneys as we age?
Urine starts life in the kidneys, where the blood is filtered to remove waste. As we age, the flow of blood to the kidneys is reduced [1], along with a host of other changes that seemingly make a number of diseases more likely.
Our bodies use chemicals called hormones which control the functions of its organs. As well as oestrogen and testosterone, increasing age sees us produce less of a hormone called anti-diuretic hormone (ADH). This hormone concentrates the urine (recovering water into the body). When this hormone level is reduced, more urine is produced, especially at night. This is also a reason why older adults wake to use the toilet around 1-2 times per night.
What happens with our bladder as we age?
The bladder is a muscle sac. With ageing the bladder muscles are at increased risk of starting to lose tone and function. This leads to a reduced ability to contract and squeeze. As a result the bladder takes longer time to empty and might not totally empty, leaving some urine in the bladder.
There can be changes in how the bladder senses how full it is. In some, the sensation is heightened, meaning that the bladder is more sensitive to its contents. This will lead to more frequent trips to the bathroom to pass relatively small amounts of urine. In others, the emptying reflex is triggered later when the bladder is almost full. This gives an older adult less warning time to get to the toilet to empty their bladder.
Flow of urine from the bladder can be greatly reduced.
In women, this can be due to weakened muscles that cause the bladder or vagina to fall out of position (prolapse). In men, the tube leading from the bladder to the outside, the urethra, can become blocked by an enlarged prostate gland. Not being able to empty the bladder completely can cause the bladder to be filled with residual urine which causes overflow urinary incontinence and is also a risk for urinary tract infections.
These conditions are important to detect early in order to get the right treatment.
If your loved one has become less mobile with age, they might not find it easy to reach the toilet. The result is, when they need to go, they can’t get there in time.
It can also be the case that they may struggle with buttons or zippers because coordinating their fingers has become harder. These types of are called ‘functional incontinence’ because the issue is not with the bladder or other parts of the urinary system, but because of difficulty with the physical act of getting to or preparing themselves to pass urine.
In such cases, they depend on a caregiver to help them remove physical barriers (e.g. clothing with Velcro, not buttons) or provide practical help getting to or onto the toilet.
Learn more
In being a caregiver, it may be helpful to understand the ageing process and how it affects mobility and cognitive ability. Learn more about age-related changes and how you can help your loved one in the following articles:
Sources
[1] Weinstein JR, Anderson S. The aging kidney: physiological changes. Adv Chronic Kidney Dis. 2010 Jul;17(4):302-7. doi: 10.1053/j.ackd.2010.05.002. PMID: 20610357; PMCID: PMC2901622.
