Updated August 27, 2021

what questions should I and my family be asking?

• When I cough, sneeze, laugh, or cry does any urine leak out?

• Do I suddenly have the urge to urinate and have to run to the bathroom?

• How often am I getting up at night to urinate?

• Am I able to make it in time to the bathroom when I want to?

• Do I have any burning pain when I urinate? Am I peeing more often?

• Do I have constipation?

• Am I drinking a lot of caffeine and coffee?

• Am I drinking a lot of fluids before I go to bed?

• Did I start a new medication that can cause urinary symptoms?

What actions can i take for this Agenda?

• A bladder diary has been shown to help your doctor know the pattern of your urination and is a great follow-up tool. A bladder diary is a record you create of the times and amount of urination you have along the day

• Make sure to have good hygiene habits when urinating to avoid getting a bladder infection. Some good habits include wiping from front to back, staying clear from irritating female products, and staying hydrated

• Do not drink a lot of fluids before going to bed

• Bladder training is a great way to reduce urge incontinence. This method entails distracting yourself when you have the sudden urge to urinate by doing problem-solving activities such as puzzles for 10 minutes then going to the restroom. Doing this trains the bladder with time to not be overactive. This can take weeks but evidence has shown good results

• Kegel exercises strengthen the pelvic muscles and have been shown to reduce stress incontinence. This involves contracting your pelvic muscles for 10 seconds then relaxing them. Repeating that activity a few times a day for 3 months has shown good results

• Being overweight is a risk factor for incontinence. As such, exercise and weight loss can help. Refer to the “exercise” agenda for details

• Coffee and caffeine increase your need to urinate even more. If you’re a heavy coffee drinker consider cutting down  

• For those in long-term care facilities and have dementia or mobility issues, the best methods to address urinary incontinence is to exercise and schedule going to pee more frequently

What is the urinary system?

• The urinary system is the organs in your body in charge of filtering your blood, collecting, storing, and excreting urine

• If there is a problem with the urinary system, you can have bothersome symptoms. Examples are burning when you pee or urine leaking

• Older adults can get bladder infections (UTI) more commonly too

• These are not normal age-related changes and should be treated

What is urine leaking? what does it mean that i am having loss of my control to pee?

• “Urinary incontinence” is being unable to voluntarily control when you would or would not like to pee

• This is a big problem faced by many people who are aging

• For a lot of people not being able to control this function causes them a lot of stress and anxiety

• It makes it harder for one to participate in social or day to day activities

• It can even lead to isolation and depression

Urine leakage is known as incontinence and is not a normal part of aging and needs treatment

How common is this issue?

• Urinary incontinence is common

• It impacts up to 34% of older men and up to 55% of older women

• In long-term care facilities, incontinence can exceed 70% of residents

Why is urine leakage a burden? What are the risks of having a urine leak?

• Worse quality of life

• Increase risk of depression

• Increase poor self-rated health

• Increase risk of social isolation

• Causes a decline in functional activities

• Increase risk of urinary and skin infections

Why does urine leakage happen?

• The bladder spends 99% of its time storing urine and 1% of its time expelling it

• Women usually have issues with the bladder valve closing. Men usually have prostate enlarging issues that can lead to incontinence

• Sometimes the nervous system can be injured because of diseases. This can cause the bladder to be “too excited” and expels urine too frequently

• Usually, it is a combination of disease and medications that leads to incontinence

• A common and usually treatable cause of this in older adults is constipation. Refer to the “constipation” agenda for more details

Urine leaking is common and increases as we age. It can cause isolation, depression, and worse quality of life

There are many reasons causing leaking but commonly from the bladder, nerve disease, or medications

are there different types? How are they caused?

• There are five main types of urinary incontinence:

• Stress incontinence: A sneeze, a cough, or even jumping up and down can cause a leak. This can happen because the muscles that help us stop the leak have weakened over time. Especially the pelvic and bladder muscles

• Urge incontinence: Also known as an “overactive bladder.” This type makes you feel like you always have to suddenly go to the bathroom to pee. This happens because the bladder muscle is excited and squeezes incorrectly. Even when it is not full

• Mixed incontinence: This type is a combination of both stress and urge incontinence

• Overflow incontinence: Feels like a continuous leak or dribbling of urine. People who experience this type of incontinence can often have nighttime accidents. The outflow tube to allow urine out of the body (urethra) can be blocked and the bladder cannot empty completely when you try to

• Functional incontinence: Usually does not have to do with a problem in the urinary system. Instead, it is a problem with making it to the bathroom on time. This can happen from a medical condition or injury making it difficult to make it to the bathroom when you need to pee. Being unable to walk to the washroom is an example

There are many types and causes of urinary incontinence. The most common in older adults are stress and urge incontinence

should I use pads to help?

• People will stop going out and doing social activities and feel like they always need to be near a washroom

• For this, you can try using pads or protective garments. For women, this might be easy if they have used them in the past

• However, for men, it can be harder to find products or be comfortable using them

• It is important to remember that this is a problem a lot of people deal with. You should not be embarrassed in managing it in any way that improves your quality of life

• Pads and protective absorbent garments won’t fix the underlying cause of the incontinence. However, they can help with your day-to-day function

What tests can be done to know what type I have?

• The first step is to make sure you have urinary incontinence

• There are other diseases that can cause it indirectly. The most common of which is a urinary tract infection (UTI) or constipation

• Your doctor may need to order urine lab tests, an ultrasound, or other imaging tests to know what the causes are

• Always talk to your doctor to see what is right for you as these tests may not be necessary

Pads may not treat the underlying cause but can make it so that you are more functional

Bladder infections (UTI) and constipation are common causes

What types of medicines can lead to urine leaks or bladder problems?

• The most common class of medications are:

• Diuretics

• Anticholinergics

• Benzodiazepines

• That is because these medications can cause:

• Increased urination

• Body retention of fluids

• Impairment of bladder muscles

• Change your level of alertness and mobility

What is a bladder infection (UTI)? Should I be treated for it?

• A bladder infection is known as a “UTI”

• These infections are usually treated with antibiotics

• The symptoms of a bladder infection are a painful burning feeling when you pee, urinating more frequently, leak of urine, or fevers

• Older adults can also have confusion (delirium) as a symptom. Refer to our “confusion” agenda for details

• It is important to remember that testing the urine and finding bacteria without symptoms does not mean you should treat it

• Only when symptoms are present should you take antibiotics. Your doctor should decide whether or not to do so

Just because there are bacteria in your urine does not mean you have a bladder infection (UTI)

they should only be treated with antibiotics if you have symptoms but talk to your doctor first

What resources can help with this Agenda? 

References

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2. Jeffrey B. Halter et al. Hazzard's Geriatric Medicine and Gerontology 7th edition (2016)

3. Jayna Holroyd-Leduc et al. Evidence Based Geriatric Medicine (2012)

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