Have you ever leaked pee when you laughed, coughed, or sneezed? Maybe you’ve had a sudden urge to use the bathroom but couldn’t get there in time. Or perhaps you find yourself getting up several times each night to urinate.
Urinary incontinence is common among older adults, but having to plan life around your bladder can be incredibly frustrating. You may be afraid to go out because you’re worried about finding a bathroom. You may skip exercise, think twice about traveling, or wake up several times during the night to urinate.
Incontinence can also affect your safety. Rushing to the bathroom in the dark, especially at night when you’re drowsy or half-asleep, can increase your risk of falling and getting injured.
Getting help is about more than staying dry. Treating incontinence can help you stay active, sleep better, feel more confident, and maintain your independence.
What Is Urinary Incontinence?
Your bladder, pelvic floor muscles, nerves, and other parts of your urinary system work together to store and release urine. When something affects this system, you may have trouble holding your urine or getting to the bathroom in time.
Incontinence can look different from person to person. It can range from a few drops coming out when you cough or sneeze, a stronger leak when you exercise, sudden urges that send you rushing to the bathroom, or frequent dribbling throughout the day.
Even small leaks can affect your daily life. You may start planning trips around bathroom stops, avoid certain activities, or worry about an accident when you’re away from home. This is frustrating, but understanding the cause of incontinence can be the first step toward finding ways to manage or even reduce the severity of the problem.
Why Does Incontinence Happen as You Get Older?
There are many possible causes of developing urinary incontinence, including:
Weak pelvic floor muscles
Your pelvic floor is a group of muscles that supports your bladder and helps you control urine. If these muscles become weak, you may leak urine when you cough, sneeze, laugh, lift something, or exercise. Pelvic floor weakness can affect both women and men.
An overactive bladder
An overactive bladder can cause a sudden and strong urge to urinate. The urge may come on so quickly that you don’t make it to the bathroom in time.
A urinary tract infection
A urinary tract infection, or UTI, can cause temporary bladder problems. You may need to urinate more often or feel a sudden urge to go. You may also have burning or pain when you pee.
Constipation
Being constipated can put pressure on your bladder and make bladder control harder.
Medications
Some medications can affect bladder control. If your bladder problems started after you began taking a new medication or have gotten worse over time, tell your doctor. They can review your medications and decide if a change may help.
Prostate problems
In men, an enlarged prostate can make it harder to empty your bladder. When urine stays in the bladder, you may have frequent dribbling or other bladder control problems.
Other health problems
Diabetes, nerve problems, chronic coughing, and problems with movement can also contribute to incontinence. Sometimes the problem isn’t your bladder at all. You may simply have trouble getting to the bathroom quickly enough.
What Type of Incontinence Do You Have?
Urine leakage can happen in different ways. Paying attention to when and how you leak can help in figuring out what is causing it and which treatment may help.
There are 4 common types of urinary incontinence, but quite often there is overlap or symptoms may not fit neatly into one single category.
Stress Incontinence
Leaking urine when you cough, sneeze, laugh, lift something, or exercise may be a sign of stress incontinence. It happens when pressure on your bladder becomes too much for the muscles that normally keep urine from leaking. Weak pelvic floor muscles are a common cause.
Urge Incontinence
A sudden, strong need to urinate, followed by leakage before you can reach the bathroom, may be urge incontinence. This type of incontinence is often linked to an overactive bladder. You may feel like you need to find a bathroom immediately and have trouble holding your urine.
Mixed Incontinence
Some people experience both stress and urge incontinence. For example, you may leak when you sneeze or exercise and also have sudden urges that are difficult to control. Having both types is called mixed incontinence.
Overflow Incontinence
Frequent dribbling, difficulty starting your urine stream, or feeling like your bladder never fully empties may be signs of overflow incontinence. This happens when your bladder does not empty completely and becomes too full, causing urine to leak. In men, an enlarged prostate is one possible cause.
How Can You Treat Urinary Incontinence?
There are several ways to go about it.
Keep a bladder diary
A bladder diary can help you spot patterns. For several days, write down:
- What you drink and how much
- When you use the bathroom
- When you have an accident
- Whether you felt an urge before the accident
- What you were doing when the leak happened
Bring your notes to your next doctor’s appointment. They can give your doctor useful information about your symptoms.
Try timed bathroom trips
Timed voiding means using the bathroom on a regular schedule instead of waiting until you have a strong urge to go. For example, you might start by using the bathroom every two to three hours during the day. Over time, this can help you get into a regular routine and may reduce accidents.
Pay attention to what you drink
Never stop drinking water because you’re worried about leaks. Your body still needs enough fluid to stay healthy.
Do cut down on caffein, though. Caffeine, found in coffee, tea, cola, and energy drinks, has diuretic properties, meaning it can make you need to urinate more often or more urgently.
Pay attention to how your body responds to different drinks. If you notice more urgency or leaking after certain drinks, try cutting back or switching to a non-caffeinated option. It may also help to spread your fluids throughout the day rather than drinking a large amount at once.
Pelvic floor exercises
Your pelvic floor muscles help control your bladder. Strengthening these muscles can reduce urine leaks, especially if you have stress incontinence.
Kegel exercises involve tightening and relaxing the muscles you use to stop yourself from passing urine.
To find the right muscles, imagine you’re trying to stop yourself from passing gas. The muscles you tighten are part of your pelvic floor. Once you’ve identified them, tighten the muscles for about 3 seconds, then relax for 3 seconds. Repeat several times, gradually working your way up to 10 repetitions.
Do not practice Kegels while urinating. Stopping your urine stream regularly can interfere with normal bladder emptying.
Kegels can help with some types of incontinence, but they are not the right exercise for every bladder problem. If you have trouble finding the right muscles or the exercises make your symptoms worse, pelvic floor physical therapy may be worth considering. A pelvic floor physical therapist can teach you how to use these muscles correctly and tailor exercises to your needs.
Review your medications
Water pills (diuretics) increase the amount of urine your body produces. Other medications may make it harder to empty your bladder completely.
If you take several medications, check the labels and look for bladder or urinary side effects. Your pharmacist can also help you identify medications that might be affecting your bladder and explain whether the timing of a dose could be playing a role.
Never stop or change a prescription medication on your own. Some medications need to be reduced gradually or adjusted carefully.
What About Medication for Incontinence?
Some medications work by calming an overactive bladder and reducing sudden urges to urinate. Others work in different ways to help the bladder store or release urine.
Medication choices can be especially important as you get older. Some bladder medications, including oxybutynin and other anticholinergic drugs, can cause dry mouth and constipation. In older adults, they may also cause or worsen confusion, falls, and memory problems.
Another group of medications, called beta-3 agonists, includes mirabegron. These medications can help relax the bladder and may reduce urgency and frequent trips to the bathroom. However, mirabegron can raise blood pressure and may not be suitable for everyone.
When considering medication for incontinence, look at the possible benefits and side effects, especially if you already take several medications or have other health conditions, as there may be more than one option available to you.
When Should You Talk to Your Doctor?
Don’t wait for bladder problems to become severe before getting help. Talk to your doctor if you:
- Have new or ongoing urine leaks
- Suddenly need to urinate very badly
- Wake up often at night to use the bathroom
- Have trouble starting your urine stream
- Feel like you can’t completely empty your bladder
- Avoid activities because you’re worried about leaking
- Are rushing to the bathroom and worried about falling
You may also need a physical exam or urine test to look for possible causes.
Get Medical Help Promptly If You:
- See blood in your urine
- Feel pain or burning when you urinate
- Have a fever along with urinary symptoms
- Suddenly cannot urinate or empty your bladder
When Should You See a Specialist?
Your primary care doctor can help with many causes of urinary incontinence. But you may need to see a urologist if your symptoms don’t improve, the cause isn’t clear, or you may have a problem with your urinary tract or prostate.
Women with certain bladder and pelvic floor problems may be referred to a urogynecologist, a doctor who specializes in women’s urinary and pelvic health.
Take Care
Urinary incontinence may become more common as you get older, but don’t let fear of leaks keep you from exercising, traveling, seeing friends, getting a good night’s sleep, or enjoying your everyday life. With the right treatment and support, you may be able to improve your bladder control and get back to doing the things you enjoy.