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Incontinence in older adults: causes and treatments

Incontinence is the involuntary loss of bladder and bowel control. It may be a temporary condition that results from an underlying or known medical condition. Regardless, it can be challenging and often sensitive to deal with, leading to early retirement, social withdrawal, depression and loss of independence.

It’s estimated that more than 3 million people in the UK experience urinary incontinence.1 Female incontinence is more common than male incontinence. This is because incontinence in women is more likely to develop after the hormonal changes of menopause but also during or after pregnancy.

This guide aims to answer common questions about elderly incontinence and provide an insight into minimising symptoms and the different treatments available.

If your loved one is experiencing incontinence, our professional Home Care services can help. Our Carers can provide a reassuring presence, helping with Personal Care needs and assisting with reaching and using the toilet frequently through continence care. For friendly guidance or to find out more about how we can help, find your local Alina Homecare Team today.

What is elderly incontinence?

There is more than one way incontinence can manifest itself. Some people can experience one or two symptoms, while others may experience more.

Urinary incontinence may be a small occasional leak, a continued leak, or total loss of bladder control. There are several types of urinary incontinence – the most common one for people with dementia is an overactive bladder. This causes the feeling of a sudden and intense need to urinate, or frequent urination.

Faecal incontinence is less common than urinary incontinence. It can range from accidentally leaking when flatulating, to having no bowel control at all.

What are symptoms of incontinence in the elderly?

Symptoms of urinary incontinence may resemble other conditions or medical problems. As a result, it can be difficult to diagnose or determine the cause. Therefore, you should always consult a medical professional for a proper diagnosis.

Some common symptoms of incontinence are:

  • Constant feeling of wetness without the sensation of urine leakage
  • Feeling unable to empty the bladder completely
  • Leakage before or after surgery
  • Leakage from exercise, movements or anything that prevents daily activities
  • Leakage when coughing, sneezing or laughing – often referred to as stress incontinence
  • Not reaching the toilet in time – for example, due to reduced mobility
  • Not reacting quickly enough to the sensation of needing the toilet
UrgencyThe sudden need to pass urine that is difficult to ignore.
FrequencyThe need to pass urine more often during the day and night.
StressUrine leakage with certain activities, such as coughing, sneezing, laughing or exercising.
OverflowThe overly full bladder leaks, usually due to an obstruction to the bladder outlet or an underactive bladder muscle.
FunctionalReaching and/or using the toilet successfully is difficult – this is often a main symptom of incontinence in people living with dementia.

Lower urinary tract symptoms (LUTS)

The lower urinary tract includes the bladder and the tube that urine passes through as it leaves the body (urethra). Lower urinary tract symptoms are common as people get older and experiencing them can make urinary incontinence more likely.

Symptoms include:

  • Problems after passing urine, such as feeling the bladder is not completely emptied or passing a few drops of urine after finishing
  • Problems passing urine, such as a slow stream of urine, straining, or stopping and starting while urinating
  • Problems storing urine, such as an urgent or frequent need to urinate or feeling a need to go again shortly after having been

Other symptoms of incontinence in the elderly may be as a result of:

  • Confusion – this is common in people who have memory loss, like Alzheimer’s or dementia and become confused by their surroundings. For example, your loved one may be unable to find or recognise the toilet which may cause them to urinate in an inappropriate place, such as a bin, because they’ve mistaken it for a toilet. Additionally, they may be unable or forget how to use the toilet such as undoing clothing beforehand
  • Difficulty communicating – for example, your loved one may be unable to tell someone, such as a Carer or relative, that they need to use the toilet or they may not understand a prompt to use the toilet
  • Embarrassment – refusing to use the toilet or accept help with going to the toilet could be due to embarrassment or not understanding the offer of help. Embarrassment after an incontinence episode may result in your loved one trying to hide soiled clothing
  • Mental health issues – due to depression, lack of motivation or distraction, your loved one may make no attempt to use the toilet, resulting in soiled clothing

Often, symptoms of elderly incontinence are even more difficult to manage at night time. This is because an elderly person may be unable to get out of bed unassisted to reach the toilet in time. The darkness also impacts visibility which can make it difficult to navigate. If this is the case, there are washable bed pads for elderly people which can help. Alternatively, you may find your loved one would benefit from an Overnight Carer to assist them during night time hours with using the toilet or changing bed sheets.

Male client & female Carer

What are the different types of incontinence?

There are several different types of incontinence. The main ones are:

Functional incontinence

Functional incontinence is leakage that occurs due to difficulty reaching the toilet in time because of restrictions due to a physical condition, such as arthritis, injury or another disability.

Mixed incontinence

Mixed incontinence is when there are symptoms of both stress and urge incontinence present. For example, someone may experience urine leakage after a cough or sneeze, but also experience an intense urge to pass urine.

Overflow incontinence

Overflow incontinence, also called chronic urinary retention, is when the bladder cannot completely empty when urinating. As a result, this causes the bladder to swell.

Someone with overflow incontinence may experience small leakages of urine often. It may feel as though the bladder is never fully empty and cannot be emptied completely no matter how hard they try.

Stress incontinence

Stress incontinence is not related to feeling stress; instead, it’s the leakage of urine when the bladder is put under extra pressure. Women are at particular risk of stress incontinence caused by pregnancy or childbirth. The urine passed is usually small, but stress incontinence can sometimes cause larker leakages, particularly if the bladder is very full.

Body movements that put pressure on the bladder and cause leakages include activities such as:

  • Coughing
  • Exercising
  • Jumping
  • Laughing
  • Lifting heavy objects
  • Sneezing

Total incontinence

Total incontinence refers to urinary incontinence that’s continuous. It may result in constantly passing large amounts of urine, even at night time, or passing large amounts of urine occasionally and leaking smaller amounts in between.

Urge incontinence

Otherwise known as urgency incontinence, this is when there is a sudden and intense need to urinate and the inability to hold long enough to reach the toilet. There are often only a few seconds between the need to urinate and the release of urine.

The need to urinate may be triggered by a sudden change of position or even by the sound of running water.

This type of incontinence can be a separate condition, but it may also be an indication of other conditions that would also warrant medical attention. It often occurs as part of a group of symptoms called overactive bladder syndrome, which is when the bladder muscle is more active than usual.

As well as causing urge incontinence, overactive bladder syndrome can create the need to urinate frequently, including several times during the night.

What are the causes of elderly incontinence?

There are many possible reasons why someone may lose continence. Incontinence is not an inevitable result of ageing – it can occur at any age – but it is particularly common in older people and people with dementia.

As we age, the bladder’s muscle fibres are partially replaced with stiffer, fibrotic tissue and the neurological signals that we rely on to maintain normal urinary function decline. This essentially means that:

  • The contraction of the bladder muscle is less forceful
  • The need to urinate is more frequent
  • The sensation to empty the bladder occurs when the bladder is fuller than in a younger person

In some cases, older people have a higher risk of incontinence due to a medical condition, use of medications or the onset of an illness. Mobility limitations, cognitive impairment, diabetes, obesity, congestive heart failure, and more can all contribute to incontinence.

Understanding the cause of incontinence in older adults is important to determine the type of incontinence and, consequently, how to treat the issue.

Overflow incontinence

The bladder is unable to empty completely due to an obstruction. Pressure from the urine left in the bladder builds up behind the obstruction, causing leaks.

Causes of obstructions in the bladder:

  • An enlarged prostate gland
  • Bladder stones
  • Constipation

Causes of the detrusor muscles not fully contracting:

  • Certain medications
  • Damaged nerves – for example, as a result of surgery to the bowel or a spinal cord injury
Stress incontinence

The urethra (the tube that allows urine to leave the body) may be unable to stay closed if the pelvic floor muscles are weak or damaged. Similarly, if the urethral sphincter (the ring of muscle that keeps the urethra closed) is damaged, this can also cause stress incontinence.

Damage to these muscles can result from:

  • Certain medication
  • Childbirth – particularly vaginal delivery
  • Increased pressure on the tummy, such as pregnancy or obesity
  • Neurological conditions that affect the brain or spinal cord, such as Parkinson’s or Multiple Sclerosis
  • Surgery – damage to the bladder or nearby area, such as a hysterectomy or removal of the prostate gland
Total incontinence

The bladder cannot store any urine. This could be caused by:

  • A bladder fistula (small tunnel-like hole that can form between the bladder and nearby area)
  • Injury to the spinal cord which disrupts signals between the brain and bladder
  • Problems with the bladder from birth
Urge incontinence

The detrusor muscles relax to allow the bladder to fill with urine, then contract when going to the toilet to let urine out. Sometimes the detrusor muscles contract too often, creating an urgent need to go to the toilet.

Possible causes for the detrusor muscles contracting too often:

  • Certain medication
  • Conditions affecting the lower urinary tract, such as UTIs or tumours in the bladder
  • Constipation
  • Drinking too much alcohol or caffeine
  • Neurological conditions
  • Not drinking enough fluids

Other medical causes of incontinence in older adults include:

How are symptoms of elderly incontinence diagnosed?

For people with urinary incontinence, it’s important to consult a medical professional for a correct diagnosis. They will ask questions about the symptoms your loved one is facing and their medical history. The questions they ask may include:

  • How much fluid, alcohol or caffeine is consumed
  • If there’s difficulty urinating when using the toilet
  • If there’s a frequent need to use the toilet during the day or night
  • Whether the incontinence happens when coughing or laughing
  • Whether the person is taking any medication

Your loved one may be asked to record their bladder habits for a few days to provide as much information and detail as possible. The diary may include how much fluid, or the types of fluid consumed, how often they need to pass urine and the amount of urine passed, how many episodes of incontinence are experienced and how many times they urgently need to use the toilet.

Diagnosis may also include:

  • Cystoscopy involving a thin tube with a camera attached to look inside the bladder and urinary tract
  • Dipstick test to check whether bacteria is present in urine samples
  • Physical examinations to check pelvic floor muscles and prostate glands
  • Residual urine test to check if the bladder has emptied completely – usually involving an ultrasound scan
  • Urodynamic tests to check the function of the bladder and urethra

Treatments for incontinence in elderly people

Specific treatment for incontinence in elderly people will be based on:

  • Age, overall health and medical history
  • Expectations for the course of the condition
  • Tolerance for specific medications, procedures or therapies
  • Type of incontinence and extent of the condition

There are both surgical and non-surgical incontinence solutions for elderly people. Your loved one should seek professional medical advice for a proper diagnosis and to discuss which treatment option is best for them. Some effective treatments include:

Bladder training

Bladder training involves learning to increase the length of time between the urge to urinate and going to the toilet. This sometimes means following a fixed schedule for urinating, such as every few hours, and supressing the urge in between. For someone with mixed urinary incontinence, it may be combined with pelvic floor muscle training.

Incontinence products

Incontinence products are not a treatment, but they are useful for managing the condition whilst awaiting assessment or treatment to start. Incontinence products include:

  • A catheter
  • Absorbent products, such as pants or bed pads for elderly people
  • Devices to prevent leakages
  • Handheld urinals
Lifestyle changes

A medical professional may suggest your loved one makes simple lifestyle changes to improve symptoms, regardless of the type of incontinence. This can include changes such as:

  • Losing weight – if your loved one is overweight, losing weight will reduce pressure on the tummy
  • Monitoring fluid intake – drinking too much or too little can make incontinence worse
  • Reducing caffeine intake – caffeine can increase the amount of urine the body makes so drinking less tea or coffee will help

If lifestyle changes and exercises are not helpful in improving continence, there are medicines available to manage symptoms. These must be prescribed by a medical professional.

Pelvic floor muscle training

The pelvic floor muscles surrounding the bladder and urethra control the flow of urine. If they’re weak or damaged, this can result in an incontinence issue. Strengthening these muscles can help urinary incontinence and is often recommended as a treatment. The NHS has useful information on pelvic floor muscle exercises, also known as Kegel exercises. A medical health professional may also offer a referral to a specialist.

Electrical stimulation can also be used to help strengthen pelvic floor muscles. It can be unpleasant, but it may be beneficial to your loved one if they’re unable to complete pelvic floor muscle contractions without it.


Other treatment options may be recommended if non-surgical treatments for incontinence in elderly people are unsuccessful or unsuitable. These may involve a surgical procedure such as Botox injections or a sling.

Female client & female Carer

Tips for managing elderly incontinence

There are a few useful tips which can help ease the burden of incontinence:

Appropriate clothing

Clothing with elasticated waists or Velcro fastenings instead of zips or buttons will make it easier to undress during an urgency to use the toilet.

Home adaptations

If your loved one needs to use the bathroom frequently, elderly slips and falls can happen more easily. Ensuring the bathroom is as accessible as possible and that any liquid or spills are cleaned up quickly will help to avoid accidents.

Hydration & healthy eating

Unless advised by a medical professional, your loved one should drink the recommended amount of liquid each day but avoid caffeinated drinks which can make incontinence symptoms worse.

Eating plenty of fibre nutrient foods, such as fruit and vegetables, will help avoid constipation that puts pressure on the bladder. If able, physical activity and exercise can also help with regular bowel movements.

Incontinence products

There are many products available for people living with incontinence, available through the NHS or to purchase privately. Having the right products will provide you and your loved one with peace of mind in urgent moments and help ease the stress of elderly incontinence.

Absorbent pads are the most popular products which can be worn inside underwear to soak up urine. For mild incontinence, these can be purchased locally from supermarkets or pharmacies. However, for severe incontinence, the NHS may provide free incontinence pads for elderly people. To qualify for NHS products, your loved one may need an assessment by a healthcare professional.

Other useful incontinence products include waterproof bed pads for elderly people. These often come as disposable options or washable bed pads for elderly people. Washable products are likely to be more cost effective, but ultimately your loved one’s comfort is the primary concern.

Also available are incontinence pads for elderly people. Absorbent incontinence pants often look very similar to normal underwear so provide discretion and confidence whilst offering the security of high absorbency protection.

Other incontinence products which may benefit older adults include waterproof chair covers and skincare products such as wipes and creams.

Steep stairs, inadequate lighting and a lack of handrails can all mean navigating stairs is extra risky. If possible, opt for stairs with a gradual incline and if not, at least ensure sufficient tread depths are in place. Install handrails on both sides of the stairs. Contrasting colours on steps, such as stickers, could improve visibility.

Personal Care

If your elderly loved one suffers from incontinence, Personal Care services can help avoid complications such as skin rashes, odours and accidents.

Washing regularly and drying with a soft towel will help keep skin healthy and less prone to rashes. Also changing pads regularly and ensuring they fit properly without rubbing will help avoid skin becoming red and sore.

Incontinence care for the elderly

If your loved one is experiencing symptoms of elderly incontinence, they may want to consider additional help at home. The level of help they receive will vary according to their needs. Our Home Carers can visit them to provide as much or as little help as needed, ensuring safety and comfort to continue living independently with dignity at home.

If they need regular, comforting continence services, we have a range of care options available:

Personal Care

Personal Care at Home helps your loved one with intimate tasks like bathing, getting dressed or preparing for bed. Our Home Carers are expertly trained through our exclusive Training Academy, so they’re knowledgeable about incontinence and the assistance it requires. Whether your loved one needs regular toilet reminders to avoid leakages, or support using a commode, bed pan or continence pads, our Carers provide a safe and respectful environment.

Overnight Care

Elderly incontinence can be managed by a healthy and regular routine. If your loved one needs some added reassurance during the night time, our Overnight Care service could help. An Overnight Carer can help with using the bathroom in the late and early hours of the day, as well as providing reassurance if your loved one needs pads or bed sheets changing during the night.

Dementia Care

We offer a specialist Dementia Care service. Our Carers provide a calming, reassuring presence if your loved one has incontinence and needs assistance with reaching or using the toilet. Our Dementia Carers will help your loved one with their needs so they can live as independently as possible. From preparing balanced meals to light household tasks, or even just being a friendly face to talk to. Our Carers receive specialised training to help with the symptoms of dementia and the challenges your loved one faces living with the condition.

Live-in Care

If your loved one has elderly incontinence and struggles during the day or night, Live-in Care involves a Carer moving into the home to provide round the clock support. This is especially helpful if your loved one has accidents during the night, as they’ll have someone nearby for continuous reassurance. Our Carers can ensure your loved one is clean and make them feel comfortable. Our person centred care is focused on maintaining dignity and delivering support with sensitivity and dignity.

Mobility Care

For people living with reduced mobility, our Mobility Care at Home enables people to do as much as they can independently with the right level of support. If your loved one needs assistance with using the bathroom, our Mobility Carers can help – whether it’s due to a restricting health condition or general frailty as a consequence of growing older, our Carers can help them feel safe and secure in familiar surroundings.

Visiting Care

Visiting Care is available for as little or as much as required. A Home Carer will visit your elderly loved one at home to provide reassurance, as well as practical help. This could involve anything from making meals or chatting with your elderly loved one, to using the bathroom and getting ready for bed. We also provide help with shopping assistance if your elderly loved one is unable to get out and about by themselves.

1. Age UK, “Urinary incontinence”, Reviewed 10 May 2024