Urinary incontinence in older adults: causes, assessment and treatment

The NHS defines urinary incontinence as the unintentional passing of urine and describes it as a common problem thought to affect millions of people. It happens when the normal process of storing and passing urine is disrupted.

In later life it can affect independence, sleep, mood and confidence. The most important message from the NHS is that it should not be accepted as simply part of getting older: there are assessments and treatments that help.

The NHS describes several types, and it is possible to have a mixture of stress and urge incontinence. The type matters because treatment differs.

The NHS says urge incontinence can be linked to drinking too much alcohol or caffeine, not drinking enough fluids (which makes concentrated urine that irritates the bladder), constipation, urinary tract infections, tumours in the bladder, neurological conditions and certain medicines. Overflow incontinence is often caused by an obstruction, including an enlarged prostate gland in people with a penis, bladder stones or constipation.

Stress incontinence may follow damage during childbirth, surgery such as hysterectomy or prostate removal, or neurological conditions such as Parkinson's disease or multiple sclerosis. The NHS also lists a family history, obesity and lower urinary tract symptoms as risk factors.

Because several of these causes can be treated, a review of medicines, bowel habit and fluid intake is often a sensible early step. The NHS says that stopping a medicine that is causing the problem, if a doctor advises it, may help resolve incontinence.

The NHS says urinary incontinence can usually be diagnosed after a consultation with a GP, who will ask about your symptoms and may do a pelvic examination (if you have a vagina) or a rectal examination (if you have a penis). The GP may suggest keeping a diary of how much you drink and how often you pass urine, and you may be referred to a specialist for more tests.

NHS continence services are staffed by specialist nurses, sometimes called continence advisers, and specialist physiotherapists, who should be able to diagnose the condition and start treatment. A GP can refer you and in some cases you may be able to refer yourself.

The NHS says conservative treatments are tried first: lifestyle changes, pelvic floor muscle training and bladder training. The lifestyle advice includes cutting down on caffeine and alcohol, adjusting how much you drink (drinking too much or too little can make incontinence worse) and losing weight if you are overweight.

Pelvic floor training programmes should include a minimum of 8 muscle contractions at least 3 times a day and last for at least 3 months, according to the NHS. Bladder training, which is one of the first treatments for urge incontinence, teaches ways to lengthen the time between feeling the need to pee and passing urine, and usually lasts at least 6 weeks.

If these do not help enough, medicines may be considered. For urge incontinence the NHS names antimuscarinics such as oxybutynin, tolterodine and darifenacin, whose side effects include dry mouth, constipation, blurred vision and tiredness, and mirabegron or vibegron as alternatives. For stress incontinence, duloxetine may be used if surgery is unsuitable. For night-time passing of urine (nocturia), low-dose desmopressin or a loop diuretic taken in the afternoon may be used. Because older people may be taking many medicines, any new prescription needs review by a doctor or pharmacist.

Surgery may be considered depending on the type, such as sling procedures for stress incontinence. The NHS notes that incontinence products such as pads, handheld urinals and catheters are not a treatment but can help manage the condition while waiting for assessment.

• Keep a simple bladder diary of drinks and toilet visits to take to the appointment.

• Cut down on tea, coffee, cola and alcohol, which can irritate the bladder or increase urine production.

• Do not cut fluids too far: the NHS says too little can make symptoms worse.

• If you pass urine often at night, try drinking less in the hours before bed while keeping up fluids in the day.

• Treat constipation, which the NHS lists as a cause of both urge and overflow incontinence.

• Ask a pharmacist or GP to review your medicines for any that may be contributing.

• Keep to a healthy weight and stay active.

On the NHS, assessment and treatment start with a GP or a local continence service, and the NHS website has information about getting free incontinence products on the NHS. If you need help with day-to-day living or you care for someone with incontinence, the NHS social care and support guide explains the options.

Some people choose to see a private urologist, urogynaecologist or continence physiotherapist for faster access or a second opinion. The basic assessment, conservative measures and medicines are broadly the same in either setting. It helps to bring a list of medicines, your bladder diary and a clear description of how symptoms affect daily life.