Department of Health

Key messages

  • Some physiological aspects of ageing can cause bladder and bowel changes that affect continence.
  • Incontinence has an enormous impact on an older person’s quality of life and adds significant burden on family and carers.
  • Continence problems can develop or become more severe if an older person is experiencing other health issues.

As a person ages, their bladder and bowel changes, which affects their function.

Bladder changes include1:

  • the elastic tissue of the bladder wall becomes tough and less stretchy and unable to hold as much urine
  • weakening of the bladder muscles
  • increases in involuntary bladder contractions
  • urethral blockage:
    • in women this can be due to weakened muscles causing the bladder or vagina to prolapse
    • in men this can be due to an enlarged prostate gland
  • increases in post-voiding residual volume (50–100 mL)
  • increases in fluid excretion at night.

Bowel changes include2:

  • sphincter weakness (for example, due to childbirth stretch injury)
  • loss of anal sensation
  • impairment of gastrocolic reflex
  • softening of stools.

Incontinence has a big impact on health and quality of life

Incontinence has an enormous impact on an older person’s quality of life. It adds significant burden on family and carers and is a major factor in deciding to go into residential care.

Incontinence also puts people at greater risk of health issues such as falls and pressure injuries.

Incontinence has financial implications due to the cost of continence aids. It can affect a person’s general wellbeing and make them socially isolated due to embarrassment.

Continence problems can develop with other issues

In older patients, incontinence is usually caused by a combination of factors, including age-related changes to the urinary tract.

Continence problems can develop or become more severe if an older person is experiencing:

  • Reduced mobility – can lead to falls when attempting to reach the bathroom. This is the single most predictive factor for incontinence, and urge incontinence has been identified as a high falls risk for men and women and as a major contributing factor to hip fractures in older women.3
  • Impaired cognition – including delirium, dementia and depression, limit a person’s ability to self-toilet, particularly in an unfamiliar environment. Incontinence may add to the burden of depression.4
  • Under nutrition (hydration and fibre) – adequate hydration and fibre intake is essential in maintaining bladder and bowel function. Many older people report limiting their fluids to avoid getting up to go the toilet while in hospital. This can contribute to constipation and urge incontinence.
  • Medication side effects (particularly diuretics, sedatives, caffeine and alcohol) – medications can cause constipation and drowsiness, which can increase the risk of falls. Diuretics can increase frequency. Caffeine and alcohol are bladder irritants and can also increase urinary frequency.
  • Skin integrity problems – exposure to urine and faeces can cause skin breakdown and leave the skin susceptible to damage from friction and pressure, dermatitis, and bacterial and fungal infections.
  • Frailty – people who are frail and functionally impaired need accessible, safe toilet facilities and often benefit from assistance or supervision in hospital.

1. Keane, D.P, O'Sullivan S, Urinary incontinence: anatomy, physiology and pathophysiology. Best Practice & Research Clinical Obstetrics & Gynaecology, 2000. 14(2): p. 207-226.

2. Cooper, Z.R, Rose S, Fecal incontinence: a clinical approach. The Mount Sinai journal of medicine, New York, 2000. 67(2): p. 96-105.

3. Gray, M., The importance of screening, assessment, and managing urinary incontinence in primary care. Journal of the American Academy of Nurse Practitioners, 2003. 15(3): p. 102-107

4. Trantafylidis, S.C.-A., Impact of urinary incontinence on quality of life. Pelviperineology, 2009. 28(28): p. 51-53.

Reviewed 05 October 2015


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