By Brooke Schmidt, RN
As an RN who’s worked in geriatrics for over 14 years, I know first hand that changes in bladder control can be a common part of aging. However, what I’ve also learned is that the treatment and management of these changes differ depending on whether they are due to aging or other conditions.
If you’re experiencing more frequent trips to the bathroom or sudden, intense urges to urinate, you might be wondering what is going on and what you can do about it. Let’s talk through some of the changes that might be going on in your body and how you can be better prepared to manage your bladder control.
Physiological Changes That Happen Within the Body
To better understand bladder control, it is helpful to understand how it works. The bladder is an organ that sits in your lower abdomen and is empty or hollow inside and fills with urine. The bladder is part of the urinary system and is connected to your kidneys (organs that filter blood) and the urethra (the opening through which urine leaves the body). The urinary system works together to filter toxins by flushing them out in your urine and returning nutrients to your body.
Just like our skin loses elasticity and wrinkles form with age, the urinary system undergoes changes we cannot control, too. The bladder walls become thinner and have a harder time stretching and shrinking to accommodate urine. When the bladder becomes less elastic, it can start sending signals to your brain more frequently. It has a reduced capacity to stretch and may be more prone to spasms and contractions, which signal to your brain that you need to use the bathroom more often.
Furthermore, the kidneys become less efficient, meaning they may not filter nutrients and toxins as well, so instead of urine accumulating in the bladder at a steady rate, it can be variable and less concentrated. All of these changes can cause increased urinary frequency, urgency, and incontinence (the involuntary loss of urine).
In addition to the structural impacts of aging, there are also changes to what we call the brain-bladder axis. This is the pathway through which your brain and bladder communicate. When your bladder fills with urine, and the pressure increases, it signals to your brain that you need to use the restroom. As we age, changes in our brain and the nervous system’s ability to adapt decrease. These changes impair the connection between the brain and bladder, leading to loss of bladder control or impaired signaling. The dysfunction can cause symptoms such as urgency or frequency even when the bladder is not at capacity. In a real-life scenario, this can look like someone who previously had bladder control but suddenly experiences a strong urge to urinate, and they may find themselves rushing to the bathroom only to discover there is not much urine in their bladder.
Other Causes of Bladder Control Issues
Apart from the changes that occur directly due to aging, other conditions can also affect bladder control. While these conditions are not directly due to aging, the likelihood of developing them and the impacts increase with age. These conditions can include a weakened pelvic floor (most common in women, especially those who have gone through childbirth), hormonal changes (such as menopause), benign prostatic hyperplasia (a common occurrence for men as they age), chronic kidney disease, neurologic changes experienced due to stroke, Parkinson’s disease, or diabetes, surgeries, and taking certain medications.
BPH is one of the most common reasons why men may experience changes in bladder control. BPH is when the prostate (a small gland below the bladder in males) enlarges and puts pressure on the urethra (the tube through which urine leaves the body). This can lead to changes in bladder control, such as a more frequent or urgent need to urinate, a delayed or weak urine stream, and incomplete bladder emptying.
Chronic kidney disease (CKD) occurs when your kidneys stop working well and struggle to filter blood efficiently. Untreated CKD can result in other serious problems, such as heart disease and kidney failure. Symptoms of CKD often go unnoticed, but changes in bladder control, such as decreased urine output, can be a warning sign.
Another major contributor to bladder control changes in adults is medication side effects. Common medication types that can cause issues are diuretics (medications that draw water out of the body), muscle relaxants or sedatives, narcotics (pain medication), antihistamines (usually used to treat allergies), and alpha-adrenergic antagonists (used to treat high blood pressure and other disorders).
Different Symptoms Experienced With Changes in Bladder Control
The symptoms each person experiences can vary widely. Bladder control is not just about leaking urine. Symptoms may include small urine leaks, especially during activities such as exercise, lifting, coughing, or laughing. Leaking urine with no warning, also described as not feeling the sense of fullness or urgency. Urgency is a common symptom best described by the sudden feeling of needing to urinate and being unable to ignore the urge, resulting in leaking. Many people also describe this as getting the urge to urinate but then not having enough time to reach the restroom before urination occurs. Experiencing nighttime wetness or a decrease in urine output are also symptoms associated with bladder control.
I often hear from patients that they are using the restroom more frequently or waking up multiple times at night to use the restroom. They are wondering where the line is between normal changes in bladder control and if something is wrong. A general guideline I give patients is that if your bladder control is affecting your daily needs, you need to speak with your medical provider. That means if you have frequent trips to the bathroom or nighttime wakings that are disrupting your sleep, making you skip out on activities, or causing you concern, you need to make an appointment to first rule out any other non-aging causes and then develop a plan to better manage your symptoms.
In healthcare, how we manage bladder control depends on the underlying cause. Anytime a patient calls me with new-onset or worsening bladder control concerns, I start by ruling out any non-age-related cause. This looks like asking questions such as, “What symptoms are you experiencing?” “Have you started any new medications?” “Has the change been sudden or developed slowly?” “Do you have any other conditions that affect your kidneys?”
What Can Help With Bladder Control
The two most common things people are surprised about are lifestyle modifications and recommendations around fluid management. When helping patients experiencing changes in bladder control, I start by discussing lifestyle modifications they can make. Some of the easiest ones are to decrease or eliminate intake of caffeinated beverages and alcohol. Both of these are considered diuretics and can be irritating to the bladder, causing feelings of urgency. Additionally, regular exercise or activity helps maintain pelvic floor strength, which also helps reduce episodes of urinary incontinence. Exercise can also help maintain a healthy weight, as being overweight puts more strain on the bladder and pelvic floor, which can contribute to loss of bladder control.
Managing fluids is another important part of bladder control. I really hone in on people who avoid fluids; that’s not the goal. It is important to stay well hydrated to ensure your kidneys are working as well as they can. Fluid recommendations for adults over 50 are to drink about 1/3 of your body weight in ounces, or 9 cups for women and 13 cups for men.
A common scenario I see when caring for older adults is self-induced fluid restriction. Any time they are away from home, they will avoid drinking fluids. This helps them reduce the frequency of bathroom trips or episodes of incontinence. While this tactic can work, it is also extremely dangerous. Dehydration occurs much faster in older adults and has more serious consequences. Instead of avoiding fluids, I educate my patients to avoid drinking large amounts of fluid at once, which can cause urgency and frequency with urination. It is better to drink small amounts more frequently, which is less likely to cause loss of bladder control. This can look like taking a sip of water every 10 minutes.
In addition to these recommendations, I often suggest to my patients to consider bladder training and using incontinence products. Bladder training is best explained as a scheduled toileting plan. This is especially helpful for people experiencing dysfunction of the brain-bladder connection who find themselves rushing to the bathroom with little notice or experiencing incontinence with no warning. A bladder training schedule usually consists of going to the bathroom every 2 hours, whether you need to go or not. This can help your body to completely empty your bladder and reduce accidents and urgent trips to the bathroom.
Incontinence products like those offered by LivDry can be a great support tool if you’re continuing to experience leakage. These come in many styles, including liners (placed in your underwear), pull-up disposable underwear, and briefs (traditional tabbed diaper style). The products that are best for you will depend on the frequency and amount of urine elimination you experience.
Pelvic floor physical therapy is another wonderful option to help with bladder control. There is a misconception that this type of therapy is only for women after giving childbirth, when it is beneficial for both men and women experiencing any kind of bladder control issues. It aims to improve the strength and control of the pelvic floor muscles, which are directly related to bladder control.
Depending on the reason for your bladder control issue, your medical provider may prescribe medication to help. For people struggling with bladder emptying or decreased urinary flow, medications called alpha-blockers can help the bladder and prostate relax, allowing urine to leave the body more freely and completely. For those who experience urinary frequency or urgency, there are medications called antimuscarinics that lessen bladder spasms, which helps reduce the number of trips to the bathroom. Taking medication for bladder control issues is usually not a first-line intervention. You will need to discuss your specific symptoms with your provider, who will help develop a plan.
There are some cases of bladder control where surgery may be recommended. Conditions that can be improved by surgery are usually bladder or uterine prolapse and BPH. These surgeries aim to correct the physical abnormality and restore normal function of the urinary system and other involved structures.
Bladder control is in your hands
While you can’t predict how bladder control may affect you, having a better understanding of the urinary system and how aging affects it can help you be less surprised if changes occur. If bladder control issues are already something you’re dealing with, take control by implementing lifestyle modifications, using the right incontinence products, and making a plan with your medical provider. These steps can help prevent bladder control issues from impacting your daily life.
This article was developed in partnership with, and sponsored by LivDry. NAFC collaborates with select partners to bring our community information and resources that support bladder and bowel health.
