It’s Not Normal: Urinary Incontinence


Cleveland, MaryJo 4x6Maryjo L. Cleveland, MD
Medical Director, Post Acute & Senior Services
Chief, Division of Geriatric Medicine
Summa Health System
Akron, Ohio


This month we are going to talk about one of those problems that no one wants to talk about. Urinary Incontinence. There, I said it. Now you can too.

Urinary incontinence is the involuntary loss of urine and boy, is it common. Probably 50% of older women and 15% of older men suffer from this problem. But most older adults don’t tell their healthcare provider about it. Why? If you have followed this blog at all, you already know the answer. Because people think it’s normal, and that nothing can be done about it. Fortunately, this thinking is wrong!

If you have episodes of involuntary loss of urine, please talk to your healthcare provider. Your healthcare provider should begin to ask you questions about your experience. Don’t be embarrassed to answer these frankly!  Honest answers will help determine the cause and the approach to treatment.

Some of the questions will likely include:

  • How frequently is it happening?
  • Is it affecting your work, social life, or sex life?
  • Do you lose small amounts or do you soak your clothing or pad?
  • Is it worse when you cough or sneeze?
  • Do you have to rush to the bathroom to avoid and accident?

There are basically five types of incontinence:

1.  Stress incontinence – also called stress urinary incontinence, this is not caused by emotional stress or being nervous.  This type of incontinence is the loss of small amounts of urine when you exert pressure on your abdomen and bladder-coughing, sneezing, laughing, lifting heavy objects. This happens because the muscle that keeps the bladder closed has weakened over time. In women, this is usually due to pregnancy and childbirth and in some men it can happen after their prostate has been removed.

2.  Urgency urinary incontinence – also called urge incontinence or overactive bladder, this type is the loss of larger amounts of urine with little or no warning. You may have seen television commercials for this type of incontinence.  This is often caused by infections, bladder irritants, or brain diseases such as Alzheimer’s disease or strokes.

3.  Overflow incontinence  this is a frequent dribble of small amounts of urine and the inability to completely empty the bladder. This is often a complication of diabetes and is more common in men due to prostate problems.

4.  Mixed incontinence – this is combination of the above types.  It is mostly a combination of stress and urgency urinary incontinence.

5.  Functional incontinence – this is incontinence due to something outside of the bladder. In older adults it is because of physical or mental impairments that prevent them getting to the bathroom in a timely manner.

Your healthcare professional will usually have you complete a bladder diary to help identify the type of urinary incontinence you have.  Then, a treatment plan can be formed. Usually, simple things are suggested first and are often surprisingly helpful. Some of these ideas include:

  • Alcohol and caffeine are bladder stimulants – two cups of coffee or less is best.
  • Other things act as bladder irritants and should be minimized such as carbonation, artificial sweeteners, foods high in spice
  • Certain medications may worsen incontinence and may be able to be adjusted (Talk to your healthcare provider about this.  Don’t do this alone!).

You may also be asked to continue to keep a diary of your bladder symptoms as you make some of these changes to document patterns and look for improvement. And, your healthcare provider may order some basic blood and urine tests to rule out infection, elevated blood sugar or other treatable causes.

At this point, further treatment will depend on your response to the non-drug approaches. While the incontinence may not completely disappear, it is likely that the frequency and intensity of symptoms can be reduced to allow you to go about all your usual activities.

So, if you are having incontinence symptoms, you are not alone. Ask your healthcare provider what you can do about it. And remember, It’s Not Normal!

Related Resources from
Urinary Incontinence
Caregiving How-tos:  Urinary Incontinence