Incontinence in ageing: causes, challenges, solutions

If you or someone you care for is experiencing bladder or bowel control problems, you’re not alone. An estimated 1.17 million Australians aged above 65 years of age experience urinary or faecal incontinence, with those over 85 more likely to develop severe bladder or bowel control issues.

Lack of bladder or bowel control is not an inevitable part of ageing, and the stress it brings cannot be overlooked. For this reason, care providers and allied health professionals should collaborate in helping patients manage and overcome the condition.

Understanding the causes

There are two types of incontinence: faecal and urinary. With the right products for effective incontinence management, both types are easy to control, treat, and cure.

Urinary incontinence ranges from occasional leakage of urine when you cough or laugh to complete loss of bladder control. Some of the common causes of this problem among people include:

• reduced holding capacity of the bladder due to ageing
• enlarged prostate glands in men
• diabetes
• stroke
• Parkinson’s disease
• pelvic muscle weakness due to old age or childbirth
• menopause.

Faecal incontinence is characterised by involuntary loss of stool from the bowels. Individuals with this condition may frequently experience faecal leakage, leading to stains on their undergarments or have an inability to control wind. Common causes of faecal incontinence include:

• weak back passage muscles due to old age
• Coeliac or Crohn’s disease
• long-term heavy lifting leads to weak pelvic muscles
• diarrhoea and constipation
• dementia

Though anyone can experience incontinence, age is a predisposing factor. According to the MSD Manual, the condition affects about 15 per cent and 30 per cent of older men and women, respectively.

Emotional, physical and social challenges

A person with incontinence may experience negative emotional, physical and social difficulties, especially if the condition is not well-managed. These challenges also affect caregivers and allied health professionals.

Emotional impact

People experiencing an involuntary loss of urine or stool can often carry the emotional burden of embarrassment and shame. Due to fear that they may have “an accident,” those with incontinence tend to shy away from social activities. They may withdraw from hobbies, social events, and interactions they previously enjoyed. Eventually, shame and isolation can cause depression and anxiety.

While caring for a person can be demanding, looking after somebody who is experiencing incontinence can be challenging at times. Many aged care providers may feel frustrated, or overwhelmed. With recent staff shortages in aged care, carers are often working longer hours which can create fatigue and emotional exhaustion that can have an impact on the quality of care provided to those patients.

Financial burden

Incontinence can create a financial burden for those who are managing this condition. The cost of incontinence aids and healthcare expenses can place a significant financial burden on care recipients. Continence Aids Payment Scheme – CAPS – is a government program that assists people with incontinence. It helps cover the costs of continence aids so people don’t have to pay for them out of pocket. The carer or care recipient doesn’t pay for CAPS.

The indirect costs are also high. According to the United States National Association of Incontinence, about 23 per cent of women suffering from loss of bladder control take time off from work. Loss of work, coupled with treatment costs, leads to serious financial drain.

Physical challenges

Patients can suffer from skin infections due to constant exposure to wetness. Incontinence-associated dermatitis – IAD – and bacterial and fungal infections are common problems, especially when the skin comes into constant contact with urine or faeces.

Incontinence also exposes seniors to a higher risk of falls and related injuries. The urgency to reach the toilet can affect the balance of those elderly individuals experiencing incontinence. This increases the risks of trips or falls, leading to injuries and fractures.

Practical solutions for managing incontinence

Managing bladder and bowel leakage calls for a combination of lifestyle changes and medical interventions. Some practical solutions include pelvic floor exercises, planning a toileting schedule, maintaining a healthy weight, and reducing alcohol and caffeine intake.

Do pelvic floor exercises

Kegel exercises are an effective way of bolstering and rehabilitating pelvic floor muscles and improving urine storage. Studies have shown that patients can start experiencing positive changes after three weeks of regular exercise.

Health professionals and aged care providers should guide older people through the motions of these exercises to achieve the desired results.

Develop a toileting schedule

Don’t wait until you feel the urge to use the toilet. Instead, practice using the toilet at set intervals. This will prevent your bladder from becoming too full to necessitate a rush to the bathroom. Over time, you can gradually increase the interval as you gain more control over your bladder.

Limit caffeine and alcohol intake

Alcohol and caffeine irritate your bladder, making it harder to contain urine. Consider reducing alcohol consumption and switch to decaffeinated coffee. It’s also advisable to avoid energy drinks, fizzy drinks, and hot chocolate since they contain caffeine. You can replace them with water or fruit teas. 

Reduce weight

Excess body weight weakens the pelvic floor muscles because of the pressure of the fatty tissue on the bladder. If you lose weight, your symptoms could greatly improve or disappear altogether. Care providers and healthcare professionals should guide patients on effective weight reduction strategies.

Get the right treatment

Your healthcare specialist may recommend medication or surgery if other methods fail to alleviate symptoms. Prescription medication helps to calm your nerves and reduce symptoms, while surgical procedures like sling insertion can help support and strengthen the bladder.

Create a supportive environment

Caregivers and medical professionals should foster a supportive environment that prioritises dignity and quality of life for persons with incontinence. Here are the tips that can help create an empathetic approach to care and treatment.

• Uphold respect and be sensitive: treat patients with sensitivity and uphold their privacy in every aspect of care
• Offer emotional support: keep providing emotional assistance and support. This helps alleviate the patient’s feelings of frustration and embarrassment
• Avail the appropriate products: ensure patients have access to absorbent garments, pads, and equipment for self-care
• Provide Personalised care: acknowledge that each person is unique and consider individual preferences when planning care delivery
• Empower: involve your clients when making decisions that impact care. Also, provide them with the necessary information concerning treatment and related procedures.

Lesley Barton is the National Clinical and Training Manager at Bunzl & Atlas McNeil Healthcare Community. She also serves on the board of Continence Health Australia (formerly Continence Foundation of Australia) and founded the Clinical Care Connections program.

World Continence Week runs from Monday 16 June to Sunday 22 June 2025 – campaign resources from Continence Health Australia available here

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