Everyone uses their bladder many times each day, but they may not know what to do to keep their bladder healthy.

Located in the lower abdomen, the bladder is a hollow organ, much like a balloon, that stores urine. It is part of the urinary system, which also includes the kidneys, ureters, and urethra. Urine contains wastes and extra fluid left over after the body takes what it needs from what we eat and drink.

As you get older, the bladder changes. The elastic bladder tissue may toughen and become less stretchy. A less stretchy bladder cannot hold as much urine as before and might make you go to the bathroom more often. The bladder wall and pelvic floor muscles may weaken, making it harder to empty the bladder fully and causing urine to leak.

Common Bladder Problems

Bladder problems are common and can disrupt day-to-day life. When people have bladder problems, they may avoid social settings and have a harder time getting tasks done at home or at work.

Common bladder problems include:

• Urinary tract infections (UTIs)—UTIs are the second most common type of infection in the body and can happen anywhere in the urinary system. More than half of women will have at least one UTI in their lifetime. Older women are more likely to get UTIs because the bladder muscles weaken and make it hard to fully empty the bladder. This causes urine to stay in the bladder. When urine stays in the bladder too long, it makes an infection more likely. Types of UTIs include:
  • Bladder infection—This is the most common type of UTI, in which bacteria enter the bladder and cause symptoms such as strong and sudden urges to urinate.
  • Kidney infection—Infections in the bladder can spread to the kidneys, which can lead to severe problems. When kidney infections occur frequently or last a long time, they may cause permanent damage to the kidneys.
  • Urethra infection —A UTI can also develop in the urethra, but this is less common.
• Lower urinary tract symptoms (LUTS)—a group of symptoms such as trouble urinating, loss of bladder control, leaking urine, and frequent need to urinate. LUTS are caused by problems with the bladder, urethra, or pelvic floor muscles.
• Bladder cancer—Bladder cancer occurs in the lining of the bladder.

What Can Affect Bladder Health?

Many things can affect bladder health. You can’t control everything that affects bladder health, but there are many bladder health behaviors that you can control. Here are some things that may affect your bladder health.

• Constipation. Constipation can cause too much stool to build up in the colon, which can put pressure on the bladder and keep it from expanding the way it should.
• Diabetes. Diabetes can damage nerves around the bladder that help with control.
• Being overweight. People who are overweight may be at higher risk for leaking urine.
• Low physical activity. Physical activity can help prevent bladder problems, as well as constipation. It can also help you keep a healthy weight.
• Smoking. Bladder problems are more common among people who smoke. Smoking can also increase the risk for bladder cancer.
• Some medicines. Some medicines may make it more likely for your bladder to leak urine. For example, medicines that calm your nerves so you can sleep or relax may dull the nerves in the bladder, and you may not feel the urge to go to the bathroom.
• Alcohol. For many people, drinking alcohol can make bladder problems worse.
• Caffeine. Caffeine can bother the bladder and change how your bladder tells you when you need to urinate.
• Diet. Some people with bladder problems find that some foods and drinks, such as sodas, artificial sweeteners, spicy foods, citrus fruits and juices, and tomato-based foods, make the problem worse. People who have bladder problems may feel better when they don’t eat these foods and drinks.
• Pelvic Injury. Trauma—such as prostate surgery, childbirth, or sexual assault—can damage the muscles and nerves that help control the bladder.

Some activities can increase the risk of urinary tract infections, including:

• Having sex. Sexual activity can move bacteria from the bowel or vaginal cavity to the urethral opening. Urinating after sex lowers the risk of infection.
• Using a catheter to urinate. A catheter is a tube placed in the urethra and bladder to help empty the bladder. The catheter can make a direct path for bacteria to reach the bladder.
• Using certain types of birth control. Diaphragms can bring bacteria with them when they are placed. Spermicides (a birth control that kills sperm) may also make UTIs more likely.

Signs of a Bladder Problem

Everyone’s bladder behaves a little bit differently. But certain signs may mean a bladder problem. If you have signs of a bladder problem, talk with your healthcare provider.

Signs of a bladder problem can include:

• Inability to hold urine or leaking urine (called urinary incontinence)
• Needing to urinate eight or more times in one day
• Waking up many times at night to urinate
• Sudden and urgent need to urinate
• Pain or burning before, during, or after urinating
• Cloudy or bloody urine
• Passing only small amounts of urine after strong urges to urinate
• Trouble starting or having a weak stream while urinating
• Trouble emptying the bladder

Signs of Urinary Tract Infection

In some elderly people, mental changes and confusion may be the only signs of a UTI. Older adults with a UTI are more likely to be tired, shaky, and weak and have muscle aches and abdominal pain.

Symptoms of a UTI in the bladder may include:

• Cloudy, bloody, or foul-smelling urine
• Pain or burning during urination
• Strong and frequent need to urinate, even right after emptying the bladder
• A mild fever below 101°F in some people

If a UTI spreads to the kidneys, symptoms may include:

• Chills and shaking
• Night sweats
• Feeling tired or generally ill
• Fever above 101°F
• Pain in the side, back, or groin
• Flushed, warm, or reddened skin
• Mental changes or confusion
• Nausea and vomiting
• Very bad abdominal pain in some people

Some people may have bacteria in the bladder or urinary tract, but not feel any symptoms. If a urine test shows that you have bacteria in your urine, but you do not feel any symptoms, you may not need any treatment. Talk to your healthcare provider about whether antibiotics—the medications that treat UTIs—are needed.

When to See a Health Care Provider—and What to Expect

If you have any of the signs of a bladder problem or urinary tract infection, talk to your healthcare provider. Read advice on talking to your doctor about sensitive subjects, like bladder problems.

When you see your healthcare provider, he or she may perform the following tests to try to figure out what might be causing your bladder problem:

• Give you a physical exam to look for any health issues that may cause a bladder problem. For women, the physical exam may include a pelvic exam. For men, the physical exam may include a prostate exam, which is usually done with a rectal exam.
• Take a urine sample to check for a bladder (or urinary tract) infection.
• Examine the inside of your bladder using a cystoscope, a long, thin tube that slides up into the bladder through the urethra. This is usually done by a urinary specialist.
• Fill the bladder with warm fluid to check how much fluid your bladder can hold before leaking.
• Check a bladder scan using ultrasound to see if you are fully emptying your bladder with each void.

Treating Bladder Problems

Treatment for bladder problems may include behavioral and lifestyle changes, exercises, medicines, surgery, or a combination of these treatments and others. For more information on treatment and management of urinary incontinence, visit Urinary Incontinence in Older Adults.

Because most urinary tract infections are caused by bacteria, bacteria-fighting medications called antibiotics are the usual treatment for UTIs. The type of antibiotic and length of treatment depend on the patient’s history and the type of bacteria causing the infection. Drinking lots of fluids and urinating often may also speed healing. If needed, painkillers can relieve the pain of a UTI. A heating pad on the back or abdomen may also help.

Urinary Incontinence in Older Adults

Urinary incontinence means a person leaks urine by accident. While it may happen to anyone, urinary incontinence is more common in older people, especially women. Incontinence can often be cured or controlled. Talk to your healthcare provider about what you can do.

What happens in the body to cause bladder control problems? The body stores urine in the bladder. During urination, muscles in the bladder tighten to move urine into a tube called the urethra. At the same time, the muscles around the urethra relax and let the urine pass out of the body. When the muscles in and around the bladder don’t work the way they should, urine can leak. Incontinence typically occurs if the muscles relax without warning.

Causes of Urinary Incontinence

Incontinence can happen for many reasons. For example, urinary tract infections, vaginal infection or irritation, constipation. Some medicines can cause bladder control problems that last a short time. When incontinence lasts longer, it may be due to:

• Weak bladder muscles
• Overactive bladder muscles
• Weak pelvic floor muscles
• Damage to nerves that control the bladder from diseases such as multiple sclerosis, diabetes, or Parkinson’s disease
• Blockage from an enlarged prostate in men
• Diseases such as arthritis that may make it difficult to get to the bathroom in time
• Pelvic organ prolapse, which is when pelvic organs (such as the bladder, rectum, or uterus) shift out of their normal place into the vagina. When pelvic organs are out of place, the bladder and urethra are not able to work normally, which may cause urine to leak.

Most incontinence in men is related to the prostate gland. Male incontinence may be caused by:

• Prostatitis—a painful inflammation of the prostate gland
• Injury, or damage to nerves or muscles from surgery
• An enlarged prostate gland, which can lead to Benign Prostate Hyperplasia (BPH), a condition where the prostate grows as men age.

Diagnosis of Urinary Incontinence

The first step in treating incontinence is to see a doctor. He or she will give you a physical exam and take your medical history. The doctor will ask about your symptoms and the medicines you use. He or she will want to know if you have been sick recently or had surgery. Your doctor also may do a number of tests. These might include:

• Urine and blood tests
• Tests that measure how well you empty your bladder

In addition, your doctor may ask you to keep a daily diary of when you urinate and when you leak urine. Your family doctor may also send you to a urologist, a doctor who specializes in urinary tract problems.

Types of Urinary Incontinence

There are different types of incontinence:

• Stress incontinence occurs when urine leaks as pressure is put on the bladder, for example, during exercise, coughing, sneezing, laughing, or lifting heavy objects. It’s the most common type of bladder control problem in younger and middle-age women. It may begin around the time of menopause.
• Urge incontinence happens when people have a sudden need to urinate and cannot hold their urine long enough to get to the toilet. It may be a problem for people who have diabetes, Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, or stroke.
• Overflow incontinence happens when small amounts of urine leak from a bladder that is always full. A man can have trouble emptying his bladder if an enlarged prostate is blocking the urethra. Diabetes and spinal cord injuries can also cause this type of incontinence.
• Functional incontinence occurs in many older people who have normal bladder control. They just have a problem getting to the toilet because of arthritis or other disorders that make it hard to move quickly.

Treatment for Urinary Incontinence

Today, there are more treatments for urinary incontinence than ever be­fore. The choice of treatment depends on the type of bladder control problem you have, how serious it is, and what best fits your lifestyle. As a general rule, the simplest and safest treatments should be tried first.

Bladder control training may help you get better control of your bladder. Your doctor may suggest you try the following:

• Pelvic muscle exercises (also known as Kegel exercises) work the muscles that you use to stop urinating. Making these muscles stronger helps you hold urine in your bladder longer. Learn more about pelvic floor exercises and how to do them.
• Biofeedback uses sensors to make you aware of signals from your body. This may help you regain control over the muscles in your bladder and urethra. Biofeedback can be helpful when learning pelvic muscle exercises.
• Timed voiding may help you control your bladder. In timed voiding, you urinate on a set schedule, for example, every hour. You can slowly extend the time between bathroom trips. When timed voiding is combined with biofeedback and pelvic muscle exercises, you may find it easier to control urge and overflow incontinence.
• Lifestyle changes may help with incontinence. Losing weight, quitting smoking, saying “no” to alcohol, drinking less caffeine (found in coffee, tea, and many sodas), preventing constipation and avoiding lifting heavy objects may help with incontinence. Choosing water instead of other drinks and limiting drinks before bedtime may also help.

Incontinence and Alzheimer’s Disease

People in the later stages of Alzheimer’s disease often have problems with urinary incontinence. This can be a result of not realizing they need to urinate, forgetting to go to the bathroom, or not being able to find the toilet. To minimize the chance of accidents, the caregiver can:

• Avoid giving drinks like caffeinated coffee, tea, and sodas, which may increase urination. But don’t limit water.
• Keep pathways clear and the bathroom clutter-free, with a light on at all times.
• Make sure you provide regular bathroom breaks.
• Supply underwear that is easy to get on and off.
• Use absorbent underclothes for trips away from home.

For more ways to deal with incontinence and other common medical problems in someone with Alzheimer’s, visit Alzheimer’s Disease: Common Medical Problems.

Managing Urinary Incontinence

Besides bladder control training, you may want to talk with your doctor about other ways to help manage incontinence:

• Medicines can help the bladder empty more fully during urination. Other drugs tighten muscles and can lessen leakage.
• Some women find that using an estrogen vaginal cream may help relieve stress or urge incontinence. A low dose of estrogen cream is applied directly to the vaginal walls and urethral tissue.
• A doctor may inject a substance that thickens the area around the urethra to help close the bladder opening. This can reduce stress incontinence in women. This treatment may need to be repeated.
• Some women may be able to use a medical device, such as a urethral insert, a small disposable device inserted into the urethra. A pessary, a stiff ring inserted into the vagina, may help prevent leaking if you have a prolapsed bladder or vagina.
• Nerve stimulation, which sends mild electric current to the nerves around the bladder that help control urination, may be another option.
• Surgery can sometimes improve or cure incontinence if it’s caused by a change in the position of the bladder or blockage due to an enlarged prostate.

Even after treatment, some people still leak urine from time to time. There are bladder control products and other solutions, including adult diapers, furniture pads, urine deodorizing pills, and special skin cleansers that may make leaking urine bother you a little less.

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