Bladder issues are common among seniors. But they aren’t inevitable. Here’s what you need to know about your bladder to avoid leaks and infections.
When you were younger, you probably didn’t give your bladder much thought. But now that you may have experienced the occasional unexpected leak or painful urinary tract infection (UTI) — there’s a good chance you’re starting to pay more attention to what’s going on down there.
The truth is, bladder problems, while common among older adults, aren’t inevitable. There are simple lifestyle changes and daily habits that can help keep your bladder healthy.
Use this guide to learn what happens to your bladder as you age, and what you can do to stave off bladder problems, now and in the future.
What is the bladder?
The bladder is a hollow, elastic organ nestled in the pelvis, between the hip bones. It is part of your body’s urinary system. It looks a bit like a balloon, and even functions somewhat like one. But instead of air, your bladder expands as more urine collects inside it.
How does the bladder work?
After urine is produced in the kidneys, it flows to the bladder via the ureters (or ducts). Once the urine is in the bladder, it is stored there until it leaves the body through the urethra. In men, the urethra passes through the prostate gland into the penis. In women, it runs from the bladder to the vagina.
About 1.5 quarts of urine leave your body through the bladder each day, according to the National Institute on Aging.
How does your bladder change with age?
As we get older, the bladder loses elasticity. It becomes less flexible, so it can’t hold as much urine as it once did. Meanwhile, the muscles in the bladder wall and pelvic floor (a group of muscles that spread out like a hammock and attach to the pelvis and spine) also weaken. This makes it harder for the bladder to fully empty, leading to leakage.
How do you know if your bladder is healthy?
If you’re not feeling pain when you urinate and you’re going to the bathroom regularly (and making it to the toilet on time), chances are your bladder is probably in good shape.
But if you experience leaks, feel pain while urinating, or see blood in your urine, there could be a problem with your bladder.
Ideally, you’ll urinate at least once every 3 to 4 hours. Holding your pee for too long can weaken your bladder muscles and set you up for an infection.
What are the most common bladder problems for older adults?
The risk of two common bladder problems increases with age:
Urinary incontinence. Urinary incontinence (UI) — accidental leaking of urine — is one of the most common bladder problems among older adults, especially women. A 2021 Journal of Urology study suggests that about half of women over the age of 20 have urinary incontinence.
There are, however, multiple types of incontinence, which can cause different symptoms. (We’ll go into these types in more detail, below.)
Bladder infections, like UTIs. Your bladder is susceptible to infections from bacteria, and the most common type of bladder infection is a urinary tract infection (UTI). (That said, a UTI can develop in other parts of your urinary tract, too, including the urethra, ureters, or kidneys.)
Women are more likely to develop a bladder infection than men, in part because of a difference in plumbing. In women, the urethra is shorter and closer to the anus, which can harbor infection-causing bacteria like E. coli.
At least 2 in 5 women will develop a UTI during their lifetime, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and about 1 in 4 of them will have repeat infections.
What are the symptoms of a bladder infection?
The telltale symptoms of a bladder infection, such as a UTI, include:
Pain or burning while you pee
The need to pee often
Feeling as if you have to urinate, even if you just emptied your bladder
Blood in your urine
Pressure or cramping in your groin or lower abdomen
But older adults may also experience some lesser-known symptoms, including:
Mood changes
Lethargy
Incontinence
Falls
Urinary retention
Decreased appetite
Decreased mobility
Signs that a UTI may have spread to the kidneys include:
Fever
Back pain
Nausea
Vomiting
Because of the wide range of possible signs, it’s important to alert your doctor as soon as you feel something is “off” or not normal for you. A 2022 report in the Journal of the American College of Emergency Physicians Open notes that UTIs send more than 2 million Americans to the ER each year, with about 400,000 people needing to be admitted.
What are the symptoms of urinary incontinence?
The main symptom of urinary incontinence is leakage. But when and how we leak can look different for everyone.
If you find that you’re not making it to the bathroom or you have to urinate every two hours, that could be a sign of urinary incontinence, says Lauren Streicher, M.D. She is a professor of obstetrics and gynecology at the Feinberg School of Medicine at Northwestern University, in Chicago, Illinois, and the host of Dr. Streicher’s Inside Information podcast.
Another possible sign? “I you’ve emptied your bladder and in spite of that, you jump and urine comes out,” she says.
What are the different types of urinary incontinence?
Urinary incontinence, also called overactive bladder, occurs when a person accidentally leaks urine. But there are different types of incontinence, all of which can have different causes and trigger slightly different outcomes.
They include:
Stress incontinence, which occurs when certain movements (like coughing, sneezing, or laughing) put pressure on the bladder, causing urine to leak out. While stress incontinence can occur with age, it can also appear in younger people, especially women, after pregnancy, childbirth, or menopause. In men, it can occur after prostate surgery.
Urgency incontinence, which occurs when you need to urinate, but the urine leaks out before you can make it to the toilet. Urgency incontinence is more closely associated with aging than stress incontinence, Dr. Streicher says.
Overflow incontinence, which occurs when your bladder doesn’t fully empty. When too much urine stays in the bladder, you may leak throughout the day.
Functional incontinence, which occurs when you have a disability that keeps you from reaching the toilet in time. For example, if you’re in a wheelchair or have arthritis, you may struggle to maneuver into a bathroom or unbutton your pants. And people with conditions like Alzheimer’s disease may not realize they need to urinate.
Mixed incontinence, which occurs when you have both urgency and stress incontinence.
What role does exercise play in maintaining a healthy bladder?
Being physically active may help decrease your chances of having stress, urgency, and mixed incontinence, according to a 2022 Urology study. Exercise is thought to help strengthen your pelvic floor muscles, which reduces the risk of leaking.
What’s more, exercising can help you maintain a healthy weight, which is also good for your bladder. According to a Journal of Urology study, when overweight and obese women lost weight, they saw their urgency incontinence symptoms drop by 70% after 18 months.
“If you lose weight, there’s a very good chance that you will be able to reduce the leakage,” Dr. Streicher says.
What are Kegel exercises, and how can they help?
Just as bicep curls can strengthen your arms, doing pelvic floor exercises (called Kegels) can strengthen the muscles inside your pelvis, which naturally weaken with age. Kegels are often thought of as exercises for women, but men can — and should — do them, too.
A review published in 2018 by the Cochrane Collaboration found that women who did pelvic floor exercises were five times more likely to report that their urinary incontinence had disappeared compared with women who didn’t do these exercises.
“Study after study has shown that if you do them correctly and consistently, Kegels are going to help,” Dr. Streicher says. The problem, she says, is that most people don’t do them correctly or consistently.
What is the right way to do Kegel exercises?
Here’s a quick primer on how to do Kegels the right way:
For women:
First, locate the right muscles by imagining you’re trying to hold your urine mid-stream. You should feel a “pulling” feeling in the vaginal area.
Next, squeeze the muscles in your pelvic floor for 3 to 5 seconds, then release the muscles.
Try to repeat the exercise 10 to 15 times, at least three times a day.
For men:
First, locate the right muscles by imaging you’re trying to hold in your urine. You should feel a “pulling” feeling in the rectal area.
Next, squeeze the muscles in your pelvic floor for 3 to 5 seconds, then release the muscles.
Try to repeat the exercise 10 to 15 times, at least three times a day.
Important tip: You shouldn’t do Kegels while you’re urinating. When you prevent your bladder from emptying all the way, you may increase your odds of a bladder infection.
It’s not always easy to locate the muscles in your pelvic floor or know if you’re doing these exercises correctly, so you may want to consult with a specialist.
“In a perfect world, everyone would have access to a pelvic floor physical therapist,” Dr. Streicher says. You can find one through the Academy of Pelvic Health Physical Therapy’s online physical therapist locator tool.
As with any new type of exercise, it can take some time before you build up strength. You may not see any improvements in your bladder control for about 3 to 6 weeks.
What other lifestyle changes or daily habits can help?
Whether you struggle with leakage or not, there are ways to help keep your bladder healthy and reduce your risk of infections and urinary incontinence.
Watch what you drink. It might seem like cutting back on your water intake is a good way to lessen bladder leaks. After all, if there’s less fluid in your bladder, there is less that can leak out, right?
Wrong. Not only is dehydration a serious health risk, but if you don’t get enough fluids, waste products will build up in your urine, irritating your bladder and increasing your need to use the bathroom.
You may, however, want to be more strategic about what you drink, and when. Since drinking too much, too quickly can overwhelm your bladder, try drinking smaller amounts of fluids throughout the day — about 16 ounces at meals and 8 ounces between meals, according to Mayo Clinic.
Cutting back on alcohol and caffeinated drinks may help, too. These can trigger your body to produce more urine. And carbonated drinks can irritate your bladder.
Embrace looser clothing. If you’re prone to bladder infections, try wearing cotton underwear and looser-fitting pants or skirts. Nylon underwear and too-tight clothing can trap moisture inside — a perfect breeding ground for infection-causing bacteria.
Move more. Exercising can feel like a catch-22: Being sedentary can increase your risk of urinary incontinence, according to a 2019 study, but when you exercise, you might leak a little bit.
While some people experience UI even during a walk, some types of exercises are more likely to cause leaks than others. This is especially true of exercises that put pressure on your core muscles, which help support the organs in your pelvis, Dr. Streicher says.
If you tend to leak during exercise, you may want to invest in your wardrobe — think black pants and washable underwear or liners. For women, there’s also a product called Impressa Bladder Supports, which is inserted into the vagina like a tampon and helps support the urethra, helping to prevent leaks.
Try mindfulness meditation. Dealing with urinary incontinence can be stressful, but research published in BMC Urology suggests that stress can also worsen the symptoms of UI.
Some pilot studies published in Urogynecology suggest that a mindfulness-based stress reduction program can help ease the symptoms of urgency incontinence. Aren’t sure where to start? Try the SilverSneakers LIVE Mindfulness and Meditation (Express) 15-minute online class. There are also apps that offer guided mindfulness programs.