As the body ages, problems of incontinence become more prominent. The urinary system changes in several ways. Bladder muscles become weaker, and bladder capacity decreases. The older adult has more difficult emptying his bladder, having more residual volume. The pelvic diaphragm weakens, especially in women who have had twins or triplets. In ageing men, an enlarged prostate gland often leads to urinary track problems.

Urinary incontinence is never a normal sign of aging. It is always a symptom of an underlying problem. Many older adults suffer from loss of voluntary control.

Problems with urinary continence are called acute or persistent and can range from mild loss of bladder control to total incontinence. Acute incontinence occurs suddenly and is usually related to an acute illness, common in hospitalised people, it usually ends once the illness is resolved. Several types of incontinence may co-exist, such as urge, stress, over flow, and functional.

Many older adults accept incontinence as part of the ageing process, and do not report problems. Women who have had children, often accept stress incontinence as a normal consequence of aging and childbirth. Incontinence can be embarrassing or frustrating, making older adults reluctant to discuss it.

They may fear surgery or be unaware that treatment options exist.

As a general rule, all incontinence should be reported and investigated by a health care provider, who may be able to eliminate the cause, since incontinence is the leading of nursing home placement.

Finally, the cost of incontinence care, supplies, laundry, and nursing care are extremely high. Continence is a learned ability, requiring an adequate, cognitive and physical function, motivation, and an appropriate environment for toileting.

Paulette Godfrey is a qualified geriatric caregiver and the matron of Herb Garden Seniors Residence in Southampton.