Normal bladder function
A healthy bladder holds about 4OO-6OOmls of urine during the day. It holds more at night before you feel the need to pass urine and get up to go to the toilet.
It's normal to empty your bladder:
- about 4-8 times during the day
- before bed at night
- once overnight
- when you get out of bed in the morning.
This pattern can change in older people. They may make more urine at night and need to get up more than once to go to the toilet, or they may go less during the day. Most people are able to hold on after the feel the need to pass urine, so that they can reach the toilet in time.
What is urgency and urge incontinence?
Urgency is a sudden, strong feeling that you need to pass urine and it's hard to hold on long enough to reach the toilet. Urge incontinence is when you leak urine after a feeling of urgency and before reaching the toilet.
What causes urgency and urge incontinence?
Urgency can happen when the bladder is irritated. This can be caused by a number of factors including when the person:
- doesn't drink enough fluid
- drinks too much alcohol, or has drinks with caffeine in them or fizzy drinks
- is in the habit of going to the toilet 'just in case' and the bladder is used to holding only small amounts of urine
- has a urinary tract infection
- takes diuretics (water tablets) that cause the kidneys to make more urine
- drinks too much fluid or drinks too quickly, which can cause the bladder to fill quickly and often
- is constipated, which can cause urgency when a full bowel pushes on the bladder
- has a bladder which doesn't empty completely, so fills up more quickly
- has a neurological condition, such as dementia.
How can you help a person with urgency or urge incontinence?
There are many causes and different factors that can affect urgency and urge incontinence. If the person hasn't has a continence assessment, talk with them, their carers or your supervisor about referring them to a continence nurse advisor or their general practitioner (GP). They can then look into the continence issues and develop a management plan.
You can help by:
- spreading fluids evenly throughout the day
- checking how much fluid they are drinking - if the person is drinking large amounts of fluid, they will make more urine and have to go to the toilet more often
- making sure their clothes are easy to remove when going to the toilet
- watching the person for signs that they need to go to the toilet, e.g. moving around, looking uncomfortable, pulling at their clothes
- trying not to take the person to the toilet 'just in case' - only take them to the toilet when the feel the need to go
- making sure continence products are worn correctly if they are part of the person's continence care plan, and that any other aids are within reach, e.g walking frame, urinal or commode.
- checking the person is not constipated - if they are, get help from your supervisor or their GP
- moving the person to a room closer to the toilet to make access easier
- being aware that the person with urgency may suddenly want to go to the toilet when they arrive home or if they hear the sound of water - be ready to help them quickly
- if the person takes diuretics in the morning, timing activities away from home in the afternoon rather than in the morning when they will need to go to the toilet more often
- planning any journey by using the National Toilet Map app, which shows where to find public toilets, including toilets for people with disability
- getting a Master Locksmith Access Key (MLAC), which can unlock disability friendly public toilets
- preparing for any journeys away from home. You may need to take a plastic bag for wet clothes or pads, wet wipes, disposable gloves, spare continence pads and a change of clothing and underwear.
Don't stop or make any changes to medicines unless the person's GP or a nurse practitioner asks you to.
Need more help? Call the National Continence Helpline on 18OO 33 OO 66 and talk to a continence nurse advisor.