It may surprise you to learn that incontinence contributes to falls. As a clinician since 2002 and working in home health since 2004, I have observed quite a few ways this can happen.
How Incontinence Contributes to Falls
Slip and Fall Accident
One way that incontinence contributes to falls is they slip and fall on a wet floor.
For example, I had a gentleman patient who would stand up and he couldn’t get to the bathroom before his bladder emptied. He would urinate on the floor as soon as he stood up at this walker. Then he slipped in his urine and fell on the floor.
This happened to him multiple times when he was home alone. A urinal next to his recliner was a good short term solution for him.
Forgetting to use your Assistive Device due to Urgency
Urge incontinence and urgency of your bladder are both related to having an uncontrolled need to go right away or go quickly.
People with these problems may actually walk away from their cane or walker. Forgetting to use their assistive device due to urgency may cause a fall.
Rushing to the Toilet
Rushing to the toilet, even with a cane or walker, can cause you to fall. This is because you may trip or lose your balance while rushing.
Walking in the Dark at Night while you are Sleepy
Another way that incontinence contributes to falls is getting up at night multiple times to go to the bathroom. At night, people are often groggy or disoriented and it’s dark.
This combination means a person more likely to fall at night going to the bathroom if they have a bladder problem.
It is normal for older adults to get up twice at night to urinate. More than that is too often!
This bladder problem is called “nocturia.” That means excessive trips to the potty at night.
I suggest for older adults to always have a nightlight or turn on the light to avoid walking in the dark. This can prevent falls.
You can get a motion-activated light, a flashlight, or use a headlamp if you need both hands for your walker, for example.
Incontinence contributes to falls through “purposeful dehydration.” When people have incontinence, a lot of times they don’t drink water on purpose. It is very logical because they don’t want to have an accident.
They just don’t drink anything! Then they are less likely to wet their pants in public or around their friends. They can also avoid having to rush to the bathroom.
It seems like a logical action, but the consequences of purposeful dehydration can be devastating.
Dehydration can cause Dizziness with Standing due to Blood Pressure Dropping
Dehydration can cause dizziness when you sit up or stand up.
Dizziness with standing up quickly is often caused by the blood pressure dropping. This is called “orthostatic hypotension.”
It can be a medication side effect, but is often due to dehydration.
When dehydration gets bad enough, it can cause you to have to stay in the hospital.
Many people purposefully dehydrating themselves because their bladder is leaking or they have other bladder problems. But then when they sit up or stand up, they may get dizzy. This dizziness can cause a fall.
A Reduced Sensation of Thirst is Part of Normal Aging
It is easy for older adults to get dehydrated. This is because normal aging includes a reduced sensation of thirst.
That is why I suggest for my older patients to set up an objective measure for daily water intake.
This can be 406 glasses of water or a pitcher of water that they must finish everyday before dinner.
Dehydration can cause Bladder Infections (UTI)
Purposeful dehydration also commonly causes chronic UTIs (urinary tract infections). If people don’t drink anything to avoid having an accident, then they could get chronic bladder infections.
You must have a strong stream of urine to clear out the bacteria that naturally lives near your bladder. If your urine stream is weak due to purposeful dehydration, then the bacteria can build up and cause a UTI.
A Fall is a Common First Sign of a new Urinary Tract Infection (UTI)
A fall is often the first sign of a UTI in older adults, especially in older people with impaired ability to communicate.
Many older adults do not have a robust immune system, so a fever is not always the first sign of a UTI in older adults.
Bladder Infection Medication Side Effects can Cause Falls
Also, certain antibiotics given for UTIs can cause tendons to spontaneously rupture.
For example, my Grampa fell while walking about ten years ago because his achilles tendon ruptured spontaneously while he was walking. At the time, he was on an antibiotic medication prescribed for a UTI. The tendon rupture showed up on an ultrasound and it took him 6-8 months to fully recover from that injury.
Antibiotics medications can also affect your gut health. Your gut microbiome may become disrupted causing digestive problems, from taking antibiotics.
Gut health issues can also cause dizziness and vertigo. This blog describes the connection in detail.
Bladder Control Medications Cause Dizziness and Cognitive Problems
It is also important to understand that incontinence contributes to falls by the medications that are given for bladder problems actually have a side effect of dizziness, which causes falls.
Some of the medications given for bladder control are called anti-cholinergic medications, meaning they reduce the activity of acetylcholine in the brain which long term can cause cognitive impairment.
Medications given for dementia today are targeted to increase the activity of acetylcholine in the brain!
Short-term side effects of anti-cholinergic bladder control medications include dizziness, drowsiness, and blurry vision.
Long-term potential side effects of bladder control medications can result in irreversible cognitive impairment. Yikes!
I am not suggesting that you stop taking the medication your doctor prescribes. I encourage you to take all your medications as prescribed.
Talk to Your Doctor
Perhaps there is a better way to deal with a bladder control problems in the long term, rather than just simply medicating incontinence?
If your incontinence contributes to falls – whether you are having to get up a lot at night or you are rushing to the toilet or you have the uncontrolled urge to go – this would be something to talk to your doctor about.
See a Pelvic Health Physical Therapist
Talk to your doctor. You can ask your doctor to refer you to physical therapy for a pelvic health consultation.
Specialized Exercises can Improve Bladder Control
Your doctor can refer you to a special type of physical therapist who specializes in Pelvic Health. They have expertise to help both men and women improve bladder control without using medication.
You can find a Pelvic Health PT near you using this online provider directory.
Yes, I have been doing this work for almost 20 years now and I have learned a lot from my patients! I have met many people with dizziness and falls due to chronic UTIs and other bladder problems.
With proper bladder retraining exercises, they were able to correct their problem.
I hope this information is helpful to you.
This blog is provided for informational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.