Incontinence, Delirium, and UTI: How They’re All Related

What is Incontinence?

25 million U.S. adults experience incontinence each year. This includes over 50% of all nursing home residents. Urinary incontinence refers to any loss of bladder control. Incontinence is leaking of urine that you are unable to control. It affects quality of life and stops people from doing what they love. Many think it is normal or are too embarrassed to tell anyone about it. Despite popular belief, it’s not a normal sign of aging.

Urinary incontinence is a symptom and not a disease. Patients and doctors must work together to find the medical, dietary, or lifestyle causes. Older adults have weaker bladder muscles; this makes incontinence more likely. Some risk factors of urinary incontinence are:

  • Female anatomy
  • Old age
  • Neurological conditions
  • High BMI
  • Inactivity
  • Diabetes

Incontinence can be caused by UTIs, which are responsible for 25% of infections in older adults. These infections irritate your bladder and make you feel like you need to urinate often.

What Are Urinary Tract Infections?

UTIs are the 2nd most common infection in the elderly population. They are usually caused by E. coli. This microorganism is found in the digestive tract. They are also caused by two sexually transmitted organisms. To test for UTIs, patients must give a urine sample. A doctor will look for the bacteria to make a diagnosis. If caught early enough, antibiotics are all that’s needed for UTI treatment.

Here are some general urinary tract infection symptoms to look out for:

  • Burning sensation when urinating
  • Frequent/intense urge to urinate, but hardly anything comes out when you try
  • Pressure or pain in lower abdomen or back
  • Unusual tired or shaky feeling
  • Chills or a fever

For older adults, UTIs can present in more subtle ways—like with delirium.

Delirium: A Symptom of UTI or Something Else?

Complications of UTI in the elderly are more common because the signs aren’t as obvious. Older people might only have foul smelling urine or present with agitation or delirium. 

Delirium is a quick change in someone’s mental status. It will make you think the delirious person has lost their mind. People with delirium might have trouble focusing, reading, or remembering where they are. They may be withdrawn or have trouble falling or staying asleep. You may not be able to understand them when they talk. Being more emotional, personality changes, and depression are also signs of delirium. These changes usually start over 1 or 2 days. Up to 30% of older adults experience delirium each year.

Delirium is reason to worry because it is associated with a high death rate and high rate of disease. When adults live alone, it is even harder to diagnose delirium. That’s because the person having the behavioral changes doesn’t usually notice them. Delirium can also be confused with dementia. This makes episodes of delirium or its causes hard to diagnose in someone with dementia.

It is important to find out the cause of delirium so that you can get it treated. Causes of delirium include withdrawal, drug toxicity, chronic illness, acute infection, toxin exposure, malnutrition, sleep deprivation, pain, medical conditions, hospital stays, or metabolic imbalances, like a UTI.

  • To find the cause, it’s important to think over or discuss questions like:
  • Have your loved one’s medications changed recently?
  • Did they recently stop taking an opiate or other prescribed pain medication?
  • Are they taking their medications as directed?
  • Have they recently lost weight or changed eating habits?
  • Are they staying in a hospital or unfamiliar setting?
  • Do you notice them drinking water?
  • Do they seem to be suffering from any other unusual symptoms?
  • What have their sleeping habits been like recently?

The answers to these questions can help narrow down a cause and give a doctor direction.

If the above questions don’t lead anywhere, a urinary tract infection might be causing the delirium. UTI-caused delirium might appear with typical UTI symptoms. But, it more often appears with one or more of these symptoms:

  • Hallucinations: Hearing or seeing something that is not there
  • Poor motor skills or loss of coordination
  • Dizziness
  • Falling
  • Agitation
  • Foul smelling urine

Have your loved one tested for a UTI if you notice any of those signs along with their delirium. Once the UTI is treated, the delirium should stop.

Additional Sources:

Balogun, Seki A., and John T. Philbrick. "Delirium, a Symptom of UTI in the Elderly: Fact or Fable? A Systematic Review." Canadian Geriatrics Journal. Canadian Geriatrics Society, Mar. 2014.

"Delirium." Mayo Clinic. Mayo Foundation for Medical Education and Research, 05 Sept. 2015.

Ruvolo-Wilkes, Vita. "A UTI & Delirium." Leaf Group, 22 Oct. 2015.

"Your Guide to Urinary Tract Infections (UTIs)." WebMD.