POL Scientific / Bladder / Volume 13 / Issue 1 / DOI: 10.14440/bladder.0327
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REVIEW

Geriatrics and the bladder: From a neurourological point of view

Ryuji Sakakibara*
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1 Department of Neurology, Dowakai Chiba Hospital and Neurology Clinic Tsudanuma, 274-0825 Funabashi, Chiba, Japan
Bladder 2026 , 13(1), e21200079; https://doi.org/10.14440/bladder.0327
Submitted: 9 October 2025 | Revised: 14 November 2025 | Accepted: 24 November 2025 | Published: 27 February 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Background: Bladder problems in older individuals are very common; however, their pathophysiology and management remain poorly understood. Objective: This article examines geriatrics and the bladder from a neurourological perspective. Aging notably impacts the brain. Among octogenarians (over 80 years old), the following estimated prevalences are reported: white matter disease (WMD) at 80%, Alzheimer’s disease (AD) at 33%, and dementia with Lewy bodies (DLB) at 8%. Both isolated and combined pathologies are frequent, with AD+WMD being the most common combination. WMD is considered the primary pathological cause of overactive bladder in the elderly, while AD and DLB also contribute, though to a lesser extent. In advanced dementia cases due to AD or DLB, functional urinary incontinence may occur because of immobility, cognitive impairment, and loss of initiative. Early overactive bladder may be managed with β3 adrenergic receptor agonists and anticholinergics with minimal blood–brain barrier penetration. Advanced functional urinary incontinence may be addressed with behavioral strategies (e.g., prompted/timed voiding), toileting/environmental optimization, gait rehabilitation, and therapies targeting cognition and mobility. These conditions are potentially treatable in geriatric patients. Conclusion: This review highlights the unique integration between aging brain pathology and urodynamic findings, as well as functional urinary incontinence.

Keywords
Geriatrics
Overactive bladder
Functional incontinence
White matter disease
Alzheimer’s disease
Dementia with Lewy bodies
Funding
None.
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Conflict of interest
The authors declare no conflicts of interest.
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Bladder, Electronic ISSN: 2327-2120 Print ISSN: TBA, Published by POL Scientific
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