When to See a Doctor About Bladder or Bowel Changes

Call 112 or go to emergency now

Seek emergency help at once for:

• Inability to pass urine, with a swollen, painful lower abdomen, restlessness or severe discomfort (acute urinary retention).
• Loss of bladder and bowel control with numbness around the buttocks, genitals or inner thighs, or new leg weakness, back pain, difficulty walking or a feeling of "pins and needles" in the legs. This pattern, sometimes called cauda equina syndrome, can signal pressure on the spinal nerves and needs urgent scanning and treatment to avoid permanent damage.
• Fever with shaking chills, fast breathing, low blood pressure, severe confusion or drowsiness together with urinary symptoms: possible sepsis; see fever in older adults: why it can be subtle and when to call.
• Heavy bleeding from the bladder or bowel, with clots, faintness or collapse.
• Severe abdominal pain with a hard, swollen abdomen, vomiting, and no stool or gas passed (possible bowel obstruction).
• Vomiting blood or passing large amounts of black, tarry stool, with dizziness or weakness.
• Severe, sudden pain in the back or side with fever, or blood in the urine (possible kidney infection or stone).
• A catheter that has been pulled out with bleeding or severe pain, or one that is blocked with severe pain and no urine; see catheter care basics for families.
• Sudden bladder or bowel incontinence with stroke signs, such as facial droop, arm weakness, slurred speech or confusion.
• A foreskin that cannot be returned over the head of the penis and is swollen and painful.
• Severe pain in a testicle, swelling or vomiting.
• Signs of dehydration with persistent diarrhoea and vomiting: very dry mouth, dark urine or none, dizziness, confusion; see diarrhoea and dehydration in seniors.

See a doctor within a day or two

• Blood in the urine (pink, red, brown or cola-coloured), even once and even if painless; this always needs assessment.
• Blood in the stool, black stool, or blood on toilet paper; rectal bleeding in an older adult is never to be ignored.
• Burning or pain on passing urine, frequency and urgency that is new; or cloudy, foul-smelling urine with feeling unwell; see urinary tract infections in older adults: atypical signs.
• New confusion, drowsiness or falls with any change in urine or bowel habits.
• Fever or chills with urinary symptoms, or flank pain.
• A weak, slow or interrupted stream, straining, dribbling, a feeling of not emptying, getting up several times at night, or sudden stopping of the stream; see prostate problems and urinary symptoms in older men.
• Leaking small amounts constantly (possible overflow).
• Sudden onset of incontinence, in someone who was previously continent, particularly after a fall, medicine change, stroke, surgery or infection.
• Constipation lasting several days, with pain, bloating or overflow leakage of loose stool; see bowel incontinence and constipation in later life.
• Persistent diarrhoea for more than a few days, or with fever, blood or weight loss.
• Painful bowel movements, anal pain, a lump at the anus or bleeding.
• A bulge or heaviness in the vagina, or a lump at the groin.
• Skin soreness, rash or open areas in the groin or buttocks; see incontinence-associated skin damage: prevention and care.
• Catheter problems: leaking, not draining, pain, cloudy or bloody urine, fever.
• Blood sugar problems or increased thirst with passing large amounts of urine, which can signal diabetes; see diabetes after 60: a home care guide.
• Swollen legs with night urine and breathlessness; see heart failure at home: daily checks and warning signs.

Book a routine appointment

Arrange an appointment in the coming days or weeks, ideally with a doctor who knows your parent, for:

• Leaking urine or stool at any frequency, even if mild; incontinence is treatable and not normal; see incontinence in older adults: causes and types.
• Frequent urination, urgency, or waking more than once at night.
• Persistent constipation or a change in bowel habit lasting more than a few weeks, especially after fifty.
• Unexplained weight loss, loss of appetite or tiredness with bowel or bladder changes.
• Changes after starting a new medicine; do not stop it yourself.
• A change in the person's ability to reach the toilet, for reasons such as pain, weakness or confusion.
• Embarrassment, avoidance of outings or fear of leaks.
• Recurrent urinary infections.
• Questions about products, exercises or routines.

What the doctor will want to know

Prepare to describe:

• When the problem began, how often it happens, how much leaks, and what triggers it (cough, urgency, night).
• Urinary and bowel symptoms: pain, burning, blood, stream, emptying, constipation, diarrhoea, soiling.
• Other symptoms: fever, confusion, pain, weight loss, thirst, swelling, breathlessness, back pain, numbness, weakness.
• Medicines, including over-the-counter and herbal products, with doses and times. Bring the strips or a list; see keeping a health record at home.
• Medical history: diabetes, prostate, stroke, Parkinson's disease, dementia, surgeries, childbirth and previous infections.
• Fluids and diet: how much and what your parent drinks, including tea, coffee and alcohol.
• Mobility and the home: how far the toilet is, aids used, falls.
• What products they use, and how many.
• How it affects life: sleep, mood, outings and skin.

A three-day diary of drinks, toilet visits and leaks is very helpful; see bladder training and timed toileting.

Who to see

• Family doctor or geriatrician: first assessment, medicine review, urine test and general health.
• Urologist: for men with prostate or bladder problems, blood in urine, retention, stones and catheter issues.
• Gynaecologist or urogynaecologist: for women with prolapse, stress incontinence and menopause-related problems.
• Continence nurse or specialist: for assessment, bladder training, products and catheter care.
• Pelvic health physiotherapist: for pelvic floor training; see pelvic floor exercises for older adults.
• Gastroenterologist or colorectal surgeon: for persistent bowel changes, bleeding or faecal incontinence.
• Neurologist or spine specialist: if nerve or spinal causes are suspected.
• Dietician: for fibre, fluids and weight.
• Psychologist, counsellor or dementia specialist: for distress, anxiety or dementia-related issues.
• Emergency department: for the emergencies above.

What to expect at the visit

• Questions and a physical examination, including the abdomen and often the genitals, and in some cases a rectal or vaginal examination, performed with consent and privacy. You may ask for a same-gender doctor or a chaperone; see dignity in intimate care: words, privacy and consent.
• Urine test: a clean sample; see the cautions about interpretation in urinary tract infections in older adults: atypical signs.
• Blood tests: for kidney function, sugar, infection markers and other conditions.
• Bladder scan or ultrasound to check emptying and the kidneys.
• Prostate checks for men, as the doctor advises.
• Stool tests or bowel investigations, such as colonoscopy, if bleeding or changes persist.
• Imaging or specialist tests such as urodynamics (bladder pressure tests), cystoscopy or an MRI scan of the spine in selected cases.
• Medicine review and plan.
• A trial of treatment, exercises or routines.

Ask what the findings mean, what the options are, how long they take to work and when to return. Write down the answers.

Common concerns

"It is embarrassing." Doctors and nurses deal with these problems every day, and want to help. Say it plainly: "My mother is leaking urine." Bring a note if words are hard.

"It is just old age." Common, yes; untreatable, no. Many causes can be improved.

"I do not want tests." Discuss what is necessary and what can wait, in line with the person's wishes and health. Many first steps are simple.

"Medicines for bladder will make her confused." Some can. Tell the doctor about memory problems and ask about options; see medicine side effects families should watch for.

"Can we manage with pads instead?" Pads are useful, but they do not find or treat causes, and some causes are serious.

"My parent refuses to go." Try again gently, link it to a general health check, and see talking about incontinence with a parent without shame and managing a parent who refuses help. If there are red flags, do not delay.

While waiting for the appointment

• Keep drinking regular fluids, unless a doctor has restricted them.
• Keep the skin clean and dry, and change products promptly.
• Avoid new medicines or remedies without advice, and do not give leftover antibiotics.
• Keep a diary of symptoms.
• Make toilet access easy, with commodes or urinals; see commode chair guide and urinals for men and women: bedside use.
• Watch for red flags, and call earlier if things change.
• Prevent falls; see night-time toilet trips and falls.
• Use a thermometer if your parent seems unwell; see digital thermometers: choosing and using them for older people.

See also knowing when to call the doctor.

When to ask a professional

This whole guide is about when to do so. In short: emergencies go to 112; blood, new infection signs, confusion, retention symptoms and sudden changes need a doctor within a day or two; any persistent leaking or bowel change deserves a routine appointment. A pharmacist can advise on medicines and products while you wait, but cannot replace a doctor's assessment.