The Bathroom Rush: Connecting Pelvic Health and Fall Prevention in Older Adults

Picture this, your patient arrives at the clinic reporting they fell in the middle of the night after waking up with a sudden, strong urge to urinate. As their clinician, you are left asking yourself, was this a balance problem or a bladder problem? In many older adults, the answer may actually be both. Urinary urgency, rushing to the bathroom, poor nighttime lighting, impaired balance, and fear of leakage can all combine to create the ideal conditions for a fall. Yet bladder symptoms are often overlooked during traditional fall-risk assessments, despite growing evidence linking urinary dysfunction and falls in older adults. Research has shown that urinary incontinence is significantly associated with increased fall risk in older adults, particularly those with urgency symptoms (Moon et al., 2021).

In the United States, approximately 20 million women and 6 million men report symptoms of urinary incontinence in their lifetime (Moon et al., 2021) . As the older adult population continues to grow, many are affected yet underreport due to social stigma and the belief that bladder dysfunction is simply a “normal” part of aging. Urgency to urinate can cause older adults to move with variable gait patterns and rushing behaviors that put them at increased risk for falls. Research suggests that a strong desire to void may reduce gait speed and step width, potentially contributing to instability during walking. Factor in poor lighting, anxiety, and disorientation from being woken in the middle of the night, this creates a recipe for a potential fall. Nocturia may also require the person to perform multiple trips in the middle of the night, each expending more energy, increasing fatigue, and creating additional risk for falls to occur.

So why do older adults still avoid discussing these symptoms? One major reason is normalization. Many individuals believe urinary leakage, urgency, and nighttime frequency are unavoidable parts of aging rather than manageable conditions. In addition, embarrassment about discussing bladder symptoms may lead older adults to not say anything until symptoms have become severe or a fall has already occurred. Research has also demonstrated a lack in screening and preventative education surrounding urinary health in older adults (Arena et al., 2025). One recent study found that many older adults reported urinary symptoms, yet very few had previously received education intervention related to urinary health and fall prevention (Arena et al., 2025).

This is where the role of physical therapy clinicians becomes increasingly important. Physical therapists do not need specialized pelvic health certifications to perform basic screenings, provide education, or make referrals related to urinary symptoms. Simple questions about urgency, nocturia, frequency, and leakage can easily be incorporated into mobility and balance screenings. These conversations may help identify pelvic health conditions contributing to fall risk and allow patients to receive appropriate referrals and earlier care. Many interventions already commonly used in rehabilitation overlaps with pelvic health management, including hip and core strengthening, balance training, gait training, and functional mobility activities. Additional pelvic health focused strategies may include pelvic floor muscle training, urge suppression techniques, timed voiding, and education on bladder irritants. Physical therapy clinicians can also provide education on home modifications such as improving nighttime lighting, removing tripping hazards, and adding grab bars near the bathroom. Importantly, research has shown that PT-led urinary health education can improve confidence, knowledge, and self-management strategies in older adults, even when delivered by physical therapists without advanced pelvic health specialization (Arena et al., 2025).

Moving forward, rehab professionals across all settings should consider including pelvic health screenings and education about prevention to all older adults. Early conversations and intervention may help reduce stigma, improve quality of life, and decrease fall risk. As physical therapists, physical therapy assistants and students, we should continue expanding our knowledge of pelvic health regardless of practice setting because every patient has a pelvis, and these symptoms can significantly impair safety, mobility, and independence. 

References

Arena S, Wilson C, Boright L, et al. Outcomes of physical therapist-led urinary health and fall risk education for older adults. Home Healthc Now. 2025;43(4):230-237.

 Moon S, Chung HS, Kim YJ, et al. The impact of urinary incontinence on falls: a systematic review and meta-analysis. PLoS One. 2021;16(5):e0251711. doi:10.1371/journal.pone.0251711

Meet the Author

Ashley Peitz, SPT

2026 CAPP Webinar Scholarship Recipient

Ashley is a third-year Doctor of Physical Therapy student at the University of Central Florida with professional interests in geriatrics and pelvic health. She is passionate about volunteering, community outreach, and promoting access to care through advocacy and service.