Urinary incontinence is a common and often distressing issue, particularly among adults over 60.
Although it’s not an inevitable part of ageing, the likelihood of experiencing incontinence does increase with age, influenced by a range of physical, medical and lifestyle factors.
We got in touch with some experts to gain a better understanding of the root causes behind urinary incontinence and to find out some effective strategies for managing and preventing this common issue.
What is urinary incontinence?
“Urinary incontinence is the inability to hold your urine and the spontaneous discharge of urine at times when you are not trying to pee,” explains Miss Sushma Srikrishna, a consultant urogynaecologist and obstetrician at London Bridge Hospital, part of HCA Healthcare UK.
There are many factors that can contribute to this, but it is often a consequence of an overactive bladder or stress incontinence.
“An overactive bladder is where the bladder muscle contracts when it should be resting and makes urine come out without the person wanting to pass urine,” explains Mr Gans Thiagamoorthy, consultant gynaecologist and certified urogynaecologist at Nuffield Health Woking Hospital.
“Whereas, stress incontinence is when the muscles around the urethra are weak or damaged. The urethra is the hosepipe which connects the bladder to the outside world.”
Srikrishna agrees and adds: “For example, when there is weakness in the pelvic floor, the ‘stop valve’ doesn’t work as well as it ought to. So, when there are situations where we increase the pressure on the pelvic floor, for example, if you cough, laugh, sneeze or run, it can led to a leak.”
What physiological changes associated with ageing contribute to urinary incontinence?
Thinning around the bladder
“In post-menopausal women, without extra oestrogen, the vagina and bladder base become ‘atrophic’ and become thin and more prone to irritation,” explains Thiagamoorthy.
Reduced bladder capacity
“Our bladder capacity reduces the older we get, and so does our sleep density,” highlights Srikrishna. “So, we have a double whammy, where your bladder cannot fill as well as it used to, and when your bladder starts filling (which it does, even overnight) and your sleep is also not as dense. This causes many people to wake up several times to pee overnight.”
Medications
“High blood pressure and diabetes can effect the urinary tract, and so can the medications you take for them,” notes Srikrishna. “For example, a lot of antihypertensives (used to treat high blood pressure) are also diuretics, so they make you make more wee, and also make you have to run to the loo more often.
Bowel dysfunction
“The elderly are also much more susceptible to bowel dysfunction and constipation, and constipation makes urinary incontinence significantly worse as well,” adds Srikrishna.
However, urinary incontinence is not an inevitable part of ageing – here are five ways it can be effectively managed and, in some cases, prevented…
1. Stay fit
“One of the best ways to try and preempt it is to enter the perimenopausal/ menopausal part of our lives, being as fit as we possibly can be,” recommends Srikrishna. “Make sure that you are undertaking regular exercise. Being overall fit in terms of musculoskeletal health means that we are also not allowing mobility issues to interfere with how long it takes us to get to the toilet.”
2. Try pelvic floor exercises
“Pelvic floor exercises are excellent for any age group, particularly those going into the menopausal stage, and is one of best ways to help give ourselves extra time to get to the toilet,” says Srikrishna. “My advice would be to seek guidance about this from a qualified pelvic floor therapist, rather than watching a YouTube video.”
3. Seek professional help
“Urinary incontinence is awful and can really affect your quality of life,” says Srikrishna. “It limits your activities and enjoyment, and can be socially isolating, but all of these things can be nipped thoroughly in the bud with timely intervention.
“Go and see somebody who knows what they’re talking about and can help you figure out what is causing it and give you some tailored advice on medication, surgery options and lifestyle changes. Seeing an urogynaecologist on a regular basis also means conditions like a prolapse, which might be making urinary incontinence worse, can be picked up quicker.”
4. Discuss the effect of your medication
“I frequently write to my patients’ cardiologist or GP saying, could we possibly tweak this medication for this one because it has this effect,” shares Srikrishna. “This often works really well as we are keeping our patient at the centre of these sort of discussions.”
5. Avoid bladder irritants
“I routinely talk to women about food and drink they can avoid which are bladder irritants,” says Srikrishna. “Top of the list would be fizzy drinks, sour foods, caffeine, vinegar and citrusy fruits and drinks.”