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Bladder Control: The Problem Older Women Don’t Talk About

By Chris Iliades, MD

Urinary incontinence is the involuntary loss or leaking of urine. It may be the most frequent and most troubling symptom that women never talk about. A recent article in the Journal of the American Medical Association (JAMA) finds that urinary incontinence affects at least one out of three older women. Incontinence can range from the leaking of a few drops of urine when coughing or laughing to a complete and sudden loss of bladder control and an embarrassing soaking.

"Urinary incontinence is a common geriatric syndrome that affects at least 1 in 3 older women and can greatly diminish quality of life." —JAMA

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The risk of public embarrassment because of urinary incontinence and the need to wear incontinence supplies—what’s typically referred to as adult diapers—may keep older women from leaving their home. It may also keep older women from talking about the problem with their caregivers or with their doctors. And they may believe that loss of bladder control is just a normal part of aging and something they have to live with. However, the truth is that not talking about the problem can lead to complications that can make the situation worse and delay treatment that is often successful.

What Causes Urinary Incontinence?

Control of urination depends on a healthy coordination of nerves and muscles that control the bladder and the sphincter muscles surrounding the urethra, the tube that carries urine to the outside. Although it is true that muscles become stretched with age, especially in women who have had children, and that the bladder may not be able to hold as much urine as before, urinary incontinence is not a normal part of aging. Some conditions that may contribute to urinary incontinence in older women include:

  • Thinning and drying of the linings in the vagina and the urethra
  • Weakened pelvic muscles from childbirth
  • Medications for blood pressure or muscle relaxation
  • Constipation
  • Being overweight
  • Urinary tract infections
  • Diseases like diabetes or Parkinson's disease

Types Of Urinary Incontinence

Knowing the type of urinary incontinence you have helps your doctor understand the underlying cause and plan appropriate treatment:

  • Stress incontinence causes leaking of urine when laughing, coughing or lifting. Stress incontinence is usually caused by stretched or weakened pelvic muscles.
  • Urge incontinence is a very sudden need to urinate that results in large amounts of urine leaking out before getting to a bathroom. This type of incontinence can be seen with a urinary tract infection.
  • Overflow incontinence occurs when urine leaks because the bladder is overfilled or doesn't empty all the way. It can be caused by certain medications or by diabetes.
  • Functional incontinence occurs when there is a normal urge to urinate, but it takes too long to get to the bathroom. This can occur if you have arthritis or another type of physical disability.
  • Mixed incontinence is common in older women. They may have both urge incontinence and stress incontinence.

"Urinary incontinence treatments yield high levels of patient satisfaction and improvements in quality of life." —JAMA

Treatment For Incontinence

The most important thing for older women to understand is that most types of urinary incontinence can be treated no matter what the type or the cause. Some treatment options include:

  • Exercise. Like any other muscles, the muscles that control the bladder can be strengthened. The exercises are called Kegel exercises and many women will see improvement in bladder control after a few months.
  • Bladder training. Women can keep a bladder diary to learn when and how often they need to urinate. By keeping to a schedule called "timed voiding," women can avoid waiting until the bladder is full before urinating.
  • Medications. Several prescription medicines may be helpful including medications that relax bladder muscles. Estrogen cream may be helpful for cases of mild stress incontinence.
  • Surgery. Surgery to support the bladder can improve bladder control. Newer procedures are now available that can accomplish bladder support with tiny incisions done on an outpatient basis.

Tips For Older Women And Caregivers

"Often unreported and thus untreated, it is important to include incontinence as part of the review of systems for all older women." —JAMA

  • Bladder control problems are common and should never be ignored. Living in fear of being away from the bathroom is unnecessary. If women don't volunteer information about bladder control they should be asked.
  • Minor bladder control issues can be avoided by limiting certain liquids like coffee, tea and alcohol.
  • Although using an incontinence pad occasionally for slight bladder leaks, if you need the protection of an adult diaper, you need to tell your doctor about your condition.
  • All types of urinary incontinence are treatable at any age. Don't let embarrassment interfere with quality of life.