Men and women often experience different health issues and changes as they age, but both sexes can have problems with incontinence. However, incontinence affects men and women differently. According to one study of more than 5,000 people age 60 and older, the prevalence of urinary, fecal and double incontinence increases with age in both men and women, though more so among men of the most advanced age. In general, urinary incontinence is more often seen in women than in men, while fecal incontinence and double incontinence occurred at about the same rates. Different factors can be involved in the different types of incontinence, specifically urge and stress incontinence.
Incontinence is not only more common in women, it may also first appear at much earlier ages than in men. Because of the stresses on the body from pregnancy and childbirth, stress incontinence is the most common type of incontinence among young and middle aged women. It can be caused by weakness of the urinary sphincter resulting from childbirth, pelvic surgery or simply an abnormal position of the urethra or uterus. Later in life, the hormonal changes that accompany menopause can be at the root of incontinence. The urethra shortens, its lining becomes thinner and the urinary sphincter doesn’t close as tightly. Lower levels of estrogen during menopause lead to vaginal tissue thinning, in turn causing irritation, worsening urinary urgency and contributing to incontinence. Older women may experience mixed incontinence—having more than one type of incontinence—such as both urge and stress incontinence.
For men, incontinence is often related to prostate health (this organ encircles the urethra and can place unwanted pressure on it). As men age, the rate of urine flow from the bladder through the urethra can slow, especially when the prostate gland enlarges. An enlarged prostate can actually block the opening into the urethra from the bladder. Overflow incontinence is usually caused by some type of blockage or by weak bladder contraction due to nerve damage or weak bladder muscles. While not as common, blockage can be caused by narrowing of the bladder neck or the urethra after prostate surgery or radiation therapy for prostate cancer. Stress incontinence can be a consequence of prostate surgery if the upper part of the urethra or the bladder neck is injured.
Shared causes of incontinence include urinary tract infections, diabetes and even smoking because of the hacking cough that often results. Obesity can lead to or worsen stress incontinence because unwanted weight stresses the bladder. Some changes that naturally occur with aging may also affect urinary control in either sex. As we age, the bladder tends to hold less than it used to and you may not be able to hold in urine for as long as you used to once you feel the need to go.
Another problem is that the bladder becomes less efficient at emptying—the amount of what’s called residual urine (urine that remains in the bladder after urination) increases with age. Constipation can cause overflow incontinence if the rectum puts pressure on the bladder neck and the urethra. A lack of mobility can lead to functional incontinence—urine loss resulting from the inability to get to a toilet or get there fast enough—in men or women. This means that older people may have both urge and functional incontinence.
While incontinence is not inevitable, age-related changes do increase the odds of developing incontinence as we age. Because older adults are often more severely affected by incontinence and because incontinence is less likely to resolve quickly or on its own, it’s important that both men and women talk to their doctor about finding the underlying cause of their incontinence and getting the right treatment, if available.