Urinary Incontinence and Aging
Answers to your questions about this common condition.
Written by Melissa Bean Sterzick
Incontinence might seem like an inconvenient and inevitable side effect of aging, but it is treatable for both men and women. With more than 40% of women over age 65 affected by urinary incontinence, according to the Centers for Disease Control and Prevention, it is a more common condition than many may realize. It also increasingly affects men as they age and is estimated up to 34% of older men have some form of urinary incontinence.
Physicians are comfortable discussing all aspects of their patients’ health, so those experiencing incontinence should talk to their doctor about their symptoms. Here Sunetris Fluellen, MD, and Joseph Roofeh, MD, both Torrance Memorial Physician Network OB-GYNs, answer important questions about incontinence.
What are the symptoms and types of incontinence?
Dr. Roofeh: The main symptom of incontinence is involuntary leakage of urine. However, it also depends on the type of incontinence. There are many causes and types of urinary incontinence. The most common type is stress incontinence, which is leakage of urine in situations of increased abdominal pressure (for example: sneezing, laughing, coughing, lifting heavy objects). This is due to the weakening of the pelvic floor musculature. Urge incontinence, or overactive bladder with incontinence, is another common type. It arises from overactivity of the muscles in the bladder, giving the urge to void immediately, with involuntary leakage prior to getting to the restroom.
What causes incontinence?
Dr. Fluellen: Several factors are associated with urinary incontinence. These include increasing age, obesity, smoking, chronic coughing or constipation, and specifically for women, the number of pregnancies.
Dr. Joseph Roofeh: Less commonly, causes of incontinence are certain medications, urinary tract infections and other medical conditions such as diabetes, high blood pressure, stroke or a neurological disorder.
How is incontinence treated?
Dr. Roofeh: For stress incontinence, we start with lifestyle modifications, pelvic floor physical therapy and pelvic floor muscle strengthening exercises (such as Kegels). If that does not work, we advance to a continence pessary (a prosthetic device) or surgical intervention.
Dr. Fluellen: Stress incontinence is typically treated with a minor surgery involving a sling. Studies have shown moderate improvement with pelvic floor physical therapy, but the definitive treatment is the sling. This procedure can only be done once the patient is done with childbearing. For patients who cannot have surgery or decline surgery, they can also try a pessary to help with symptoms. Urge incontinence is typically initially treated with oral medication. If symptoms do not improve after trying two different types of medication, there is also a procedure called InterStim that some patients are candidates for.
What lifestyle changes can help reduce the symptoms of incontinence?
Dr. Fluellen: Patients can decrease smoking, focus on weight loss and do Kegel exercises to help strengthen the pelvic floor. Keeping a food and bladder-voiding diary may also help. This will allow you to track certain triggers that may worsen incontinence. For instance, foods with high acidity, carbonated drinks, alcohol and caffeine have been shown to worsen urgency symptoms.
Dr. Roofeh: Urinary continence sometimes arises from increases in abdominal pressure such as chronic cough and obesity. Weight loss will decrease abdominal weight and pressure, helping relieve symptoms of incontinence. Rapid urine production can worsen symptoms of incontinence. Alcohol and smoking both cause diuresis and increased urine production.
What is important for individuals to know about incontinence?
Dr. Roofeh: Incontinence is very common, and while it is usually seen in older women, it can affect all ages. In men over 65, it is often related to prostate issues. The first step in treating incontinence is to see a doctor.
Dr. Fluellen: Pregnancy, childbirth and menopause all affect the urinary tract and pelvic floor muscles. Those muscles can become weak or damaged, and this makes it difficult for the bladder to hold urine. I want women to know there is no need to be embarrassed to talk to your physician about incontinence. If your symptoms are affecting your quality of life, please seek treatment with your OB-GYN or urologist.
Factors That Contribute to Incontinence
- Being overweight
- Previous pelvic surgery or radiation treatments
- Having other medical conditions, such as diabetes, high blood pressure, stroke or a neurological disorder
- Genes that cause weakened pelvic floor muscles
- Experiencing chronic constipation, which exerts pressure on the pelvic structures and strains pelvic floor muscles
- Consuming too much caffeine or alcohol
Ways to Prevent or Control Incontinence
- Eat a balanced diet
- Be more physcially active. It can help you lose weight, prevent constipation and reduce pressure on your bladder
- Cut back on alcohol and caffeine, which can stimulate the bladder
- Stop smoking
- Strengthen pelvic floor muscles by performing Kegel exercises
Kegel Exercises to Keep Your Pelvic Floor Muscles Strong
- Empty your bladder and lie on your back. Tighten your pelvic floor muscles, hold the contraction and then relax.
- Increase pelvic strength by trying to lift pelvic floor into abdomen like an elevator rising. Work up to 10-second hold.
- Practice 8 reps, 3 times a day. Consistency is key! With consistent daily exercise, you should see results in six to eight weeks if your primary problem is small leakages with exertion.
Sunetris Fluellen, MD, is an OB-GYN specialist at Torrance Memorial Physician Network Women’s Center in Torrance at 2841 Lomita Blvd., Ste. 200. She can be reached at 310-784-6822. Joseph Roofeh, MD, is an OB-GYN at Torrance Memorial Physician Network Women’s Center Carson Obstetrics at 824 E. Carson St., Ste. 203. He can be reached at 310-543-5488. Both doctors practice at Torrance Memorial Physician Network Women’s Center in San Pedro at 24909 S. Western Ave. in Rancho Palos Verdes.