You’ve probably seen those commercials where people have to run off to the bathroom at the most inconvenient times, forgo outings because of the frequent urge to urinate, or avoid social situations for fear that a sudden cough or sneeze will lead to leakage. Urinary incontinence, involuntary loss of urine, can be quite embarrassing. It’s also quite common. It’s estimated that up to 40 percent of older adults may experience urinary incontinence (UI). Incidences increase as people reach their seventh and eighth decades.
“It’s often an underreported problem because many older adults think urine leakage is a natural part of aging, but it’s not,” says geriatrician Grace Chen, MD, UCLA Division of Geriatrics.
Urinary incontinence can occur for many reasons: Some are unique to a person’s sex, while others apply to both men and women. For example, diuretics, antidepressants, sedatives, and some herbal remedies may cause UI. Health issues related to UI include constipation, obesity, urinary-tract infections, diabetes, kidney problems, nerve damage, Alzheimer’s disease, and arthritis.
Process of Elimination
Every day the kidneys filter about 120 to 150 quarts of blood to produce 1 to 2 quarts of urine. The amount of urine produced depends on many factors, including how much liquid and food a person consumes and how much fluid is lost through sweating. Thin tubes carry urine from each of the kidneys into the bladder, which is a balloon-shaped organ that expands as it is filled. The bladder can hold about two cups of urine. As the body ages, the bladder may not be able to hold as much. Voiding up to seven times per day is considered normal, with the morning volume typically being higher.
Once the bladder is full, signals sent to the brain convey that it’s time to go. Muscles keep urine in place until you are ready to empty it. Urine is released through the urethra, located at the bottom of the bladder.
Men and UI
The prostate gland surrounds the urethra and is notorious for causing urinary problems in men. Prostatitis, an inflammation of the prostate, can cause debilitating urinary and sexual symptoms. The disease sometime results from infections, which can be treated, but for unclear reasons the infection persists in some men and can be quite difficult to cure. Risk factors for prostatitis include recent history of urinary tract infection or sexually transmitted disease. Prompt treatment of those issues reduces the risk of chronic prostatitis.
Benign prostatic hyperplasia (BPH), enlarged prostate, is caused by excess tissue growth. It irritates the bladder, causing it to contract, even when there is just a little urine present, and creates the sensation of needing to urinate more often. Hormones are suspected to play a role in the development of BPH. The condition is estimated to affect about 60 percent of men by age 60. By age 80, most men are affected by BPH. There are several medications that treat BPH. Lasers and water vapor techniques are also used to remove excess tissue.
UI in men may also result from prostate cancer treatments. In some men, function is restored in about a year post cancer treatment, though some treatments for UI may be needed. Surgical options include an artificial sphincter, urethral sling, and adjustable balloon devices. One study found that men who were not obese and were physically active were less likely to be incontinent after prostate cancer surgery.
Women and UI
Compared to men, women are twice as likely to experience UI. But as in men, the prevalence of the disease increases with age. The postmenopausal decrease in hormone levels may play a role in overactive bladder in women. According to Dr. Chen, women may also have symptoms from weakened or stretched pelvic muscles after childbirth or thinning and drying of the vaginal walls or urethra after menopause. Researchers think having low levels of the hormone estrogen after menopause may weaken the urethra, which may cause UI.
Any surgery that involves a woman’s reproductive organs, such as a hysterectomy, can damage the supporting pelvic floor muscles, especially if the uterus is removed.
UI treatments for women include the use of vaginal rings or creams containing estrogens that can help strengthen the muscles and tissues in the urethra and vagina. Botox injections can help reduce symptoms of an overactive bladder. The effects of Botox are not permanent, but can last six to 12 months. A reusable vaginal pessary is a small donut-shaped device inserted into the vagina. It pushes up against the vaginal wall and urethra to help support pelvic floor muscles and reduce stress incontinence. These prescription devices come in several sizes. Bulking agents, such as collagen injected into the tissues around the bladder and urethra to cause them to thicken, are another option that can reduce the amount of urine that leaks out. Surgical procedures include a sling, which acts as a hammock to support the urethra and hold the bladder in place. Serious complications can occur with this procedure, so it’s essential to fully understand the risks and benefits.
Tips for Better Bladder Health
It may seem like a good idea to drink less fluid to reduce urine leakage, but it isn’t. Adequate hydration is needed for good health, and older adults tend toward dehydration due to a reduction in the ability to feel thirsty. Getting enough fluid helps the kidneys and bladder stay healthy. Fluid helps flush out the urinary tract to prevent infections, and also helps prevent constipation, which makes UI worse. Avoiding caffeinated beverages may help some people prevent urine leakage. Whenever you go, try to empty your bladder completely.
For women, it’s especially important to sit on the toilet and relax rather than hover above the toilet seat to urinate. By hovering, the pelvic floor muscles can’t relax enough, which can result in some urine being left in the bladder. That, in turn, can cause leakage and possibly urinary or bladder infections. It’s also wise to urinate after sex to help flush out any pathogens.
Timed voiding may improve bladder control. Timed voiding means you urinate on a set schedule, for example, every hour. You can slowly extend the time between bathroom trips. When timed voiding is combined with biofeedback and pelvic muscle exercises, you may find it easier to control urge and overflow incontinence.
Pelvic floor muscles support the uterus, bladder, small intestine, and rectum. Kegel exercises, or pelvic floor retraining, can help prevent or reduce UI. However, some women have UI because their pelvic floor muscles are persistently tight, in which case doing Kegels may cause more problems.
Losing weight if you are overweight is helpful as it reduces pressure on the bladder and other urinary structures.
Talking with Your Doctor
To prepare for a visit with you doctor, keep a bladder diary for two to three days before your appointment. Jot down what you ate, how much, and when. Log when you urinate and try to estimate the volume (for example a cup or less). Note how many times your urine leaks, whether you felt a strong urge to do so, and consider what you were doing when the leak occurred (such as if you were lifting something, or if you coughed or sneezed).
During your appointment, your doctor will take a medical history, perform a physical exam to look for medical problems, and perhaps order lab tests, such as requesting a sample of urine to check for infections or kidney problems.
If you don’t treat UI, it can lead to urinary tract infections, skin rashes, sores and infections. Though it can be difficult to discuss bladder issues with your doctor, the more he or she knows about the specifics, the better your UI can be evaluated and treated, and the better you will feel.
The post Better Bladder Health for Men and Women appeared first on University Health News.