Many women over 50 have leaky bladders, most don't seek treatment

[November 02, 2018]  By Linda Carroll

(Reuters Health) - Nearly half of women over age 50 report bladder leakage and many say it's a major problem for them, according to a new U.S. survey.

Of the more than 1,000 women ages 50 to 80 who participated in the survey, 43 percent of 50- to 64-year-olds said they suffered from incontinence, as did 51 percent of those 65 and older.

Even so, two-thirds of the women who experience leakage haven't spoken to a doctor about the problem. And just 38 percent say they've been doing Kegel exercises to strengthen the muscles that can help hold urine in, write the authors of the National Poll on Healthy Aging report.

Many women simply rely on coping strategies like using pads, wearing special underwear, limiting fluid consumption and wearing dark clothing to disguise signs of leakage.

"What I'd like people to take away from this is that urinary incontinence is common and treatable and that women don't have to just live with it," said Dr. Carolyn Swenson of the University of Michigan in Ann Arbor, a specialist in female pelvic medicine and reconstructive surgery who helped develop the poll questions and analyze the findings.

The national poll was conducted by the University of Michigan Institute for Healthcare Policy and Innovation and sponsored by the AARP and Michigan Medicine.

Among women with incontinence, 41 percent said it was a "major problem" or "somewhat of a problem." One-third said they experience an episode nearly every day. Nearly half said they worried about the condition worsening as they got older.

The most common triggers for leakage were coughing and sneezing - reported by 79 percent, and not having enough time to reach the bathroom - experienced by 64 percent.

Those symptoms are signs of two different types of incontinence, Swenson explained. Women with stress incontinence "have leakage when they are laughing, coughing, sneezing or exercising," she said. "The other type, urge incontinence, is more of a bladder issue when you're on your way to the bathroom but can't make it."

The important thing to realize, Swenson said, is that both types of incontinence can be treated. "We have so many options now that while I would hesitate to say we can get everybody 100 percent dry, we can definitely help improve symptoms for all women with urinary incontinence," she added.

For urge incontinence, alternatives include Botox for the bladder and a surgically implanted pacemaker for the bladder that prevents it from involuntarily contracting too much, Swenson said. Women who want to pursue less invasive alternatives might cut back on substances that irritate the bladder, such as caffeine, artificial sweeteners, nicotine and alcohol, she added. Another strategy would be to empty the bladder more often.

For stress incontinence, there's the option of surgery to repair the hammock-like support structures that help hold the bladder and other pelvic organs in place. But there are also less invasive treatments such as "vaginal inserts that look like tampons," she said. "They help support the urethra."

Women with either type of incontinence may benefit from pelvic floor physical therapy, Swenson said.

The survey results did not surprise Dr. Doreen Chung, a urologist at NewYork-Presbyterian/Columbia University Medical Center who specializes in female pelvic medicine and reconstructive surgery.

Chung, who was not involved in the poll, sees many patients who were reluctant to bring up their incontinence because they were embarrassed or they thought it was a normal part of aging that couldn't be helped.

"I tell them something can be done to improve their symptoms," Chung said, adding that many older men also suffer from incontinence but are also too embarrassed to talk about it.

There's a range of leakiness, Chung said, "from some who only leak a few drops, which is common after childbearing, to others who use a pad or less, which is considered mild, to others who use several. Many wear diapers. There are even younger patients wearing diapers."

Some women develop urge incontinence as a result of being told since childhood to hold their urine in. "They're always contracting the urinary sphincter and then it becomes very hard to pee normally," Chung said. "You shouldn't let your bladder fill more than half a liter. For most, that means peeing every two to four hours."

SOURCE: https://bit.ly/2CSj7ae National Poll on Healthy Aging, online November 1, 2018.

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