Managing Urinary Incontinence in Older Women
Urinary incontinence (UI) is a common problem that affects numerous people worldwide. It occurs when urine leaks involuntarily because the person has lost control over his/her bladder or the urinary sphincter of the bladder is weak.
It is a highly embarrassing condition that could cause severe psychological, social and emotional stress. This is because people with this condition may avoid certain daily activities like travelling, shopping, religious and social gatherings for fear of leaking urine in public.
They may also feel embarrassed to let anyone know and fail to seek treatment because they think it is a condition that can not be managed or treated. It also affects the patients’ quality of life. In a study conducted in Austria, almost 70% of the women stated that urinary continence affects their quality of life.
Urinary incontinence in older women
The risk of UI increases as a person gets older, hence it is one of the most common and disabling conditions among older people. These have been attributed to several factors such as an impairment of the cognitive, physical and physiological function, the use of multiple medications as well as comorbidities like type 2 diabetes.
This condition is even more common in older women and literature reports that it affects about 1 in 3 older women. This is due to certain factors anatomical and physicological changes peculiar to the woman. An older woman may already be exposed to multiple pregnancies and childbirth which weaken the bladder or pelvic floor muscles and may lead to UI. In addition, she experiences hormonal changes, like lowered estrogen levels that occur in menopause and affects continence.
Furthermore, urinary tract infections (UTI), more common in women due to their short and straight urethra have been observed to increase the likelihood of developing UI. In older women, along with a decreased level of immunity, changes in the vaginal and urethral mucosa allow for the colonization of bacterial organisms and increases the chances of obtaining a UTI. Researchers suggest that UTI worsens the state of the bladder, causes bladder irritation symptoms, increases urgency and frequency of urination, which may eventually lead to UI.
Types of urinary incontinenceThere are mainly two types of UI common in women.
Stress urinary incontinenceStress UI occurs as a result of increasing intraabdominal pressure. In this case, obesity, chronic cough or menopause can reduce the anatomical support of the bladder neck and the urethra, making the urethra hypermobile. Therefore, when there is intraabdominal pressure while coughing, laughing or exercising, the urethra is pushed downwards rather than being compressed. This results in a lower pressure in the urethra than in the bladder, leading to leakage of urine.
Urge urinary incontinenceWhile stress UI has to do with physical changes, urge UI is due to physiological changes to the bladder. This can occur due to several reasons. It could be due to repeated contraction of the detrusor muscle in the bladder which leads to a false perception of urine urgency, and subsequently urine leakage. It could also be as a result of the failure of the bladder to expand, causing increased discomfort and pressure during filling and limited capacity. Finally, it could be due to a hypersensitive bladder, resulting in overactive bladder syndrome.
Treating Urinary IncontinenceIt is often wrongly assumed that as people age, it becomes a normal occurrence for them to lose their ability to control their bladders. However, this assumption is false. UI in older women can be treated using drugs, vaginal devices, electrical stimulation, treating the underlying UTI and surgery which is more effective for stress incontinence than urge incontinence.
Behavioural therapyIn a study by Susan Mayer in 2019 involving the review of randomized control trials, it was concluded that behavioural therapy was a more effective method of treating stress or urge UI in women when compared to drugs.
Behavioural therapy is a recommended form of managing UI that involves conditioning the pelvic muscles and making behaviour changes that can modify the bladder function. These behavioural or lifestyle changes are;
This is a technique employed to suppress the urge to urinate. This is more effective in older women who still have their cognition intact and can go to the toilet. Here, the patients learn to urinate according to a schedule by delaying voiding through the use of distraction and relaxation techniques. Voiding intervals are delayed by 15 – 30 minutes weekly until a longer voiding interval is reached. This technique is useful in treating all types of UI.
This is another technique used to treat both stress and urge UI. Kegel exercises are repeated contraction and relaxation of the pelvic floor muscles. This improves the ability to voluntarily contract the external sphincter, and when done correctly can be highly effective.
To perform kegel exercises, you need to identify the right pelvic floor muscles; the muscles you tighten when stopping the flow of urine midway. Once this is done, tighten those muscles for three seconds at a time and relax for three seconds. This should be done for three sets of 10 to 15 repetitions daily. Kegel exercises can be done anytime and in any position.
Smoking cessationStudies have reported that women who smoke are more likely to have UI, and smoking has been reported to worsen their symptoms. A reason for this could be due to the chemicals present in cigarettes which travel down to the bladder causing its irritation. Also, the frequent coughing associated with smoking could result in stress incontinence. In older women, smoking reduces the already low levels of estrogen which interferes with the proper functioning of the urethra. Therefore, cutting back on cigarettes is an important lifestyle modification that can reduce UI symptoms in older women.
Weight loss has been shown to reduce the incidence of UI, and decrease the frequency of incontinence. Women who are obese have more intraabdominal pressure compared to non-obese women. Weight loss helps manage obesity as well as other comorbidities like type 2 diabetes that have are risk factors of UI.
Modified fluid intake
The timing of fluid intake is important and can help in managing UI. Restricting fluids can lead to dehydration and increase the risk of UTIs, hence this is not recommended. Rather, there should be a reduction of fluid intake in the evening.