A recent cohort study found that incontinence affects more than a fifth of people aged over 85 years old.
Urinary incontinence is much more common in older people and is associated with considerable morbidity. 20% of community dwelling older adults have enough incontinence to limit some aspect of their lives. It is associated with considerable morbidity. The risk of incontinence, however, is much higher in older females. It is that is thought that up to 50% of older women suffer from urinary incontinence.
Dr Fleming, president at ACP asserts, “Urinary incontinence is a common problem for women that is often under-reported and under-diagnosed”.
Why is Incontinence in Elderly Females so Common?
Risk Factors for Seniors
Seniors are more at risk of nerve damage, mobility issues and arthiritis. Problems with nerve damage affect the communication between the brain and the bladder. Parkinson’s disease is a common problem that causes individuals to lack control over their bladder. Mobility issues can cause functional incontinence, making it hard to reach the toilet and buy the correct products. In addition to this, seniors are also more likely to develop cognitive problems such as Dementia.
Changes to the Female Bladder
Elderly women differ from younger females by the presence of several changes in the urinary tract. As you get older, the bladder also changes. A woman's elastic bladder tissue toughens and becomes less stretchy with age. A less stretchy bladder doesn’t hold as much urine as before, causing you to urinate more frequently. The bladder wall and pelvic floor muscles also weaken with age, making it harder to empty the bladder fully.
Older women are also more likely to get UTIs as the bladder muscles weaken and make it hard to empty the bladder fully.
Health Factors Exclusive to Women
There are a number of key factors exclusive to women that play a factor in causing incontinence. Common contributing factors are the following:
- Menopause. Oestrogen plays a vital role in continence mechanism with the bladder and urethral function becoming less efficient with age. During menopause, the body suddenly stops producing oestrogen. This can cause lack of bladder control.
- Pregnancy. The weight of pregnancy puts extra pressure on the bladder, weakening the muscles. Childbirth further damages these muscles through the stretching and strain of the muscles during birth.
- Hysterectomy. A hysterectomy is an operation to remove a woman’s uterus. This can also remove some structures that are required to provide pelvic support for bladder control.
The combination of these factors can alter the condition of the bladder and pelvic floor. This makes incontinence much likely later in life.
Incontinence in Older Women is more Common than most Chronic Medical Conditions!
Older People and Seeking TreatmentOlder people are more likely to delay seeking help for urinary incontinence. Symptoms are often also poorly managed in care. Drug treatments and conservative treatments have been proven to work in older people. However, older people still remain under treated. Embarrassment may be a key cause for this. Linda Brubaker, MS, professor of female pelvic medicine and Loyal University Chicago School of Medicine, states, “female incontinence is embarrassing. It can really affect your quality of life-your emotional state, body image, sexuality”. One main reason as to why senior women don’t seek help is due to normalizing the condition. We all know that incontinence is more prevalent in older people, so women often feel like they should just accept it. Brubaker asserts, "many women think it’s normal, part of having children or going into menopause and don’t seek help."
Incontinence is a word most people say quietly. For most people, it is discussed only with a Doctor, or never at all.
However, the studies that have taken place over the years never fail to shock people. The majority of studies have found that incontinence affects around 300m people worldwide. This equates to about 5% of the population. A huge issue is that due to the lack of talk about it, there may be many more people suffering from incontinence than has been found. To date, it is estimated that around 7 million people in the UK have urinary incontinence (5-10% of the population). The fact that many do not even see a Doctor means this proportion could be even higher.
The infographic below shows the partition on a population of 50 million people:
Yes, it affects more women. But don’t forget about the men.
As you may expect, incontinence does affect more females than males. Incontinence affects roughly twice as many women as men. Combined faecal incontinence and urinary incontinence affects 10% of women and 5-6% of men in the community, increasing to almost 50% in nursing home residents.
This increase in prevalence is due to common changes in a woman’s health and body, such as pregnancy, hormonal changes, menopause and ageing. In pregnancy, the expanding uterus puts pressure on the bladder. The muscles in the bladder sphincter and the pelvic floor muscles can be overwhelmed by this and become weakened. Increased uterine weight is another huge important factor affecting the frequency of leakages during pregnancy. During childbirth, these muscles are further stretched and weakened, leaving many women suffering from stress incontinence.
Over 10% of men over 65 admit to having urinary incontinence to some degree. Most commonly, male bladder problems are caused by Prostate Cancer, Prostate Surgery, neurological disorders and nerve damage. Many men suffer from benign prostatic hyperplasia, a non-cancerous condition that causes prostate enlargement. Constipation, obesity and bladder infections are other complications that can lead to male incontinence symptoms.
“I’d Rather Keep It a Secret”
Although we have rough statistics, the fact is that it is hard to estimate how many people have incontinence, as it is barely spoken of. Fewer than half of adults with severe urinary incontinence seek help from healthcare providers. One study found that men would rather admit to sexual impotence than symptoms of incontinence. Women are a little bit more open about the issue, sharing these problems on websites such as “Mumsnet” and “Women’s Health”. However, still only 1 in 5 women claim that they seek help for incontinence issues, the rest keep it a secret. We clearly still do need to spread incontinence awareness for both sexes.
What is the Most Common Type of Incontinence?
Symptoms of stress incontinence are the following:
- Experiencing leakage when you exercise
- Experiencing leakage when you cough, laugh or sneeze
- Leaking when standing up
- Leaking when lifting something heavy.
Author and runner Rose George shared her experience of stress incontinence an article in the Guardian. She states, “I know it happens from discussing it with my female club mates. I know it happens from running forums online. And I know it happens because it happens to me.”
Surprising Fact: More people suffer with bladder problems than with asthma, diabetes or epilepsy!
The Risk Factors For Incontinence Include:
- Being a senior or in later years
- Pregnancy or childbirth
- Menopause and hormone replacement therapy
In general, individuals of child bearing age are more likely to have slight incontinence, whereas senior individuals are much more likely to have severe incontinence. The increase in prevalence around the age of 50 is likely to be due to Menopause.
Recommended Heavy Incontinence Products
Recommended Light Incontinence Products
The Impact of Incontinence on the Population
Studies find that incontinence influences four important areas:
2. Existing partnerships
3. New partnerships
4. The search for professional help
Incontinence is a threat to people’s autonomy and incontinence. This toll on mental health is not only apparent for incontinence sufferers, but also for carers. As authors Cassells and Watt claim in their article, "Carers of people with incontinence have reported sleep deprivation, depression and social isolation". They state “It is a both a caregiver burden and predictor of institutional placement.”
Depression and incontinence is also a large issue on a worldwide scale. In a Canadian study of women with urinary incontinence, more than 15 percent had experienced major depression in the previous year.
There are many methods available for treating incontinence, with the medical world rapidly expanding on solutions. Pilates is an exercise that is becoming increasingly popular for incontinence.
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The peak prevalence of incontinence in women occurs around the time of the menopause. Recent studies have found that the reduced levels of oestrogen during menopause is a huge reason for this fact.
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