Humans are inherently wired to be incontinent. It's why as babies, the default is for us to get rid of waste as it hits our bladder or rectum. This is biologically important, since conditions that inhibit this default can be life-threatening. As we age, we are taught and eventually learn to rid of waste when it is socially appropriate. This is also biologically important, so that we can be productive and avoid being in compromising positions at inopportune times.
The ability to learn urine and fecal control demonstrates the relationship between our brain and neural pathways with the bowel and bladder. This is the basis for overactive bladder treatments like percutaneous tibial nerve stimulation (PTNS) and sacral neuromodulation (ex/ Axonics, Interstim).
As we age, certain unmodifiable life events like pregnancy, childbirth, and menopause impact our pelvic floor, as well as modifiable factors like our fluid intake, diet, use of bladder irritants, and excess body weight. Conditions that affect pelvic support are often linked to stress incontinence, or leaking with activity. Treatments that I offer for this include mid-urethral slings, urethral bulking and vaginal suspension. In addition, certain diseases like neurological conditions, stroke, chronic constipation and chronic cough can increase the risk of bladder leaks and bowel accidents.
What is one peeing habit people 50 and older should NOT do and why?
The biggest mistake I see people 50 and older make with their peeing habit is ignoring bothersome urinary symptoms. With 51 as the average age of menopause, people may have perimenopause changes starting 5-10 years before they stop having periods. These hormonal changes impact the bladder, because the bladder and its surrounding tissue have estrogen receptors. As estrogen levels decrease, the resulting changes make the bladder more sensitive. Up to 2 in 3 women around this age will experience more frequent urinating, difficulty controlling bladder urges, burning with urination, and weakening of the surrounding tissues causing leaks with activity.
Peeing habits are often put on the back-burner until they're severely problematic. In the context of many women's lives at this time, they've often postponed addressing their own health in sacrifice of caregiving with children or parents. They're often highly invested in their careers, and patients often don't get into my office until their symptoms impact one of their social domains. They can't exercise because they leak. They avoid going out if they know bathrooms aren't nearby. Bladder leaks impact intimate relationships, and can even cause intrinsic problems like embarrassment, anxiety, and a decreased sense of self-worth. The best habit people 50 and over can establish for their bladder is to recognize bothersome symptoms, and address them with their doctor.
If someone continues to ignore their bladder health, how will it affect them?
Regularly ignoring bladder symptoms will inevitably lead to worsening problems. The changes that impact bladder control are age-related and progressive. In extreme situations, people can suffer in silence. Incontinence and overactive bladder have been linked to a condition called frailty, which is associated with muscle wasting, decreased activity, and increased morbidity. Urinary health is an integral part of aging with vitality.
These are the top three habits I recommend for bladder health as a urogynecologist:
1) Ensure that you are adequately hydrated. For people with bladder control problems, I recommend that they drink small cups (4-6oz) of water throughout the day (every 1-2 hours) as opposed to large amounts of water a few times a day. More often, I see people try to cut out fluids as much as possible, and rarely I see people drinking too much water as part of a fad diet (ex/ "a gallon a day," or "their body weight in ounces"). Drinking a small amount throughout the day helps keep the bladder comfortably full, in order to maintain the second habit I recommend, which is to try timing voids during daytime.
2) Timed voids during the day helps with urinating too much in daytime, nighttime voids, and under-emptying. Most adults should be able to hold their bladder for 2-4 hours. As the body experiences age-related bladder changes, many people will need to re-train their bladder in order to re-establish good bladder habits.
3) Avoid bladder irritants. Cigarette smoking, drinking alcohol, and certain food intake impacts our bladder sensitivity. Additionally, cigarettes increase the risk for bladder cancer. Certain chemicals, like caffeine and alcohol, increase urine production as well as cause more bladder spasm with urges to void. Some foods, often spicy or acidic, can also cause more bladder irritation, though this is more dependent on the individual. Having good gut health may decrease the risk of bladder infection, since most urinary tract infections originate from misplaced gut bugs, so high fiber and probiotics are key. It's important to take stock of how your diet and fluid intake impact your bladder habits.
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