One in three women in their 40s suffer from urinary incontinence. How to mitigate it?

Childbirth history and obesity are among the risk factors for stress urinary incontinence in women aged 45 and over.

When you leave home to go shopping or meet friends, do you ever wonder where and how quickly you can find a toilet in case of a sudden and urgent urge to pee? You might think this is another unpleasant side effect of aging. In a way, you would be right.
A new study published December 15, 2021 in Menopause, the journal of the North American Menopause Society, found that women between the ages of 45 and 54 are more likely to suffer from overactive bladder syndrome (OAS). The prevalence of overactive bladder increases with age until menopause and beyond, it’s something really common.

Two main types of incontinence

Stress urinary incontinence and overactive bladder are the two main types of urinary incontinence. Stress urinary incontinence (SUI) manifests as leakage when you cough, sneeze, or exercise. The other type is an overactive bladder, which can be wet or dry.

Wet Overactive Bladder and Dry Overactive Bladder: What’s the Difference?

We speak of a dry bladder when the urge to go to the toilet is very pressing and it is difficult to wait, but there are no leaks. We talk about wet bladder when the urge is very pressing but you can’t go to the toilet in time and there is leakage of urine. If you have both types, it is said to be mixed.

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A study conducted on more than 12,000 women

A survey asked women about how often they want to urinate or wake up to urinate. To investigate the prevalence and factors that may influence urinary symptoms, the researchers used cross-sectional data from 12,198 women enrolled in the Japan Nurses’ Health Study (JNHS), a prospective cohort study of nurses.

The cross-sectional survey for this study was part of the JNHS, which is an ongoing cohort study of nurses in Japan, established in 2001. Participants completed the baseline survey, and every two years information was provided. collected on lifestyle habits, disease history, reproductive health and drug use. Participants in the JNHS study came from all 47 prefectures in Japan, and most of them were currently employed as registered nurses, nursing assistants, public health nurses or midwives. They were at least 25 years old (the average age of the participants was 46) and lived in Japan at the time of the initial survey. Participants were asked to answer the following questions:

– » In the past month, how much influence have urinary problems had on your daily life? »
– » What symptoms have affected your daily life? “.

These general questions were followed by more detailed items describing symptoms with which participants agreed or disagreed, such as:

– I urinated frequently during the day.
– I woke up to urinate.
– I suddenly had to urinate and it was hard to wait.
– I was unable to wait to urinate and I leaked urine.
– I leaked urine when coughing or moving my body.

Age, body mass index (BMI), smoking, history of diabetes mellitus, history of hysterectomy and menopausal status were also collected.
The researchers used the odds ratios to determine the risks of overactive bladder, stress urinary incontinence, and mixed urinary incontinence.

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Risk factors for overactive bladder and other urinary problems

The study found a significant association between overactive bladder in women aged 45 to 54 and postmenopausal status. Symptoms of stress urinary incontinence (SUI) have been shown to increase due to a woman’s high body mass index and number of deliveries. Other factors studied, including smoking, history of diabetes, hysterectomy and use of hormone therapy (HT), were not associated with urinary incontinence.

Leaking urine, urgent need to go to the bathroom, and more: Bladder problems are very common

This study shows the huge percentage of women who show symptoms of all different types of incontinence. Although this study does not necessarily show us anything new or completely unseen, it does raise awareness of a problem that is not trivial. In the age group where incontinence is most prevalent, i.e. women aged 50 to 54, 18.2% suffer from stress urinary incontinence, 12.6% from overactive bladder and 3 % mixed incontinence, which is a huge percentage of women.

Across all age groups, 19% of women had some type of incontinence, which is also a high percentage of women. It’s a huge quality of life issue. Also, although the study focuses on Japanese nurses, the results would likely translate very well to the entire global female population.
Because the obesity epidemic contributes significantly to the prevalence of stress urinary incontinence, as it is a major risk factor.

Hormone therapy and symptoms of urinary incontinence: does it help?

There were not enough women on hormone therapy (HT) for the authors to draw conclusions about its impact. Topical estrogens, such as estrogen-based vaginal creams, have been shown to help with urge incontinence, so more research to clarify this would be helpful.

Overactive bladder and stress incontinence can affect quality of life

Urinary incontinence can impact relationships and sexual functioning. Women are often afraid of leaking during sex. The impact on quality of life and sexual functioning is underestimated. Some women don’t want to leave the house because they are afraid of having an accident. Many women cannot participate in their normal activities, and it is also difficult for them to travel or have social contacts.

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Many women are embarrassed by their symptoms: urinary incontinence often goes undiagnosed.

Studies have shown that many women with incontinence do not consult their doctor enough. This is explained by the fact that it can be very embarrassing to talk about these symptoms, to admit to your doctor that you leak urine, that you wear sanitary pads and that it bothers you. Women often resort to all sorts of workarounds to deal with incontinence rather than discussing the problem with the doctor. This may include wearing menstrual pads instead of urinary pads, or scented pads, which can irritate the vulva.

How to alleviate urinary incontinence

Along with prescriptions or pills, lifestyle changes can help ease the symptoms of urinary incontinence. Since stress incontinence is associated with a higher BMI, trying to achieve a healthy weight may help improve it. Pelvic floor strengthening exercises are also good for helping stress incontinence. Knowing how to prevent overactive bladder is more difficult. But it seems that certain foods and drinks can exacerbate the symptoms: caffeinated drinks, so coffee, tea, sodas, alcohol. Sometimes spicy or acidic foods can make overactive bladder symptoms worse. Avoiding or limiting these food drinks can therefore be helpful.


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