Maybe you leak urine every time you cough or sneeze or lift a bag of groceries. Maybe you plan your errands around trips to the toilet. Maybe you tuck extra pads into your purse when you go out. Or maybe you blaze a path to the bathroom as soon as you unlock your front door.
Perhaps you think this is all normal. Or maybe you know your bladder is a problem but feel too embarrassed to talk about it.
"These scenarios are extremely common," says Dr. Mallika Anand, a urogynecologist and female pelvic reconstructive surgeon at Beth Israel Deaconess Medical Center and assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School.
"Women often chalk up urine leakage, frequency, or urgency to something that just happens after childbirth or as we age," Dr. Anand says. "And some have been dealing with it for so many years, they expect it to stay the same — until it gets worse."
By the time they visit Dr. Anand to address their bladder issues, "some women are in severe distress," she says. "It's rarely a minor bother — it's very disruptive and limits the activities they can do or even want to do. Whether bothersome or not, it can be reassuring to understand what's happening, rule out concerning causes, and know your treatment options."
Why bladder issues worsen
Why might bladder problems increase as we get older, even if we feel otherwise healthy? Aging itself — aggravated by a decrease in estrogen during menopause — is a major risk factor, Dr. Anand says. So is giving birth vaginally. By age 40, about one in three women already deals with some degree of urinary urgency, frequency, or leakage with urgency or activity, a rate that continues to rise as decades pass.
"We see both ends of the spectrum — women who start experiencing some urine leakage shortly after childbirth," she says, "and others for whom the effects of childbirth take years to show up."
Additional factors contributing to bladder problems include weight gain; chronic constipation; pelvic organ prolapse, when structures such as the bladder, uterus, vagina, or rectum sag or bulge; and the types of beverages you drink, how much, and how often.
Sparkling water or carbonated drinks can irritate the bladder, while caffeinated drinks rank as the "No. 1 culprit," Dr. Anand says. "For some people, even a small amount of coffee can cause bladder spasms and make them want to run to the bathroom."
Get rid of lingering urinary tract infections and stave off new ones
About six in 10 women will have at least one urinary tract infection (UTI) in their lifetime. But for more than a quarter, the infection returns within six months despite antibiotic treatment.
Recurrent UTIs are characterized by two such infections in six months or three or more in one year, says Dr. Mallika Anand, a urogynecologist at Beth Israel Deaconess Medical Center. UTIs usually happen when bacteria that normally live in the digestive tract, such as Escherichia coli, travel from the rectum to the vagina and invade the urinary tract, infecting the bladder.
Usually marked by pain and burning while urinating, frequent urges to urinate, and difficulty starting the urine stream, UTIs can also lead to cloudy, strong-smelling urine and blood in the urine. In older women, especially those with cognitive problems, confusion or another change in mental abilities might be the only symptom. Back pain and fever can signal that the infection has spread to a kidney.
Despite initial treatment, Dr. Anand says, sometimes these bacteria can live inside the bladder, go dormant for a time, and then become active again, reigniting symptoms. UTIs are more prevalent in women during the transition to menopause and beyond because declining estrogen levels hinder the growth of helpful bacteria in the vagina. These tissues can also become thinner, enabling bacteria from the colon to take hold.
Dr. Anand recommends these therapies to prevent recurrent UTIs:
Vaginal estrogen. In menopausal and older women, regularly applying estrogen cream or ointment to urethral and vaginal tissues can create conditions ripe for replenishing healthy bacteria and warding off infection-causing bacteria. Vaginal estrogen tablets or a vaginal ring can also bring estrogen to the area.
Methenamine. This prescription medication is taken twice a day with vitamin C to make urine more acidic and less friendly to bacteria. Methenamine, however, must be stopped during treatment of an active UTI.
Dr. Anand suggests women consider these additional methods to help ward off UTIs:
D-mannose supplements. A natural sugar found in fruits, D-mannose may help to prevent bacteria from sticking to the lining of the urinary tract.
Cranberry juice or supplements. Cranberry also contains compounds that can block bacteria from attaching to the urinary tract lining.
Lactobacillus probiotics. These supplements can increase "good" bacteria in the vagina and urethra, optimize vaginal pH levels, and discourage harmful bacteria.
Hydration. Drink plenty of water throughout the day to continuously flush bacteria from your urinary tract.
Proper hygiene. Wipe from front to back after using the toilet to avoid spreading bacteria from the rectum to the vagina and urethra. Also, gently rinse your urethral area with clean tap water after sexual activity. Of note: douching will not prevent infections.
Empty the bladder. Use the bathroom before and after intercourse, and urinate whenever you feel the urge rather than holding it in, which can allow bacteria to flourish.
While the majority of bladder problems involve urination, others aren't as obviously related to the hollow, triangle-shaped organ. Dr. Anand highlights seven that should prompt a doctor's visit.
Bladder pain. Pain just behind the pubic bone, where the bladder sits, or in the urethra (the tube that carries urine from the bladder) may point to urinary tract infection (UTI). But these symptoms can also suggest bladder pain syndrome. Also called interstitial cystitis, this condition is characterized by pain that escalates as the bladder fills and eases as it empties. In menopause, pain in the urethra can also occur regardless of infection, signaling thinning of its delicate lining.
Blood in the urine. Bladder or kidney infection may be the culprit, along with kidney disease, cancer, or thinning of the urethra's lining. The blood may come from anywhere along the urinary tract or sometimes from a neighboring organ such as the vagina or bowel.
Cloudy or strong-smelling urine. Murky urine suggests a UTI, but this is especially so when accompanied by burning, frequent urination or achiness around the pubic bone. Urine color and odor can change depending on kidney health or what we eat or drink as well. If in doubt, get a urine test.
Urgency. If every trip to the toilet feels like a race to get there in time, get evaluated. In addition to testing for bladder infection and overactive bladder, your doctor will want to rule out so-called neurogenic bladder. This condition involves bladder contractions you may not feel that stem from a neurologic condition such as stroke, spinal trauma, multiple sclerosis, Parkinson's disease, or long-term effects of diabetes.
Frequency. If you need to urinate more than 10 times a day, testing can determine if it's due to a condition such as UTI, diabetes, overactive bladder, or neurogenic bladder. Drinking large amounts or taking medications such as diuretics can also lead to frequent urination, as can constipation or pelvic floor muscle spasms.
Increasing nighttime urination. The "wee hours" take on new meaning when you rise more often to use the bathroom. About 85% of women 60 and older need to urinate once during the night, and nearly half need to visit the bathroom twice or more. "See your doctor if it's once a night and bothersome, or more than once a night," Dr. Anand says. Evening fluids, caffeine, insomnia, diabetes, certain medications, and sleep apnea should be ruled out as contributors.
Leakage. If you pass tiny amounts of urine when you cough, laugh, bend, lift, jump, or sneeze, it's known as stress incontinence. If you leak when you feel the urge to urinate, it's urge incontinence. Leakage isn't dangerous in itself, but larger amounts that soak through pads can cause skin irritation, which can damage the delicate skin of the vulva.
See your doctor if your leakage distresses you or interferes with things you like to do.
The bottom line, Dr. Anand says, is that any noticeable change in the way your bladder seems to work merits a doctor's attention. One early tactic to determine what could be awry is keeping a "bladder diary" to track amounts, types, and timing of fluids you drink; urination timing; and any urine leakage.
"Even if your symptoms seem mild, it's the right time to come," she says. "Getting checked out earlier is wise, since treatments might be less invasive and prevent further problems."
Image: © Marina/Adobe Stock