Finding solutions to bladder problems that often come with age

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Always looking for a bathroom? Bladder leaks can interfere with your well-being and people, especially women, are more likely to experience them as they age. Only 3 percent of women under 35 experience incontinence, compared with 38 to 70 percent of women over 60, according to Wolters Kluwer’s UpToDate, a tool for doctors.

Many factors that weaken the pelvic floor muscles, such as childbirth, menopause, obesity, and constipation, can increase the risk of bladder leakage. Neurological disorders such as multiple sclerosis and Parkinson’s disease can also interfere with bladder function, says Arthur Louis Burnett, MD, professor of urology at the Johns Hopkins School of Medicine in Baltimore. Conditions affecting the prostate can also cause incontinence.

But leaks are not a normal part of aging. “There’s always something that can be done,” says Jason M. Kim, clinical assistant professor of urology at the Renaissance School of Medicine at Stony Brook University in New York.

You may be hesitant to broach the subject, but talking about it can improve your quality of life. Here’s what you need to know to find a solution that works for you.

Before recommending treatment, your healthcare provider will determine the type of incontinence you are experiencing. The most common form is stress urinary incontinence, or leakage when you sneeze, cough or laugh. “Anything that adds abdominal pressure can force the bladder to leak urine,” says Brian J. Linder, a urogynecologist at the Mayo Clinic in Rochester, Minnesota.

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Overactive bladder, or urge incontinence, makes people feel like they have an urgent and frequent need to use the bathroom, and that if they don’t do it in time, they might have an accident. “Some people have to go every 20 minutes, which limits what they can do,” says Kim.

Evidence-based treatments for urinary incontinence range from lifestyle tweaks to surgery, and your provider should start with the least invasive options. If your regular doctor doesn’t give you a variety of strategies to try, a specialist like a urologist or urogynecologist can help you find what works. “You don’t have to deal with it just because you’ve learned to live with it,” says Kim.

Lifestyle modifications they are usually the first line of treatment. If you’re overweight, losing a few pounds can reduce bladder pressure. Relieving constipation with dietary changes, such as increasing fiber intake, or with medication, if needed, can have the same effect. Alcohol and caffeine can irritate the bladder and promote leakage, so limiting their use can also help.

Physical therapy of the pelvic floor, which helps strengthen the muscles involved in urination, is another non-invasive treatment. Known as Kegel exercises, these exercises can help with both stress incontinence and overactive bladder. They can take several sessions to work, says Kim, and you can practice at home.

medication could be the next option, says Linder. Anticholinergic drugs such as oxybutynin (Ditropan and Ditropan XL) can help calm an overactive bladder, but research has linked them to symptoms of dementia in older adults, especially at higher doses. A beta-3 agonist like mirabegron (Myrbetriq) might offer some of the same effects without the cognitive risks, Kim says.

More invasive procedures they are often the last resort. Among these, the gold standard for stress incontinence, Kim says, is a sling procedure, which generally uses mesh to help support the urethra and prevent leakage. Most people find that this operation relieves their symptoms, but complications can sometimes be serious. Doctors may also inject bulking agents into the bladder. This is less invasive, but there is little long-term data, according to American Urological Association guidelines. For overactive bladder, Botox injections into the bladder muscle can help. “It will last about six months,” says Linder, so repeated treatments are necessary, and some side effects can be severe.

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