Lack of bladder control, incontinence, affects 1-in-3 women and 1-in-10 men. As many consider it a normal part of ageing, it is often not discussed or treated. Incontinence broadly falls into three categories – stress, urge and mixed.
Stress incontinence can result from stretching pelvic floor muscles in pregnancy, chronic constipation or obesity and occurs with coughing, sneezing, straining or playing sport. Urge incontinence is when the bladder becomes overactive, contracting when it isn’t full and/or the muscle work overtime, causing frequent, sudden urges and bladder leakage.
Continence can also be affected by some medications, urinary infection, diseases, menopause and prostate gland enlargement.
Lifestyle changes can improve control in around 50% of cases. Try,
- Altering fluid intake to 1.5L/day and minimising evening intake;
- Limiting caffeine and alcohol;
- Avoiding or treating constipation by increasing fibre intake in wholemeal bread, cereals, fruit and vegetables;
- Practicing regular toileting habits with good posture for complete emptying.
The combination of calcium and magnesium may help prevent bladder spasms, whilst zinc-rich foods, such as fish and dark green vegetables, may help improve function. Schedule toilet visits to help increase the length of time between passing urine, so the bladder muscle gets stronger and can hold more without emptying. Regularly do pelvic floor exercises by tightening pelvic floor muscles for 3-5 seconds, increasing to ten seconds as the muscle gets stronger. Relax for as long as the muscles were tightened. Do this 5-7 times, 3x/day to start increasing to 15 exercises 3x/day.
If these measures aren’t successful, pads can be useful to give confidence in day-to-day life. Medicines most used are anticholinergic and alpha-adrenergic agents. The older anticholinergics (Oxybutynin, antidepressants) reduce the number and strength of bladder contractions, are subsidised but side effects are frequent. Newer medicines aren’t subsidised but may be easier to tolerate. Alpha-adrenergic agents contract the muscles around the bladder neck to form a tighter seal and prevent leaking. Discuss these and other measures with your Doctor.