Without your knowing it, changes in the bladder and urinary system happen slowly and can become quite significant with age. Bladder problems in older women are not uncommon. These changes may cause bladder problems which manifest as involuntary behavior and affect the quality of life of both older women and men.
Most semi and retiring adults (like myself) typically transition into senior citizenship without really knowing what to expect. This review of medical publications, government agency articles and contemporary articles on bladder problems focuses primarily on older women and addresses the questions of concern – What changes should I expect? What is normal and what is not? What causes bladder problems and how do I know I have an issue?
The review spans back over a 10-year period and provides researched material in an easy informational guide format for older women to help make informed choices, while seeking medical advice. This will allow them to continue to enjoy the quality of life they have been used to.
What are The Tell – Tale Signs of Bladder Problems in Older Women?
Do you experience ANY of the following signs and symptoms as an older woman?
|√||Inability to hold urine, or leak urine (incontinence) during common everyday activities such as lifting, bending, coughing or exercising
|√||Have a "got to go, got to go right now" sensation - sudden and urgent need to urinate right away
|√||Leak urine without any warning or urge
|√||Being unable to reach a toilet in time
|√||Bed wetting during sleep
|√||Have trouble passing urine or emptying the bladder
|√||Unusual frequency of urination - 8 or more visits per day
|√||Observe blood in the urine
|√||Observe that urine is cloudy
|√||Pain when urinating
|√||Wake up several times at night to urinate
|√||Pain or burning before, during, or after urinating
|√||Pass only small amounts of urine after strong urges to urinate
|√||Have a weak stream while urinating
My recommendation……… Schedule a visit to your doctor or health care professional as soon as possible. This is because some symptoms may indicate serious health problems which may include infection or even bladder cancer.
To assist you with your visit to the doctor, this article equips you with some relevant information.
What Aging Changes Occur in My Urinary Tract?
The urinary tract is made up of 2 kidneys, 2 ureters, the bladder and the urethra (the passage from the bladder to the outside of the body). The upper part of the urinary tract is made up of the kidneys and ureters, while the lower part of the urinary tract comprises the bladder and the urethra.
The kidneys filter our blood assisting with the removal of wastes and excess fluid, and they also help to control the chemical balance of the body,
Kidneys: In a healthy aging adult, kidney function continues to be normal although functioning may be affected by use of certain medicines, illness or other conditions. With aging, there is a decrease in kidney tissue, causing inability to concentrate urine as efficiently as before. Blood vessels to the kidneys can also harden with age making the kidneys filter blood more slowly.
Bladder: The capacity of the bladder is reduced and the bladder wall becomes less stretchy because of a toughening of its elastic tissue. This means that the bladder cannot hold as much urine as it previously did. Weakening of the bladder muscles can decrease its ability to contractwhich in turn can lead to having residual urine in the bladder even after you visit the washroom.
Moreover, the brain and the nervous system send and receive signals to control the bladder. Slower response time with aging also cause a slower response time between the warning signals from the brain through the nervous system to inform the bladder that it is full and needs to be emptied
Urethra: Changes in women due to aging include a reduced elasticity of the urethra and reduced sphincter muscle strength. This decline is brough about by the loss of estrogen after menopause which makes the urethra more susceptible to being colonized with bacteria (The Simon Foundation for Incontinence n.d).
These weakened muscles can cause the bladder or vagina to moveout of position (prolapse) and block the urethra.
Let’s Take A Quick 101 On Common Bladder Problems
Common bladder problems are grouped into three categories – Urinary tract infections, Lower urinary tract symptoms and Cancers in the urinary tract.
URINARY TRACT INFECTIONS (UTIs):
UTIs are commonly caused by bacteria entering and colonizing the kidneys and bladder. The tubes which connect them and the urethra are rarely infected. UTIs are one of the most common types of infection in the body (Institute of Aging 2017). Depending on where they occur in the urinary tract, UTIs may also be of three types::
Bladder infection (Cystitis): A bladder infection is the commonest type of UTI. Bacteria enter the bladder typically through the urethra and cause symptoms such as strong and sudden urges to urinate.
Bladder infection can be “Simple” or “Complicated”. Simple bladder infections affect only healthy women with normal urinary systems and are easier to treat than Complicated bladder infections (Harvard Health Publications, 2019).
If bladder infections are not treated, they can lead to kidney infections.
Kidney infection (Pyelonephritis): Once there is an Infection in the bladder, this can easily spread to the kidneys and cause severe problems. Recurring infections or infections which last a long time, may actually cause permanent damage to the kidneys.
Urethra infection (Urethritis): This is the least common of the UTIs. Infections rarely occur in the Ureters (connecting tubes).
LOWER URINARY TRACT SYMPTOMS (LUTS):
Symptoms include trouble urinating, loss of bladder control, leaking urine, and frequent need to urinate. LUTS can be caused by problems with the bladder, urethra, or pelvic floor muscles. A previous article – Incontinence in Seniors discusses this in greater detail.
URINARY TRACT CANCERS – There are two types
Bladder cancer occurs in the lining of the bladder. The most common symptom is blood in urine and it occurs more frequently in smokers (Kendal 2018) and Kidney Cancer for which the exact causes are unknown.
Key Statistics for Bladder Problems in Older Women
Statistics from the American Cancer Society (2020) seem to show that older women are generally at a higher risk than younger women in developing bladder problems, so understanding the types of problems and seeking early appropriate medical advice is important.
URINARY TRACT INFECTIONS
- UTIs are very common. Statistics show that women have a 50% risk of UTI over their lifetime and most women will have at least one UTI in their lifetime.
- If you have had a UTI before, then there is a 20 – 30 % chance that you will have a recurrence (Fu et al 2017).
- The occurrence of UTIs in elderly women depends on their living circumstance. For elderly women living at home in the community, UTIs are the second most common infection, while it is the top cause for women living in long-term care facilities and those hospitalized because of it (Matthews & Lancaster, 2011)
- Are one of the most frequent clinical bacterial infections in women, accounting for nearly 25% of all infections.
- 50–60% of women will develop UTIs in their lifetimes.
- Occur more often in women than in men, at a ratio of 8:1.
- A urinary tract infection is labeled as “recurrent” when you have three UTIs with three positive urine cultures during a 12-month period, or two infections during the previous 6 months.
- In the United States, 70-80% of complicated UTIs are linked to catheter usage, accounting for over 1 million cases per year (Flores-Mireles et al 2015)
LOWER URINARY TRACT SYMPTOMS – BLADDER CONTROL
- Urinary Incontinence is twice as common in women as in men.
- Pregnancy, childbirth, and menopause are major reasons of the increased prevalence of incontinence in women as compared to men.
- Between the ages of 18 and 44, approximately 24% of women experience incontinence.
- Approximately 23% of women aged 60 and above deal with incontinence.
- Cigarette smoking causes about 50% of all bladder cancers
- Occurs mainly in older people – about 90% of people with bladder cancer are over age 55, while the average age at the time of diagnosis is 73.
- The chance of getting bladder cancer is much higher among older women than younger women, although older women are less susceptible to bladder cancer than older men. This is probably because of the higher incident of smoking in men, and the workplace occupational hazard of exposure to toxic chemicals in the line of work of many of them.
- The chance that women will develop bladder cancer during their lifetime is 1 in 89 for women, while the chance that a man will develop this type of cancer during their life is about 1 in 27. This is over 30% lower in women (American Cancer Society, 2020)
- According to the American Cancer Society 2020, most people with kidney cancer are older. The average age of people when they are diagnosed is 64 with most people being diagnosed between the ages of 65 and 74.
- Kidney cancer is not common in younger people below the age of 45.
- Exact cause may not be known, but certain risk factors like smoking and obesity are strongly linked to the disease.
- It is about 50% more common in men than in women and it is more common in African Americans and American Indian /Alaska Natives.
- Kidney cancer is among the 10 most common cancers in both men and women. Overall, the lifetime risk for developing kidney cancer in men is higher than in women – about 1 in 46 (2.02%). The lifetime risk for women is about 1 in 82 (1.02%).
Why Are Bladder Problems in Older Women More Common?
Bladder problems are generally a common occurrence for older adults. For older women, urinary tract infections and symptoms are more common than kidney and bladder cancers.
URINARY TRACT INFECTIONS UTIs)
Older women it seems, are more likely to get UTIs because aging weakens the bladder muscles, making it difficult to fully empty (void) the bladder. This causes urine to remain longer in the bladder. When this happens, the bladder serves as a breeding ground for bacteria to grow and will most likely cause an infection.
Incomplete voiding represents the primary risk factor to UTIs and is associated with conditions such as urinary incontinence and prolapse (Stormie et al, 2019)
Weakened bladder and sphincter valve muscles make it much easier for bacteria to enter through the urethra into the bladder and upward to the kidneys. Some symptoms when this occurs include pain or a burning sensation while urinating with, in some cases, only very little urine being voided.
LOWER URINARY TRACT SYMPTOMS
Scientists have established that lower urinary tract symptoms increase in frequency with aging (Siroky, 2004) and may show different symptoms in older women. Pus may occasionally be found in the urine even when there is no infection in older adults with lower urinary tract symptoms like incontinence (Chu et al 2018)
So…. What Are My Risk Factors?
|Sexual activity can move bacteria from the bowel or vaginal cavity to the urethral opening. Urinating after sex lowers the risk of infection.|
|You had a UTI in the past|
|You have gone through menopause|
|You are obese|
|You have trouble emptying your bladder|
|You have an abnormality of the urinary tract (National Institute of Diabetes |& Digestive and Kidney Disease 2017) - only your doctor can identify this for you|
|There is an obstruction in the urinary tract such as a kidney stone|
|You have diabetes or problems with your body's immune system|
|You recently used a catheter- a tube placed in the urethra and bladder to help empty the bladder can be an entry point for bacteria into the bladder.|
Signs You May Have A Urinary Tract Infection
Note that all symptoms listed in the table below may be experienced in any one person.
|Symptoms of a UTI in the bladder may include:|
|Cloudy, bloody, or foul-smelling urine|
|Pain or burning during urination|
|Strong and frequent need to urinate, even right after emptying the bladder|
|A mild fever|
|Symptoms of a UTI that may have spread to the kidneys may include:|
|Chills and shaking|
|Feeling tired or generally ill|
|Pain in the side, back, or groin|
|Feeling flushed, warm, or have reddened skin|
|Mental changes or confusion. In some elderly people, mental changes and confusion may be the only signs of a UTI. Older adults with a UTI are more likely to be tired, shaky, and weak and have muscle aches and abdominal pain.|
|Nausea and vomiting|
|Very bad abdominal pain|
How Do I Reduce My Risk of Developing UTIs? – Prevention
It is never too late to start taking back control of your life with these preventative measures. Some of these listed measures proposed by medics may seem a bit harsh, but keep the goal insight, which is, to prevent bladder problems.
Hydration! Hydration! Hydration! Remain hydrated by drinking at least 6 -8 eight ounce glasses of water a day. If you are like me with a preference for drinking other fluids, it is recommended that you try to make half of your fluid intake water because water is the best fluid for bladder health.
Limit your consumption of alcohol and caffeinated drinks or beverages. The key word is limit and not necessarily cut out.
Maintain a healthy high fiber diet – fruits, vegetables and whole grains – to prevent constipation. Straining for bowel movement can weaken your sphincter muscles and could also result in incontinence.
Avoid bladder irritants. Avoid or eliminate any foods that irritate your bladder. Some of these may include spicy and acidic foods, caffeine, alcohol and carbonated beverages (The Simon Foundation for Continence, 2018)
Exercise regularly to maintain a healthy weight. The benefits are :
- Regular exercise will strengthen your mobility skills so you can easily reach a washroom when you have to go
- Obesity is a risk factor for UTIs. Being obese puts a strain on your entire pelvic floor area. These are the same muscles required to maintain the bladder and the sphincter valve muscles. You do not want these muscles to weaken.
Try out pelvic floor muscle exercises (Kegel exercises). The exercises help keep urine from leaking. Ask your doctor or health care provider to help you get started with these to make sure you are doing them correctly. Refer to previous article – Incontinence in Seniors for a short video.
Practice good toileting habits
- Do not hold your urine when you feel pressure to go to the bathroom, and when you do go, do not rush. Try to be as relaxed as possible to make voiding easier.
- It is recommended that you sit on the toilet (Aging Institute 2019). Now, this can be a bone for debate – hovering over the toilet seat (which many of us do in public places) makes it difficult to relax.
- My recommendation…. NEVER leave home without disposable wet wipes. These are a life saver for public washrooms.
- Always wipe from front to back after using the toilet to prevent bacteria from entering into the urethra
- Break the habit of emptying your bladder frequently – the :just in case” mentality many of us have, as this does not help the bladder to tone, because it does not stretch when filling up.
- Void regularly every 3-6 hours as this will help keep your bladder healthy (The Simon Foundation for Continence 2018)
Don’t smoke. If you are a smoker, then it is time to quit! Your incentive? Non smokers have a lower risk of developing bladder and kidney cancer. In addition, the accompanying coughing exhibited by many smokers could weaken the sphincter muscles that help in holding in urine which could in turn cause stress incontinence.
Urinate after sex to flush away bacteria that may have entered the urethra.
Wear cotton underwear and loose fitting clothes. This allows air to circulate and keep the area around the urethra dry which is not ideal for the multiplication of bacteria. Conversely, nylons and tight-fitting clothes do the opposite.
Still, on Prevention – What’s All the Hype About Cranberries and Probiotics?
Research within the NICB PubMed, as far back as 1988 (Schmidt & Sobota ) and possibly beyond, reveal that many scientists have been evaluating the success of the use of cranberry in preventing and treating UTIs. Outcome of some of these studies have been conflicting. One interesting study in 2018 (Sarshar S) presented findings on the use of extract from fruits of the celery plant to prevent bladder and kidney infection. A lot of research are ongoing.
Traditionally, the cranberry has been used to prevent recurrent UTIs among generally healthy women. Although results from a number of clinical studies have been published supporting its benefits, the efficacy of the cranberry on prevention of rUTIs remains controversial, partly because of conflicting conclusions from meta-analyses.Lista, D. J., et al. (2016).
Several studies document that cranberries help urinary tract infections, but not as juice. Cranberry juice often contains other fruit juices and added sweeteners. For grocery purchases of cranberry juice that provides the most benefit, check the label to ensure that cranberry is listed as the primary ingredient.
Cranberry extracts taken as supplements may help to prevent development of UTIs. This is because the extract has an anti adhesive effect preventing the infecting bacteria from sticking to the walls of the urinary tract as determined by several studies including a recent one by Scharf B et al (2020).
Additional clinical trials, involving large numbers of patients are required to provide definite evidence of the preventive and curative role of probiotics in UTIs (Turgay & Tolga 2018).
Treatment of Bladder Problems in Older Women
You must consult with a doctor or health care professional and get them to conduct a thorough analysis so they can recommend appropriate treatment. Your visit to the doctor will involve questioning, examination and a urine test to evaluate your condition, so be prepared.
Most UTIs are not serious, but some can lead to serious problems especially when they affect the kidneys.
Recurrent or long-lasting kidney infections can cause permanent damage or become life threatening. Recurrent urinary tract infections are a challenge to treat because the main treatment option is long-term use of antibiotics. This of course poses a risk to having the bacteria developing resistance.
Generally, treatment for bladder problems may require medication, exercises, many of the behavioral and lifestyle changes described in the preventative measures section above, surgery, or sometimes a combination of these treatments.
Because most urinary tract infections are caused by bacteria antibiotics are the usual treatment for UTIs. The type of antibiotic and length of treatment will depend on the patient history and the type of bacteria. The full dose of antibiotics must be taken to prevent the risk of antibiotic resistance by the bacteria.
Drinking lots of fluids and urinating often may also speed healing. Painkillers can relieve the pain of a UTI if required. A heating pad on the back or abdomen may also help.
Treatment of bladder or kidney cancer will depend on the level of invasiveness and will require medical expertise.
Bladder problems in older women are common but is not as common in older men. This guide has tried to provide you with some topical information to help you maintain a good quality life.
There is no need to be embarrassed about occurrence of any type of bladder problem. I learned a lot while researching this article and hope that through sharing, I have been able to enhance your understanding.
Leave a comment below if you have any personal experience to share related to this article. I would love to hear about it.
1. National Institute on Aging (2017) Bladder Health for Older Adults .https://www.nia.nih.gov/health/bladder-health-older-adults
2. The Simon Foundation for Continence (n.d) Bladder Health and Aging https://simonfoundation.org/resources/education-materials/
3. Ahmed Al-Badr & Ghadeer Al-Shaik (2013) Recurrent Urinary Tract Infections Management in Women – A review
Sultan Qaboos Univ Med J. Aug; 13(3): 359–367. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3749018/
4. Matthews SJ & Lancaster JW (2011). Am J Geriatr Pharmacother. 9(5):286-309.Urinary tract infections in the elderly population.https://www.ncbi.nlm.nih.gov/pubmed/21840265
5. Flores-Mireles et al (2015) Urinary tract infections: epidemiology, mechanisms of infection and treatment options https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4457377/
6. U.S. Department of Health & Human Services – Office of Population Affairs (2020) Urinary Tract Infection (UTI) https://www.hhs.gov/opa/reproductive-health/fact-sheets/urinary-tract-infections/index.html
7. Urinary Tract Infections – World Health Organization https://www.who.int/gpsc/information_centre/cauda-uti_eccmid.pdf
8. American Cancer Society (2020) Key Statistics About Kidney Cancer – 2020 https://www.cancer.org/cancer/kidney-cancer/about/key-statistics.html
9. American Cancer Society (2020) Key Statistics About Bladder Cancer – 2020 https://www.cancer.org/cancer/bladder-cancer/about/key-statistics.html
10. Bladder Cancer Risk Factors. Cancer Treatment Centers of America (2020) https://www.cancercenter.com/cancer-types/bladder-cancer/risk-factors
11. Mantzorou M & Giaginis C.(2018) Cranberry Consumption Against Urinary Tract Infections: Clinical State of- the-Art and Future Perspectives.Curr Pharm Biotechnol. 19(13):1049-1063 https://www.ncbi.nlm.nih.gov/pubmed/30520372
12. Hisano M et al (2012) Cranberries and lower urinary tract infection prevention Clinics (Sao Paulo) Jun; 67(6) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3370320/
13. Schmidt D.R & Sobota A.E (1988) An examination of the anti-adherence activity of cranberry juice on urinary and non urinary bacterial isolates. Microbios. 55(224-225):173-81.https://www.ncbi.nlm.nih.gov/pubmed/3063927/
14. Flores-Mireles AL et al (2015) Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol.13(5):269-84 https://www.ncbi.nlm.nih.gov/pubmed/25853778
15. Scharf B et al (2020) Anti-adhesive natural products against uropathogenic E. coli: What can we learn from cranberry extract? J Ethnopharmacol. Apr 18;257:. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/32311481
16. Sarshar S (2018) Anti-adhesive hydro alcoholic extract from Apium graveolens fruits prevents bladder and kidney infection against uropathogenic E. coli. Fitoterapia. Jun;127:237-244.https://www.ncbi.nlm.nih.gov/pubmed/29496563
17. Lista, D. J et al. (2016). Cranberries and urinary tract infections: How can the same evidence lead to conflicting advice? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4863270/
18. Ware M (2019) What to know about cranberries. Medical NewsToday https://www.medicalnewstoday.com/articles/269142#nutrition
19. Turgay A.& Tolga K (2018) The role of probiotics in women with recurrent urinary tract infections. Turk J Urol. 44(5): 377–383 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6134985/