Dear Dr Mitchell,
Does incontinence in old age have anything to do with the number of children a woman has had? Is it that women who have multiple children are more likely to have incontinence? Is there anything that can be done about this while a woman is still young? Or are we doomed to be incontinent as a natural part of ageing?
Urinary incontinence is a common problem in women and tends to be even more common as you get older. Urinary incontinence tends to be seen in women who have reached the menopause. This may be due to several factors which include trauma to the pelvic floor at the time of vaginal delivery, low oestrogen levels as you become older, obesity with excessive belly fat, chronic cough, smoking, and diabetes mellitus.
Women who have a lot of babies and especially with each pregnancy close together, are at an increased risk of damage to the pelvic floor and urinary incontinence. Women who have big babies and those who push for a prolonged period of time, or end up with vacuum or forceps delivery, are at an increased risk of damage to the pelvic floor muscles and this results in pelvic floor prolapse with associated urinary incontinence. Women who have had rapid deliveries (precipitous labour) can also have pelvic floor damage with associated urinary incontinence.
With the onset of menopause, oestrogen levels fall off dramatically and this causes weakness of the muscles of the pelvic floor, resulting in weakness of the muscles supporting the bladder, and manifesting itself with incontinence of urine. Anything that causes an increase in pressure on the pelvic floor muscles or damages the nerve supply to the pelvic floor can result in urinary incontinence.
It is important to lose weight and achieve your ideal weight for height to reduce the risk of incontinence. Women who have diabetes mellitus that is poorly controlled are also at increased risk since there is damage to the nerves that supply the pelvic floor and bladder with resultant urinary incontinence. Proper control of diabetes mellitus reduces this risk.
Treating chronic cough, emphysema, and avoidance of smoking will definitely reduce the risk of pelvic floor damage and incontinence.
Urinary incontinence may also be due to a urinary tract infection so this should be ruled out before assuming that the only problem is a weak pelvic floor. A urine culture or urinalysis can be readily done and treatment undertaken if an infection is present. Kegels (pelvic floor exercises) can help to strengthen the muscles of the bladder and reduce incontinence. If there is significant pelvic floor prolapse, a ring pessary can be inserted in the vagina by your gynaecologist to restore some support until definitive surgery can be done, or it can be used as a long-term measure to reduce prolapse and urinary incontinence. It has to be cleaned and reinserted every three months by your doctor to reduce the risk of infection and ulceration of the vaginal walls.
The use of oestrogen vaginal cream may also help to improve the strength of the vaginal walls and reduce the risk of thinning and ulceration of the walls.
Women are not doomed to urinary incontinence with ageing. It is, however, important to recognise that your body will change as a result of childbirth and the natural ageing process. Controlling your weight by managing medical conditions such as diabetes mellitus will significantly reduce the risk of urinary incontinence as you age gracefully.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to email@example.com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 876-968-2025. All responses are published. Dr Mitchell cannot provide personal responses.
The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.