[5 MIN READ]
In this article:
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Bladder and bowel health has a big impact on the quality of life for women as they age.
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Don’t be afraid to talk to your doctor about incontinence. Nothing you can say will surprise them.
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We give you 5 questions to ask that can help you get the treatment that’s right for your age and lifestyle.
Many of us don’t like to talk about bladder and bowel issues. In fact, we don’t even want to think about them. Why? They’re uncomfortable, and even worse, they can be painful and debilitating. In addition, it can feel embarrassing to bring them up – especially to a friend, or a doctor that you don’t see very often. In fact, it is estimated that only 15% of women suffering from fecal incontinence discuss it with their doctor. And for women suffering from urinary incontinence, it may take them an average of seven years to address it.
Women are more likely to experience bladder incontinence than men, and some of the causes of bowel incontinence — like vaginal childbirth — only impact women. And because many people consider bladder and bowel issues an inevitable consequence of childbearing, hormone fluctuations, and aging, many women tend to ignore them while trying to fulfill all of the other responsibilities of their busy lives.
But bladder and bowel problems often become more severe over time, especially with hormonal changes that happen after the age of 40, causing emotional and physical distress. The good news is that most incontinence issues are treatable and manageable. And even some of the most advanced treatments and procedures can be done quickly with minimal downtime, getting you on the way to feeling better faster.
It’s important for women to establish a relationship with their primary care provider. They don’t need to be shy about reporting any and all symptoms, says Melanie Santos, MD, FACOG, FPMRS, medical director of pelvic health for St. Jude Medical Center in Fullerton, California. Santos is a urogynecologist who specializes in treating women with incontinence and other pelvic floor disorders. In past articles, she has emphasized how, through open conversations with their doctors women can manage their heart health along with other conditions that come with aging.
Don’t fear the incontinence conversation
Ignoring the signs and symptoms of incontinence can eventually lead to major disruptions in your quality of life. Incontinence can trigger feelings of fear, anxiety and anger. If you are afraid that you won’t be able to control your bladder or bowels, you might avoid the things that bring you joy in life, like intimacy, physical activity, travel and hobbies that take you outside the home.
But many things can contribute to incontinence, from surgery and medications to hormone changes and diet. Incontinence can impact anyone, and it isn’t your fault. And because it’s so common, your doctor has likely helped many patients figure out how to manage it. So while talking about it can feel embarrassing at first, being open and honest with your doctor will help you get the relief you need.
Don’t ignore the signs and causes of incontinence
How to recognize and get help for bladder problems
Bladder incontinence or urinary incontinence is the leaking of urine. Sometimes it’s temporary, but it can also be long-term, making everyday activities challenging.
People often describe bladder incontinence as:
- Accidental leaks that dampen underwear or saturate clothes, sometimes due to laughing, sneezing or activities like running or jumping
- Feeling like you can’t hold your urine
- Feeling like you urgently need to urinate
- Frequent urination
- Painful or uncomfortable urination
There are certain conditions, health milestones, and medical treatments that can increase the risk of bladder incontinence as women age, like:
- Changes to vaginal and urinary or vaginal tissue caused by chemotherapy, hormone therapy, surgery or targeted therapy
- Common diseases like diabetes and constipation
- Less common medical conditions including Parkinson’s, multiple sclerosis, stroke or spinal cord injury
- Frequent urinary tract infections (UTIs)
- Hormonal changes associated with menopause
- Hysterectomy
- Pelvic prolapse and weak pelvic wall muscles
- Pregnancy and especially vaginal childbirth
When you talk to your doctor about your bladder incontinence, they might be able to recognize the cause right away, or they might recommend testing to verify the cause and type.
Once you and your doctor know what’s causing the incontinence, there are a variety of simple treatments that can help. Some may even be combined, like:
- Incontinence products, such as pads, absorbent undergarments and absorbent bedding
- Training your bladder by assigning specific time intervals to use the bathroom
- Pelvic floor muscle strengthening (also called Kegel exercises)
- Medicines that support your bladder and the muscles that control urine flow
- Surgery for long-term incontinence, including removing blockages, injecting compounds to tighten bladder muscles, or implanting devices that help control urine flow
How to recognize and get help for bowel problems
Bowel incontinence is the accidental or uncontrollable leaking of stool or gas. People with bowel incontinence often describe it as:
- Being unable to control gas or stool
- Feeling a sudden urge to have a bowel movement
- Liquid stool or mucus leaking onto their undergarments
Just like urinary incontinence, there are certain risk factors that make it more likely for women to experience bowel incontinence, including:
- Vaginal childbirth
- Menopause
- Bowel disorders like constipation and diarrhea
- Common diseases like diabetes
- Less common medical conditions including Parkinson’s, multiple sclerosis, stroke or spinal cord injury
- History of anal trauma, surgery, or radiation therapy
Vaginal deliveries can tear, stretch or weaken the anal sphincter muscles that control bowel movements. Vaginal childbirth can also injure the nerves that control these muscles. And with multiple vaginal deliveries, prolonged labor, or a vaginal delivery that requires forceps or a vacuum device, the risk of bowel incontinence increases.
Frequently, the muscle injuries that happen during childbirth aren’t serious enough for you to notice bowel issues right after your baby is born. Some women don’t experience issues for decades after delivery until their hormones start fluctuating during menopause.
During menopause, your estrogen levels drop. Estrogen is an essential hormone that helps maintain muscle strength and mass, and it also regulates the production of collagen production, which strengthens connective tissues. With less estrogen, all of the muscles in your body weaken, including the pelvic floor muscles, increasing your chances of developing bowel incontinence.
A change in bowel habits can also signal a digestive issue or other serious health problem. This is why it is important to keep track of when and how changes have occurred and how often it happens. This can help your doctor identify whether you need to be referred to a specialist or recommend different types of treatment.
If you start to experience changes in your bowel movements or bowel incontinence, talk to your health care team. To help diagnose you and identify the cause of your incontinence they may recommend diagnostics like:
- A pelvic and rectal exam
- Lab studies
- Imaging studies such as MRI or ultrasound
- Bowel functional testing
- Colonoscopy and other endoscopies
Once you are diagnosed and the cause of your bowel incontinence is identified, your treatments and care plan might include:
- A bowel care plan to regulate your bowel movements
- Dietary changes and food journaling
- Consulting with a registered dietitian or gastrointestinal specialist
- Pelvic floor muscle strengthening, such as Kegel exercises
- Medications, both over-the-counter and prescription
- Surgery for long-term incontinence, injecting compounds to tighten anal sphincter muscles, repair of damaged anal sphincter muscles, or implanting devices that help control bowel emptying
Ask questions and get treatment that’s right for where you are in life
With so many causes and options for treatment, there is no one right way to manage bladder and bowel problems. To make sure you get the care you need, ask your doctor:
- What underlying health issues might be causing my incontinence?
- What are my treatment options?
- Will the treatments have side effects?
- Are there any dietary or lifestyle modifications that will help?
- How quickly will my symptoms improve?
With your doctor’s help, you can find solutions that will help you get back to enjoying your life. If you notice a change in your bladder or bowel habits, reach out to your health care team right away so you can work together to address the issues and keep them from getting worse.
Find a doctor
Your doctor can connect you to care and treatments for incontinence that can improve your quality of life. If you are looking for a primary care doctor, you can search for one who’s right for you in our provider directory.
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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.
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