Is urinary incontinence normal in old age? Don’t suffer in silence, there are many ways to treat it!

Author: Gao Guolan, Chief Physician, West China Second Hospital, Sichuan University

Reviewer: Lin Guole, Chief Physician, Peking Union Medical College Hospital

There is a disease that seriously affects daily work and life. Its incidence rate increases significantly with age and gradually evolves into a social problem that cannot be ignored. It is urinary incontinence.

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Unfortunately, many elderly women regard urinary incontinence as a natural part of the aging process, lack sufficient attention, and even choose to endure it in secret and avoid seeking medical treatment because they are too embarrassed to talk about it. As a result, most patients can only endure it in silence, which has an adverse impact on their physical and mental health.

1. Why are middle-aged and elderly women prone to urinary incontinence?

After women enter menopause, their ovaries fail and cannot secrete estrogen, causing a drop in hormone levels, which can lead to atrophy of the pelvic floor muscles, thinning of the vaginal mucosa, weakening of the bladder detrusor and urethral sphincter functions, making them more susceptible to various urinary incontinence.

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If women do not receive proper pelvic floor muscle rehabilitation training or treatment after giving birth during their childbearing years, they will be at a higher risk of urinary incontinence after menopause as hormone levels decrease.

If urinary incontinence is not diagnosed and treated in time, repeated urine leakage may cause vulvar and vaginal infections, increase secretions, and increase the risk of cervicitis and pelvic inflammatory disease through retrograde infection. In severe cases, it may also lead to symptoms such as chronic pelvic pain and lower abdominal discomfort. Due to the impact of urinary incontinence, some patients may avoid going out and social activities, which not only affects the quality of life, but may also lead to psychological problems such as depression and anxiety.

In fact, there are many effective treatments for urinary incontinence now, and patients do not have to suffer in silence. Some hospitals have special urinary incontinence clinics, or you can seek help at the gynecology clinic, where the doctor will take a detailed medical history and conduct professional examinations. Treatment plans usually first address the cause and then aim to restore the function of the pelvic floor muscles. Treatments include physical rehabilitation therapy, including electromagnetic and radiofrequency technology, conservative treatment with drugs, and surgical treatment.

2. What are the conservative treatments for urinary incontinence in middle-aged and elderly women?

For treatment of the cause, such as urinary tract infection and stones, urology professional anti-infection, lithotripsy, and stone removal treatments are required.

In the case of weakened pelvic floor muscle function, pelvic floor muscle training can be used to restore its function. The most commonly used training method is Kegel exercise, which is an exercise performed by contracting and relaxing the pelvic floor muscles. Another method is biofeedback therapy, which monitors the electrical signals or muscle strength of the pelvic floor muscles with the help of a machine, so as to perform more precise pelvic floor muscle training. In addition, there are electrical or magnetic stimulation treatments, which are suitable for patients whose pelvic floor muscles are very weak and have difficulty in performing pelvic floor muscle training on their own. This treatment method stimulates local muscle and nerve tissue in vitro, prompting the muscles to passively contract, gradually improving the function of the pelvic floor muscles and nerves, and thus gradually restoring the ability to control urination.

Kegel training, biofeedback therapy and electromagnetic stimulation therapy are all painless treatments for the pelvic floor muscles and bladder and urethra autonomic nerves, with significant results. After receiving treatment in the hospital, patients can continue pelvic floor muscle training at home according to the doctor's instructions.

For female urinary incontinence, conservative treatment is sufficient in most cases, and only a few cases require combined drug treatment. For example, for patients with frequent urination, urgency, or overactive bladder, oral medications can be used to improve symptoms. However, in general, the effect of drug treatment is limited and not as significant as physical therapy. For urinary incontinence that occurs during menopause, if other causes have been ruled out and it is believed to be caused by decreased hormone levels, estrogen can be applied locally for treatment under the guidance of a doctor.

3. In what cases of urinary incontinence in middle-aged and elderly women do they need surgery?

Urinary incontinence is often accompanied by pelvic organ prolapse, and most women with urinary incontinence will have a certain degree of pelvic organ bulging. For mild to moderate prolapse, conservative treatment can be used; but if the prolapse reaches a severe level, such as most of the uterus prolapses outside the vaginal opening, surgical treatment needs to be considered. For moderate to severe urinary incontinence combined with pelvic organ prolapse, surgical intervention is usually required. In addition, if conservative treatment is ineffective, or there is a defect or damage to the internal urethral sphincter, surgical repair is required.

Early and timely treatment of urinary incontinence can achieve good results, and the treatment effect is often closely related to the patient's age. For younger women, due to their better tissue repair ability, the recovery speed after treatment is relatively fast, and timely and standardized treatment can usually achieve a radical cure. Even if the condition is very serious, it can be improved through surgical treatment. Even if the treatment is successful, you should try to avoid weight bearing and reduce chronic pressure on the pelvic floor muscles to prevent recurrence or aggravation of urinary incontinence. If you do not pay attention to improving your lifestyle, urinary incontinence may still recur or worsen.