Urinary Problems Are Too Common In Midlife Women (2022)

When you leave your home to go out shopping or meet up with friends, do you find yourself mentally mapping out where and how fast you’ll be able to find a bathroom in case you suddenly and urgently need to pee? You may just chalk it up to yet another unpleasant side effect of getting older — and, in a way, you’d be right.

A new study published on December 15, 2021, in Menopause, the journal of The North American Menopause Society (NAMS), found that women ages 45 to 54 years old are more likely to have overactive bladder (OAB) syndrome.

“The prevalence of overactive bladder increases with age through menopause and beyond — it’s something that’s really, really common,” says Jennifer Wu, MD, MPH, a researcher and specialist in urinary incontinence and professor at the UNC School of Medicine in Chapel Hill, North Carolina.

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Stress Urinary Incontinence, Overactive Bladder Are the 2 Main Types of Urinary Incontinence

In general, there are two main types of urinary incontinence, explains Dr. Wu. “Stress urinary incontinence (SUI) is when you experience leakage when coughing, sneezing, or exercising. The other type is overactive bladder (OAB), of which there is wet or dry,” she says.

Wet Overactive Bladder vs. Dry Overactive Bladder: What's the Difference?

“Dry type” is when you have urgency where you really have to go to the bathroom and it’s difficult to wait, but you don’t leak, and then there’s “wet type,” where you also have the really strong urge but you can’t make it to the bathroom in time and do have urine leakage, says Wu.

“If you have both of those kinds, it’s called mixed,” she adds.

Survey Asked Women About How Often They Need to Pee, Wake Up to Pee

To investigate the prevalence and factors that may influence urinary symptoms, investigators used cross-sectional data from 12,198 women enrolled in the Japan Nurses’ Health Study (JNHS), a prospective cohort study among female nurses.

The cross-sectional survey in the present study was part of the JNHS, which is an ongoing cohort study of female nurses in Japan, established in 2001. Participants responded to the baseline survey, and every two years information was collected on lifestyle habits, disease history, reproductive health, and medication use. Participants in the JNHS were from all 47 prefectures in Japan and most were currently employed as registered nurses, licensed practical nurses, public health nurses, or midwives who were at least 25 years old (the average age of participants was 46) and lived in Japan at the time of the baseline survey.

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Participants were asked: ‘‘During the past month, how much influence on your daily life do you feel urinary problems have had?’’ and “What symptoms have affected your daily life?’’

These general questions were followed by more detailed items describing symptoms that participants agreed or disagreed with, such as:

  • I have urinated frequently during the day.
  • I have woken up to urinate.
  • I have suddenly needed to urinate, and it has been difficult to wait.
  • I have been unable to wait to urinate and I have experienced urine leakage.
  • I have experienced urine leakage when coughing or moving my body.

Age, body mass index (BMI), smoking status, history of diabetes mellitus, history of hysterectomy, and menopausal status were also collected.

Researchers used odds ratios to determine the odds for OAB, stress urinary incontinence, and mixed urinary incontinence.

Risk Factors Linked to Overactive Bladder, Other Urinary Problems

  • The study found a significant association of OAB in women aged 45 to 54 years and postmenopausal status.
  • Stress urinary incontinence (SUI) symptoms were shown to increase as a result of a high body mass index and the number of times a woman has given birth.
  • Other factors studied, including smoking status, history of diabetes, hysterectomy, and the use of hormone therapy (HT), were not found to be associated with urinary incontinence.

Leaking Urine, Urgent Need for a Toilet, and More: Bladder Problems Are Very Common

“For me, the biggest takeaway of this study was the huge percentage of women who are having symptoms of all the different types of incontinence,” says Stephanie S. Faubion, MD, the director of the Center for Women’s Health at the Mayo Clinic in Rochester, Minnesota, and the medical director of The North American Menopause Society (NAMS).

“While this study doesn’t necessarily show us anything new or completely novel, it does bring awareness to a problem that is not small. In the age range where incontinence was most prevalent, women ages 50 to 54 years old, 18.2 percent are having SUI, another 12.6 are having OAB, and another 3 percent are having mixed; that’s a huge percentage of women,” she says.

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Across all age groups, 19 percent were having some type of incontinence, also a large number of women, notes Dr. Faubion.

“That took my breath away. This is a huge quality of life issue and there are a ton of dollars spent on this,” she says. Although this study looks at Japanese nurses, the findings would likely translate very well to the overall population, she adds.

“The obesity epidemic is contributing significantly to the prevalence of stress urinary incontinence because that’s a major risk factor. I think it could also be associated with a lot of other things that we’re not taking into account here,” says Faubion.

What About Hormone Therapy and Urinary Incontinence Symptoms?

There weren’t enough women receiving hormone therapy (HT) for the authors to draw conclusions about its impact, notes Faubion. “It would have been nice to be able to determine the effect of hormone therapy although as the authors mention, systemic hormone therapy has not been shown to help with urinary incontinence — if anything it has been implicated in worsening it,” she says.

Topical estrogen, such as a vaginal estrogen cream, has been shown to be helpful in urge incontinence, and so it would be helpful to have research to provide further clarification of this, says Faubion.

Overactive Bladder and Stress Incontinence Can Hurt Quality Of Life

“Urinary incontinence can impact relationships and sexual functioning. Women are often afraid they’re going to leak during sex. I think the impact on quality of life in sexual functioning is underestimated,” she says.

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“Some women don’t want to leave the house because they are afraid that they are going to have an accident. Many women can’t participate in their normal activities, and it also makes it hard to travel or socialize,” says Wu.

Many Are Embarrassed About Symptoms; Urinary Incontinence Often Goes Undiagnosed

Research studies have shown that there are a lot of women out there who are suffering from incontinence who do not seek care, says Wu. “That’s because it can be really embarrassing to talk about these symptoms, to divulge to your provider that you’re leaking urine and wearing pads and that it bothers you,” she says.

“Women often resort to all sorts of workarounds to deal with incontinence rather than address the issue with the provider,” says Faubion. This can include wearing menstrual pads instead of urinary pads, or perfumed pads, which can irritate the vulva, she says.

“The question is, can we be doing more and asking women about their symptoms starting in the perimenopausal age range so we can help women stay dry,” says Faubion. Both Wu and Faubion agree that more providers need to be screening for urinary leakage issues during visits.

“It’s really important for your provider to work with you to figure out the kind of leakage a you are suffering from so they can tailor the management appropriately,” says Wu.

Besides Prescriptions or Pills, Lifestyle Changes May Help Ease Urinary Incontinence Symptoms

Because stress incontinence is associated with higher BMI, trying to achieve a healthy weight may help improve it, says Faubion. “Pelvic floor strengthening exercises are also good for helping with stress incontinence.”

It’s harder to know how to prevent OAB, says Wu. “There does appear to be certain foods and drinks that can exacerbate symptoms — caffeinated drinks, so coffee, tea, sodas, alcohol. Sometimes we think spicy or acidic foods can make OAB symptoms worse, and so avoiding or limiting those drinks and foods may help,” she says.

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