The ageing bladder
The phrase, the ageing bladder, sounds rather negative and implies incontinence in the elderly. But while ageing is associated with many changes in the bladder which can increase the risk of dysfunction, it is not by itself a determining factor of urinary incontinence.
As we age we can experience changes in our pelvic floor which causes changes in bladder activity. This, combined with other problems, may cause changes in urinary activity. But those changes do not necessarily cause urinary incontinence and it should not be accepted as a “normal” part of ageing.
The pelvic floor is a sheet of muscle which holds and supports your bladder and bowel. People with spina bifida often have loose pelvic floors, because the nerves to the pelvic floor muscle, from the sacral part of the spine, are affected. Good pelvic floor tone helps maintain continence by holding the bladder neck in a muscular sling which helps it stay closed. When the pelvic floor is ineffective, urine can leak out more easily when the pressure in the abdomen is raised, such as sneezing and coughing, or during excercise. This is called ‘stress incontinence’.
Pelvic floor excercises can be helpful for the general population, and need to be taught properly by a specialist physiotherapist. If you have spina bifida, the physiotherapist would need to check out which nerves were working before starting a course of treatment. This is because if the nerves don’t work, the excercises won’t be possible.
Adults with spina bifida may find their continence changing as they enter middle age; tethered cord and general ‘wear and tear’ on the vertebrae and nerves may affect bladder function. The pelvic floor is very often damaged during childbirth, which causes continence issues for many women in their middle years. Women with spina bifida who have reasonable continence might want to consider a Caesarian to prevent this damage. It is important to exercise as much as possible, keep your weight under control, and avoid caffeinated drinks which increase the need to urinate.
Any changes need to be investigated, to ensure the kidneys stay healthy, but there may well be ways of managing your bladder which can improve your quality of life. Botox injections into the bladder have been found to help many people with frequency and urgency of urine, by relaxing the bladder muscle and increasing how much your bladder can hold. Operations such as augmentations also make the bladder bigger (the operation sometimes causes shunt problems though)
If the bladder is no longer emptying completely, or you are getting a lot of urine infections, ask your GP to refer you to a Urologist with an interest in spina bifida, as intermittent catheterisation might help.
If you are on medication for your bladder, the dose may need to be changed from time to time, as the way your kidneys and liver deal with them may alter over the years.
All medications have side effects, and many medications cause constipation, increased urination, or urgency, and may lead to incontinence. A good plan of care needs to be created by using all information about health, diet, exercise, and medications. The treatment plan may include medication changes, behavioural therapy, or more supportive care, surgical intervention or the use of pads or absorbent pads.
In days gone by, many people accepted that leaking urine was a natural part of getting older, and just ‘put up’ with it. They were also too embarrassed to bring it up with their GP, so didn’t get the support or treatments which could have improved their quality of life. People with spina bifida often, but not always, have continence issues, and may be familiar with treatments and services available to them. However, their needs may change as the years pass, and treatments are improving all the time. It’s always a good idea to keep in touch with your continence service, as you may be missing out on something really useful. And if continence begins to be a problem for the first time, do discuss it with your GP, there are services that can help.
If you are finding it physically harder to get to the “loo” in time, an Occupational Therapist may be able to advise on equipment and adaptations to help at home. RADAR also operate a key scheme to let you use accessible toilets when you are out. Incontinence of urine can also be a sign of Normal Pressure Hydrocephalus. If it develops together with difficulty walking and confusion or forgetfulness, discuss this with your GP, as it is often treatable.
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Coloplast and ASBAH are working in partnership to campaign for an increased awareness of bladder and bowel health and to support ASBAH’s members and families in their efforts to live a full and satisfying life.