Frailty is a sneaky beast, encompassing a state of low energy, weakness, and inactivity that can creep in slowly with age. But even before that trajectory begins, you could be dealing with a subtle risk factor, particularly if you’re a woman: urinary incontinence, or loss of bladder control.
Pee leakage is twice as common in women versus men—affecting up to 60% of women in the US—because of factors like pregnancy, childbirth, and the hormone changes of menopause. All of the above can have trickle-down effects on the pelvic floor and bladder.
No matter the trigger, unexpected leaks can hinder your ability to stay active as you age. The result is a faster track to frailty: “The less you move, the less you’re going to be able to move,” Karyn Eilber, MD, a Los Angeles–based urogynecologist and member of the PlusOne wellness collective, tells SELF. And becoming frail doesn’t just increase your risk for a disabling fall; it makes you likelier to get sick or even die younger.
Read on to learn why urinary incontinence can contribute to frailty with age and how to get ahead of the downward spiral.
How pee leakage can increase your risk of frailty later in life
There are two main types of urinary incontinence, which can have various effects on your strength as you age. Stress urinary incontinence (SUI) involves dribbling when you laugh, cough, or jump. It happens when weak or damaged pelvic floor muscles or ligaments buckle under pressure, Dr. Eilber explains. In some cases, that pelvic muscle collapse can stem from tightness: “With constant gripping, you lose the coordination of those muscles, then gradually, they weaken,” Patty Beers, PT, DPT, a physical therapist and clinic director at Hughston Clinic, in Orlando, tells SELF.
By contrast, urge incontinence, or overactive bladder (OAB), is when you have to pee very frequently and urgently at unexpected times, Savitha Krishnan, MD, a urogynecologist and pelvic floor reconstructive surgeon at Palo Alto Medical Foundation, tells SELF. It spikes in prevalence in women over 60 because it’s tied to age-related neurological changes and shifts in bladder tissue caused by the estrogen loss of menopause, she says.
Where either kind of incontinence can spell trouble for long-term strength is in restricting mobility: If OAB threatens leakage at any given moment, you probably don’t want to stray far from a bathroom. And if SUI causes dribbling while running or jumping, for instance, “you’re going to be less inclined to engage in high-impact exercise,” Dr. Eilber says, which is a crucial type for maintaining muscle and bone mass with age.
The pelvic floor dysfunction underlying SUI can also have a negative impact on surrounding muscles: “If you have pelvic floor weakness, I can basically promise that you also have weakness in your glutes,” Dr. Beers says. Less leg strength means poorer balance and stability, she notes, all of which can up your frailty risk.
With OAB, specifically, “there’s a big risk for social withdrawal,” Dr. Krishnan points out. Not being able to predict when you might have to pee “makes it difficult to go to social gatherings because of the potential for an embarrassing accident,” she explains. Besides limiting activity, being socially isolated can harm your mental health and, in turn, your cognition, Dr. Krishnan says, which can speed up physiological decline too.
Also with OAB often comes the need to wake up multiple times throughout the night to pee, which is a common cause of hip fractures, Dr. Krishnan points out: “Women rush to the bathroom in the dark, and they slip, fall, and break a bone.” This kind of mobility-limiting injury can also initiate your descent into frailty.
How to avoid or resolve pee leakage—and lower your chances of becoming frail
Occasional leakage is often treated as an inevitable, albeit annoying, fact of life for women, particularly after having kids. But what all the experts emphasize is, plenty can be done to prevent incontinence—yes, even if you’re planning on a vaginal birth—and to treat it.
“We know from countries like France and Japan, where pelvic floor training is common before and during pregnancy, that when you strengthen the pelvic floor, there’s less need for intervention for stress urinary incontinence,” Dr. Krishnan says. And that makes sense: Muscles bounce back better from injury when they’re stronger beforehand, Dr. Eilber says.
But before you go ham on Kegels, make sure you know how to flex your pelvic floor effectively. Dr. Beers suggests tapping into these muscles with deep diaphragmatic breaths: “Think of inhaling into your pelvic floor until you can feel your vagina lengthen, and then when you exhale, contract that muscle like you’re lifting up a marble.” Once you have that motion down, working Kegels into your routine is a great preventative tactic (so long as you don’t feel pain—in which case it’s best to work with a pelvic floor physical therapist).
Other steps to lower your chances of developing incontinence include maintaining a healthy body weight (to avoid extra pressure on your pelvis) and resolving any constipation so you don’t have to strain to poop, which can stress out the pelvic floor, Dr. Eilber says.
Still, even with careful prevention, you might wind up with SUI as a result of, say, giving birth to several larger-than-average babies, or simply because of the anatomical realities of aging. And urge incontinence can be especially tricky to prevent because doctors don’t know exactly what drives the bladder and nerve changes underlying it, Dr. Krishnan says. If you’re in or nearing menopause, vaginal estrogen may be part of the solution—it can plump up the tissue surrounding the urethra to help with any kind of leakage, Dr. Krishnan says.
There are also medical interventions for each type of incontinence, which Dr. Krishnan wishes more women were aware of. When it comes to SUI, there are pessaries, or small rubber devices. They’re placed in the vagina before high-impact activities to help keep the urethra closed. Other options include minor procedures like urethral bulking (adding filler to the urethra) and the insertion of a midurethral sling (a thin mesh hammock under the urethra). And for OAB, there are medications like beta-3 agonists, which relax the muscle lining the bladder, as well as a variety of in-office treatments like bladder Botox and nerve stimulation.
Too often these incontinence solutions are presented as “elective” if they’re mentioned at all, and women resort to buying pads and adult diapers, Dr. Krishnan says. “But the reality is, intervening earlier can improve quality of life so significantly, and keep women engaged and active, so that they don’t lose muscle mass or wind up isolated or frail.”
Related:
- A 25-Minute Pelvic Floor Workout for Postpartum and Beyond
- Why the ‘Vagina Whisperer’ Is Begging You to Stop Power Peeing
- 10 Expert-Approved Ways to Strengthen Your Bladder Control
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