Frailty is a condition characterized by low energy, weakness, and inactivity that can develop slowly with age. For women, a subtle risk factor for frailty is urinary incontinence, or loss of bladder control, which affects up to 60% of women in the US.
This condition is twice as common in women as in men, due to factors such as pregnancy, childbirth, and hormone changes during menopause, which can have a negative impact on the pelvic floor and bladder.
How Urinary Incontinence Contributes to Frailty
Unexpected leaks can hinder a woman’s ability to stay active as she ages, resulting in a faster decline into frailty, according to Karyn Eilber, MD, a Los Angeles-based urogynecologist. Becoming frail increases the risk of disabling falls, illness, and even premature death.
There are two main types of urinary incontinence: stress urinary incontinence (SUI) and urge incontinence, or overactive bladder (OAB). SUI involves dribbling when laughing, coughing, or jumping, while OAB is characterized by frequent and urgent need to pee at unexpected times.
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SUI can be caused by weak or damaged pelvic floor muscles or ligaments, while OAB is often tied to age-related neurological changes and shifts in bladder tissue caused by estrogen loss during menopause, according to Savitha Krishnan, MD, a urogynecologist and pelvic floor reconstructive surgeon.
Both types of incontinence can restrict mobility, as women may avoid activities that trigger leaks or limit their social interactions due to embarrassment, leading to social withdrawal and increased risk of frailty.
The pelvic floor dysfunction underlying SUI can also have a negative impact on surrounding muscles, such as the glutes, leading to poorer balance and stability, according to Patty Beers, PT, DPT, a physical therapist and clinic director.
With OAB, the need to wake up multiple times at night to pee can increase the risk of hip fractures, as women may rush to the bathroom in the dark and slip or fall, initiating a decline into frailty.
Experts emphasize that plenty can be done to prevent and treat urinary incontinence, including pelvic floor training, maintaining a healthy body weight, and resolving constipation, to lower the risk of developing incontinence and subsequent frailty.
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Dr. Krishnan notes that medical interventions, such as pessaries, urethral bulking, and midurethral sling insertion, are available for SUI, while medications like beta-3 agonists and in-office treatments like bladder Botox and nerve stimulation can help manage OAB.
Dr. Eilber suggests that women can strengthen their pelvic floor muscles through exercises like Kegels, which can help prevent urinary incontinence and reduce the risk of frailty, by improving muscle and bone mass with age.
According to Dr. Beers, tapping into the pelvic floor muscles with deep diaphragmatic breaths can help women develop effective Kegel exercises, which can be a great preventative tactic against urinary incontinence.
Dr. Krishnan wishes more women were aware of the available medical interventions for urinary incontinence, which can improve quality of life, keep women engaged and active, and prevent frailty.
