FUN OVER 50: INCONTINENCE

There are a few reasons that incontinence becomes a thing over 50.

Think of your urethra like it's a sentient garden hose.  It can contract (vasoconstrict) or expand (vasodilate) as needed.
However, when we hit menopause or andropause (yes, this happens to guys too), our plumbing seems to stop working so well.

Here's why:

• Sex hormones, which are largely responsible for vascular tone, come in handy for body parts like your urinary tract.  Estradiol is particularly important for keeping the pelvic floor strengthened, and that hormone drops to nearly nothing in menopause.  Another example is in post-cancer treatment when patients are put on drugs that intentionally block estrogens.
  
  
• Our immune system changes when these protective hormones leave us, and we can become more susceptible to allergies and infections. Frequently, our doctors will prescribe things like steroids to help us with this.  Steroids and even some non-steroidal allergy agents are vasodilators.   
  
  
• By the time we are 50, we've taken a left hook or two, which may have fritzed our adrenal system and depleted our sex hormones even earlier.  We may find our relationship with caffeine and other stimulants more intimate than ever, because energy is in shorter supply.  Guess how caffeine and stimulants work.  
  
  Yep. They act as vasodilators, further weakening the urethra.
  
  

  And here's another thing.  Just when women get released from having to have a period every month, enter the thrill of wearing a pad every single day because of the constant leakage.  It's not exactly fair, is it?

 
  But wait, there's more!  Pads can also have problems.

  For healthy people, urinary tract infections (UTIs) are painful and annoying.  For the weaker among us, they can be deadly, as kidney infections and sepsis can follow.  The very guards we use for urinary incontinence can lead to UTIs because they are frequently lined with plastic, which does a wonderful job of containing and warming hostile bacteria. 

So what can we do?

1.  I'm a big fan of replacing the hormones you are missing with actual hormones, and not the antidepressants, melatonin, Ambien, etc. that mask the symptoms you get from being low.  Hormones may not be appropriate for everyone, but I would urge you to do your homework and find a specialist who can advise you on your options.  I am also personally a fan of higher, not lower doses because hormone replacement is just that: replacement and not "augmentation".  You will have the exact amount you are given exogenously, so you want it to be high enough to not feel all the things you do when you are low.  That goes for testosterone in men too.

Side Note:
**No, hormones/BHRT do not cause cancer (click here for just one of many studies).  This is actually old news, but again I urge you to seek out physicians who stay updated on current literature in this department.  Hormones like estradiol and testosterone build, so if you have existing cancer, it can grow in their presence.  You want to make sure you are cancer-free before starting bioidentical hormone replacement therapy (BHRT), but there ARE people who have successfully recovered, are fully in remission, and take hormones because they feel that they are protective against recurrence.  Investigate and seek out physicians with experience in this area if you are curious.  They are out there.  

2.  Check your vasodilators.  Caffeine in the form of sodas, coffee, chocolate, etc. and pharmacologic agents including oral (not creams) estrogens, alpha-blockers, sedative-hypnotics, antidepressants, antipsychotics, ACE inhibitors, loop diuretics, nonsteroidal and steroidal anti-inflammatory drugs, and calcium channel blockers have been implicated to some degree in the onset or exacerbation of urinary incontinence.  I frequently see people in their 50's-70's or who are post-event, on 6 of these medications or more.  

3.  If you currently wear plastic liner-containing products, consider switching/rotating to other options like those found in the links I'll leave below.  This can help you reduce the risk of infection as plastic holds moisture.  Include practices that improve vascular tone (i.e., hormone health, sleep, diet).  Minimize the things that diminish vascular tone (caffeine and unnecessary medications, which of course is a discussion between you and your doctor).  Finally, allow the whole area to breathe fresh air with products that don't trap bacteria.  All three practices can be a powerful strategy for staying healthy, infection-free, and feeling daisy-fresh.

4.  If you have allergies, do whatever it takes to stop coughing and sneezing, as this can lend to spasm incontinence.  Sucking on cough drops and temporarily taking cough suppressants can help to give the pelvic floor and bladder a break.

• Instead of wearing pads, try these tampon-like products that simply inhibit the urethra instead:
  REVIVE BLADDER SUPPORT or POISE IMPRESSA.  Yes, these actually work!
  
  
• Try these brands of underwear that absorb and nix odor, and you can just throw them in the washing machine (but not the dryer!) and reuse them again and again:  SPEAX by THINX, SAALT, MODIBODI, PROOF, OR KNIX are popular brands.
  
  
• Need full-on disposable options?  Consider seeking out options that do not have PLASTIC.  Not only because we want to minimize your risk for UTI, but other options can be biodegradable.  The earth will thank you.
  Check out:  DRYLOCK PREVAIL, which promises "breathability", although I'm not completely sure if it's plastic-free, and of course, the whole line of classic "DEPEND" for women.