Why/ how do bladders get weaker with age?

[TERFCat]

When I was younger, I could go hours without a wee.

These days, I'm fatter, yet I can barely last an hour without feeling the need to go!

Has my bladder got smaller?

Any tips on how to make it work better?

Deffo. It’s easier than you think. Obvs harder in menopause when the lack of estrogen weakens things but bladder training really does work x

Bladder training and drinking more.
not tons and nothing uncomfortable but staying well hydrated 2-3 liters per day.

Pelvic floor exercises make a huge difference. I have been using the squeezy app for a few weeks and my bladder has really improved.

I have interstitial cystitis also called irritable bladder syndrome. No cure unfortunately, but it can be treated, it’s horrible. All urine tests come back negative with this condition. Read professor Lee-malone who spent his life studying it and became unpopular with the medical profession. Now his treatment is widely used. He can explain it better than I can!

I refer you all to Kassie Dewitt, Dr Bri (both pelvic physios) Jessica Valantes who does prolapse/pelvic floor friendly workouts and Kelly Casperson MD - American uro-gynae who is all knowing about the bladder, vaginal oestrogen and the impact of menopause on bladder and vagina. etc.

All super brilliant resources around urinary incontinence, prolapse, bladder issues.

Kelly Casperson and Louise Newson are my regular favourite podcasts.

I went to the pelvic physio with urinary incontinence 18 months ago, to be told I had prolapses. I'm now booked in for prolapse repair in the Summer. But all of the above resources have helped me massively with coming to terms with it all and learning about how to treat my bladder.

So HRT and ovestin have changed the ability of my bladder to function normally. And the pelvic physio and kegels will help me prepare for my surgery.

I don't actually rate Elaine Miller (though she is funny and I'm sure a lovely woman), her advice to squeeze the bum hole doesn't activate the muscles around my vagina and urethra enough to make any difference. I highly recommend you try a session with a private physio to help you get the exercises right.

I had to re train my bladder years ago when I was in my 30s after a urinary infection that needed two lots of antibiotics I had got into the habit of peeing very frequently with very little coming out. I was diagnosed with “irritable bladder “. The doctor gave me tablets as well but I can’t remember what they were called. I built up gradually the amount of wee I could hold in and you had to squeeze pelvic floor muscles when you felt the urge to go. I didn’t have urinary incontinence and I’m imagining this would be difficult. This is when I learnt that going “just in case” as my mum had always made us do when we were kids wasn’t good for your bladder. The doctor also gave me a card to give to people when I was out that said I had bladder problems and could I use their toilet this was handy if in a shop etc that didn’t have public toilets and saved the embarrassment of having to explain it !
@TERFCat If you’re only 35 it sounds like something like this but I would check with doctor definitely and ask for referral to physio that has knowledge of this. I don’t want to depress you or any other younger women here but it is possible to start having peri menopause symptoms at 35 as they can start ten years before, it wouldn’t be common (average age for menopause is 50) but not completely out of the question, but you would most likely experience other symptoms too if it was lack of oestrogen in vaginal/vulval area such as general discomfort, itching feeling uncomfortable during sex. I wasn’t as young as this when I started peri menopause but I definitely think looking back it had started about age 40, I didn’t get hot flushes which is what I was expecting I was just generally feeling too warm a lot of the time and vaginal itching.

For the people using the cream - I'm using a pessary tablet (1/day for 2 weeks, and then 2/week ongoing), but have also been given the cream as a "top up". But we didn't talk about how much to use. Just to smear it on externally.

Are you all doing this, or are you using the applicator and dosing properly? Just wondering, if you are smearing it on externally like me, how much and how often are you doing it ?

Thanks!

Do you mean Ovestin cream? I used every day for two weeks then dropped to every other day. That was a year ago and now I use every two days. I put a pea-sized amount on the outside, the same on urethra and opening then a third pea-sized amount poked up inside towards the front so it is absorbed by the bladder.

I could piss for England. Not sure if a cream 'down there' would help as I have to take a water tablet, plus two of my other tablets make me pee as well. I have various health problems which mean I need this water tablet so I dunno. I not only have to use incontinence pants and pads to go in them but also bed pads at night and am thinking of getting one of those NHS type waterproof mattresses. Bloody fed up with it. Every time I am out and about there had damn well better be a functioning public loo around!

@Deathraystare If your bladder is weak Ovestin may help. I don’t know if you’re post menopausal but it replaces the lost estrogen. I had no idea the bladder had estrogen receptors and that a drop during menopause could cause so much weeing x

@Deathraystare I'm astonished that you aren't using ovestin already with all of those bladder issues.

The cream goes inside the vagina. Regularly. After a few weeks the membranes/walls between the bladder and vagina start to strengthen.

It might not be a total solution for you, but it might make a bit of difference.

I literally couldn't do an hours dog walk without needing to wee behind a tree before. Now I can go hours.

@Deathraystare are you under the care of a uro-gynae? They should be able to advise you.

Have you ruled out diabetes?

This ^

Am so glad I’ve read this. I’m 47 and on normal HRT but my incontinence is now becoming so distressing, I will go for a wee and within an hour easily it’s unbearable and I’m absolutely desperate and practically on my knees with agony I’m so desperate.

within an hour. I’m starting to leak as well. I’m 48 and probably stink of piss. I have to wear pads all the time. It’s horrific. Interestingly I’m also suffered from atrophy and whilst my patches are enough to ward it off, if I’m slightly lax with them then the pain reappears

Ovestin will help with that x

Yes, thank you - I just couldn't remember the name, mind had gone blank.

what hope is there for those of us that cannot use any form of HRT??

😰

Even if you can’t use HRT patches or tablets due to health problems you can use locally applied oestrogen. I’m pretty sure this has just recently changed as previously you weren’t able to use even the cream if you had cancer in the past.

No, I can't, nothing like that, and I am on hormone suppressants for life

@tomorrowisanotherdate i was under the impression that most uro-gynae/urologists/oncologists now allow GPs to prescribe topical vaginal oestrogen as it is local and not systemic so doesn't contribute to the growth of cancers.

Kelly Casperson and Louise newson cover this a lot.

I would be fighting for vaginal oestrogen even if I was on hormone blockers. Try episode 240 and 241 of Kelly Casperson podcast.

Ah ok sorry to hear that. Unless they have already told you specifically that you can’t use topically applied oestrogen I would ask as there has been revisions to this recently but obviously depends on your individual case.

There are other non hormonal vaginal moisturisers which help with dryness and irritation but I’m not sure they would help with bladder issues.

Same for me. I do go to the loo several times during the day, but that is only because I drink a lot of water, otherwise I can last for hours without going. I usually only go once at night, again because I drink water just before going to bed.

Please let me give you hope, because I was so quietly distressed about this issue and now (touch wood) don't even think about it day to day, sleep though all night, drink loads of water everyday and can go for hours and long walks etc completely dry.

I had stress incontinence which worsened considerably with WFH/Lock downs to the extent that I (as a fit and healthy woman in my late 40's) was so concerned about returning to the office (as I was having to change several times a day). It was increasingly miserable. So I researched and thought I need HRH. I phoned my lovely female GP who said let's take it one step at a time and insisted on sending me to the Incontinence Clinic first. And I am SO glad she did. Because I think HRT would have masked the weakness and I wouldn't have tackled strengthening my muscles. I was so cynical, but I am so grateful I took this route first. Please ask to be referred and on top of all their advice I would add:

You may also be suffering from sensitive bladder. I now know I cannot drink fizzy drinks (in particular anything with artificial sugars or caffine), caffinated tea or coffee. I just drink hot water and plenty of it (otherwise it is like flicking a switch, esp with Diet Coke etc which is disappointing, but easily avoidable)

Pilates or yoga several times a week (available on YouTube for free or even better a class). I admit I am hopeless with pelvic floor exercises, so this must be compensating for me. I am totally addicted as I know it makes such a crucial difference to me. I go 3 to 4 times a week (part of my gym membership) And I would also say an added benefit is change in body shape, better sleep, better mood, better balance, younger spine.

It took just 2 or 3 weeks to notice a difference which really spurred me on. Two or three months before I was pretty confident that near normal (baring colds or sometimes just before my period). Now almost 2 years on and I feel as if I am back to my younger pre-'issue' self. In fact, I feel so great that I havent followed up on HRT yet, although I may do that for bone density/heart health in due course.

I really hope you get sorted out soon, whichever avenue works best for you.

PS @TERFCat just rereading you're post, you can and definitely should work on stretching your bladder. Try to drink more water and go longer between going to the loo. Especially at night. It is amazing the part your brain can play in tricking you that you need the loo. I used to wake in the night and feel I had to go to the loo to get back to sleep. But it only took about 3 consecutive nights of denying myself getting up, making myself wait until morning, for that urge to get much less and eventually go away altogether in about 2 weeks.

It is difficult and torturous for those few night, but your bladder and brain can actually be quite quickly retrained with determined effort (under normal circumstances obviously, assuming no other underlying issue... Which is why the Incontinence Clinic is really worth going to, they will check your bladder if filling and emptying correctly first thing and then take their advice from there).

They will also recommend the Squeezy App and instruct on how to do a pelvic floor exercise properly/to maximum effect.