The Aging Urinary System
By Cindy Hauser, NP-C
As people age they tend to notice more frequent urination, and urgency to get to the bathroom. Some people, especially women, will notice leakage of urine. Except for leakage of urine, these changes are a part of the natural aging process of the urinary system.
Frequency has several causes. First, the kidneys lose their ability to concentrate urine and conserve water, which leads to an increase in urine production. Secondly, the bladder has an increased frequency of involuntary bladder contractions in approximately 10-20 percent of the population over 65, which leads to the sense of urgency, as well as frequency. The amount of urine left in the bladder after urinating increases to 75-100 milliliters, which is slightly less than one-half cup of liquid. The sensation to urinate occurs when there is less urine in the bladder. Often the need to urinate occurs at 150-300 milliliters, which is approximately one-half to one-and one-third cup of liquid. The amount of urine the bladder can hold decreases to 300-600 milliliters, which is approximately one and one-third cup to two and one-half cups, due to decrease muscle tone of the bladder. Imagine, if there is 75 milliliters left in the bladder at the end of voiding, and the sensation to void occurs at as little as 150 milliliters, and the bladder will only hold 150 milliliters; it is understandable why people are experiencing frequency.
Thirdly, the urethra, the tube caring urine from the bladder to the outside of the body, shortens and the lining of the urethra thins with age. The Sphincter, which controls passage of urine, is not able to close as tightly as it did at age 25, and may cause leakage. As noted earlier, incontinence is not a natural part of the aging process.
In women these changes are often related to the decrease of the hormone Estrogen and child birth. Decreased Estrogen levels changes the chemical make-up of the vagina, which allows bacteria to grow in the vagina and leaves women more susceptible to Urinary Tract Infections (UTI). Lack of Estrogen also causes the vagina to wither and thin, which leads to loss of elasticity of vagina, painful intercourse, irritation, itching and urinary urgency.
In men, due to changes in the testosterone levels, the prostate enlarges as they age. An enlarged prostate can prevent the bladder to empty completely, which causes and increase amount of urine left in the bladder after voiding. An enlarged prostate may cause hesitancy, straining to start a stream of urine, starting and stopping of the urine stream, a weak stream, dribbling after voiding, UTI, and potential damage to the kidneys due to back flow of urine into the kidneys.
There are many conservative treatments for frequency and urgency, such as life-style changes, timed voiding, bladder retraining, pelvic floor muscle exercises, bio-feed back, and anti-incontinence devices.
There are times in which medications need to be incorporated with conservative measures. Medications such as anticholinergics are often used to help control the symptoms of frequency and urgency. Together with conservative measures, the symptom of frequency and urgency are decreased.
The health care providers at Adult and Pediatric Urology are committed to improving our patient’s quality of life. We hope you will contact us should you develop any problems with your aging urinary tract. We are dedicated to the urological health of our patients.