Bladder problems are very common among aging adults. They can range from losing a few drops of urine to large accidents.
The bladder is the expandable muscular sac in the pelvis located above and behind the pelvic bone that stores the urine before it leaves the body. It can normally hold up to 400 to 600ml of liquid.
It is an important part of the urinary tract apart from kidneys, ureters, and urethra. When the bladder is empty, the shape and size resembles of that of a pear fruit.
Aging Changes in the Bladder
As you grow in age, your bladder changes and so does its functioning. Here are some of the changes in the bladder as one ages:
- The bladder muscles become weak
- The elastic tissue of the bladder hardens and doesn’t remain stretchy as before
- The muscles lining the bladder weakens and loses flexibility. As a result in the loss of strength and flexibility, you bladder may not empty completely
- The urethra may get blocked in men due to an enlarged prostate gland and in women due to weakened muscles, causing the bladder or vagina to fall out of position (prolapse).
The bladder and other parts of the urinary tract are lined with a layer of cells called the urothelium. The urothelium is separated from the muscles of the bladder wall, commonly known as muscularis propria, by a fibrous thin band called the lamina propria.
Bladder cancer develops when the healthy urothelium cells grow uncontrollably and form a mass called tumor, which can be benign or cancerous, in the bladder lining. Benign tumor is the one that can grow but will not spread, while cancerous tumor is malignant, meaning, it can grow and spread to other parts of the body.
Bladder cancer can penetrate the bladder muscle, and if untreated, it can spread to lymph nodes and other organs, such as the liver, lungs, or bones.
Types of Bladder Cancer
The bladder cancer type can be determined by the way it looks under the microscope. The three main types include:
- Urothelial carcinoma — 90 per cent of the bladder cancers fall under this type. It starts with the urothelial cells in the bladder lining. The type of cancer was formerly called transitional cell carcinoma or TCC.
- Squamous cell carcinoma — Irritation and inflammation can develop squamous cells in the bladder lining, which after a prolonged time may become cancerous. Four per cent of bladder cancers are part of this type.
- Adenocarcinoma — It develops from glandular cells and makes up for about 2 per cent of all bladder cancers.
Some other types of bladder cancer include sarcoma and small cell anaplastic cancer but are uncommon. Sarcoma takes root in the fat or muscle layers of the bladder. Small cell anaplastic cancer is a very rare type which spreads to other parts of the body.
Statistics of Bladder Cancer
Bladder cancer is the fourth most common cancer among men. It tends to be more common in men than in women with the risk of diagnosis by the age of 85 at 1 in 43 men compared to 1 in 148 women. The five-year survival rate for people with bladder cancer is 58 per cent.
Bladder Problems in Aging Men
In men, the prostate can enlarge to block the flow of urine, causing bladder problems. The three most common bladder problems include urinary incontinence, overactive bladder, and an enlarged prostate.
Overactive bladder syndrome: It can be described as frequent urination (more than eight times a day), an urge to urinate, bladder leaks, and nighttime urination. Worldwide prevalence of overactive bladder syndrome is 12.8% for women and 10.8 per cent for men.
Urinary incontinence: Accidental leakage of urine from the body, making it uncomfortable and inconvenient. For some this can affect daily activities like sports and exercise, causing a lot of emotional distress.
Enlarged Prostate: There are two prostate growths period in a man’s life: one early at puberty and other around the age of 25. Benign prostatic hyperplasia, the medical term, is not a cancerous enlargement of prostate and does not increase the chance for a prostate cancer. The prostate tends to grow after 25, but if it grows too fast, there can be annoying symptoms like difficulty in urinating, constant urge to urinate, increased nighttime urination, etc.
Bladder Problems in Aging Women
Bladder problems in women occur post-menopause due to reduction in oestrogen levels and also post-birth as a result of pregnancy.
Urinary tract infection (UTI): In the postmenopausal stage of life, women are susceptible to UTIs because of reduction in the hormone estrogen, as a result the unhealthy bacteria such as E.Coli grow in the tract and number of healthy bacteria like lactobacilli drop. Dehydration, a weakened immune system, kidney problems, immobilization, and catheterization are other factors that lead to UTIs.
Urinary incontinence: Excess weight, aging, pregnancy, childbirth, and the number of children a woman has are the main factors associated with urinary incontinence.
Researches have shown that urinary incontinence while linked to aging, can also be associated with pregnancy, delivery and the number of children one has. Studies also show that women can experience incontinence after menopause due to a drop in estrogen hormone levels.
Urinary incontinence come in different forms:
- Stress incontinence
- Urge incontinence
- Overactive bladder
- Functional incontinence
- Overflow incontinence
- Mixed incontinence
Prolapsed bladder: Muscles supporting the bladder weaken with age, causing it to collapse. This is associated with a low production in estrogen hormone levels, responsible for keeping the muscle strong.
Childbirth can also cause prolapsed bladder due to the stress on the vaginal tissues and supporting muscles. Strain due to heavy lifting, bowel movements, or even long term coughing or constipation, can also weaken the muscles leading to prolapsed bladder.
Frequent urination, frequent urinary tract infections, pain in vagina, pelvis, lower abdomen, pain during sexual intercourse, bleeding or tender tissue sticking out of the vagina are some of the symptoms of prolapsed bladder. Performing pelvic floor muscle exercises can help prevent prolapse bladder.
The main stigma about bladder problems, especially among men, is that they are less likely to open about bladder problems to their doctor. Speaking to your doctor about your bladder related problems can help implement a treatment plan to improve not only your bladder but the overall quality of your life.