Prevalence rising

There is an overall increase in prevalence of symptoms with age in both women and men, with the latter starting from a lower base but increasing to similar levels in old age. There are three distinct peaks for women – during early reproductive age, menopause and old age. 

The major problem is seen in older people and related to urge incontinence but there are recognised associations with pregnancy/childbirth (which can weaken or damage the pelvic floor), obesity and cognitive impairment. In men, prostate enlargement, prostate surgery, diabetes and obesity are all associated with incontinence.

Incontinence symptoms are more common in those who are overweight or obese. Obesity (BMI over 30) is likely to contribute to stress incontinence because abdominal fat increases intra-abdominal pressure. This in turn increases pressure on the bladder and pelvic floor muscles, which may stretch and weaken. 

These changes are thought to affect urethral mobility and worsen detrusor instability and overactive bladder. Weight loss of 5-10 per cent can improve symptoms and could result in them going away completely.

It is important to find out whether the problem is recent, chronic or intermittent. If recent, pharmacists should explore any other changes that the patient has noticed to see if there are precipitating factors.

Many people wake up once during the night to urinate, but more frequently may be a sign of urinary problems. Nocturia becomes more common with increasing age and occurs in both men and women. Nocturia can be associated with daytime urinary frequency or occur by itself.