While there are some conditions where the causes of incontinence seem clear, such as childbirth, serious lifting or chronic coughing, there are some where the connection is less obvious.
One of these is osteoporosis. A 2009 Canadian study found that middle-aged and older women with osteoporosis had a much higher incidence of incontinence than women without the condition1.
This finding is supported by Australian physiotherapist and University of Newcastle Associate Professor Pauline Chiarelli, who found similar results after analysing data from a 15-year Australian longitudinal women’s health study of more than 30,000 women.
The reason for this association, Dr Chiarelli says, comes down to mechanics; women with osteoporosis lose height because of the spinal deformity associated with vertebral fractures. This resultant spinal curvature alters the positioning of the pelvic organs, putting greater pressure on the pelvic floor, thereby increasing the risk of pelvic organ prolapse3 and incontinence.
Research also tells us that women affected by incontinence, particularly urge incontinence or nocturia (having to go to the toilet overnight twice or more), are at greater risk of falls 4. The reason for this too, also comes down to mechanics, as women risk falling over as they rush to the toilet.
This falls risk associated with urge incontinence adds considerably to the risk of serious fractures already present in women affected by osteoarthritis, a debilitating disease that affects 1.2 million Australians, predominantly women aged 55 and over.
Dr Chiarelli said that the incidence of osteoporosis in Australia was increasing. “Osteoporosis is life changing, debilitating, painful and associated with high morbidity and some mortality, but it’s very common and very preventable.
“Currently, an average of one osteopathic fracture takes place in Australia every eight minutes, and this is expected to more than double in seven years’ time if the trend continues,” Dr Chiarelli said.
Earlier this year Canadian researchers out of Montreal University found that the introduction of pelvic floor exercises dramatically reduced the incidence of incontinence in women with osteoporosis5.
The author of the study, Dr Chantal Dumolin said the main message for women with osteoporosis was to do their pelvic floor exercises, even if they didn’t suffer from incontinence, because “fractures of the lumbar spine cause their body to be slumped, which puts more pressure on the pelvic floor.”
Commenting on the study’s findings, Dr Chiarelli said women with bone loss should be assessed for incontinence as a potential further risk for falls and fractures.
"Not only are older women more susceptible to osteoporosis as they age, but they are also more likely to develop incontinence on top of it,” she said.
For advice, referrals and resources about incontinence go to continence.org.au or phone the National Continence Helpline (1800 33 00 66) 8am to 8pm AEST week days.
1. Sran MM, Prevalence of urinary incontinence in women with osteoporosis, J Obstet Gynaecol Can. (2009);31(5):434-9.
2. Mattox TF et al, Abnormal spinal curvature and its relationship to pelvic organ prolapse Am J Obstet Gynecol, ( 2000) 183(6):1381-4.
3. Pal L1, Hailpern SM, Santoro NF, Freeman R, Barad D, Kipersztok S, Barnabei VM, Wassertheil-Smoller S., Association of pelvic organ prolapse and fractures in postmenopausal women, Menopause. (2008) 15(1):59-66.
4. Brown J, Vittinghoff E, Wyman JF, Stone KL, Nevitt MC, Ensrud K, Grady D, J. American Geriatrics Society, Urinary Incontinence: Does it Increase Risk for Falls and Fractures? (2000)48 (7)721–5
5. Sran M; Mercier J, Wilson P, Lieblich P; Dumoulin C, Physical therapy for urinary incontinence in postmenopausal women with osteoporosis or low bone density: a randomized controlled trial, Menopause: (2016);23(3)286–93