Tue 05, Aug 2014

While there are some conditions where the link to incontinence is logical, such as pregnancy, childbirth or weak pelvic floor muscles, there are some where the connection is quite unexpected.

One of these is the link between osteoporosis and urinary incontinence. A recent Canadian study (Sran MM, 2009) found that middle-aged and older women suffering from osteoporosis had a much higher incidence of incontinence than women without osteoporosis.

The Canadian findings are supported by the work of physiotherapist and University of Newcastle researcher Associate Professor Pauline Chiarelli. Her work as a research associate assisting with a 15-year longitudinal study of more than 30,000 Australian women provides further evidence of the link between incontinence and osteoporosis.

Dr Chiarelli said current research was now focussing on the correlation between height loss (associated with curvature of the spine) and incontinence.

“It is well understood that women with osteoporosis lose height because of the spinal deformity associated with vertebral fractures - the most common osteopathic female fracture.

“There is also a body of research (Mattox TF et al, 2000) suggesting that curvature of the spine increases the risk of pelvic organ prolapse because of the subsequent altered positioning of the organs, muscles and bones within the abdominal cavity,” she said.

This, Dr Chiarelli said, lends support to the hypothesis that the altered forces pushing down from the abdomen onto the bladder as a result of the spinal deformity may be implicated in incontinence.

Whatever the cause, in Dr Chiarelli’s view, women who are diagnosed with osteoporosis need to be screened for and informed about their increased risk of urinary incontinence and pelvic organ prolapse.

“Osteoporosis is life changing, debilitating, painful and associated with high morbidity and some mortality, but it’s very common and very preventable,” Dr Chiarelli said.

“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.”

Osteoporosis is a common disease occurring predominantly in women aged 55 and over, with 1.2 million Australians estimated to have the condition. The disease occurs when bones lose minerals such as calcium quicker than the body can replace them, leading to a loss of bone density or mass, and a higher risk of fractures.

Osteoporosis Australia advocates three main measures for the promotion of healthy bones and the prevention of osteoporosis: adequate calcium intake, normal vitamin D levels (to help absorb calcium) and specific weight-bearing exercises.

Dr Chiarelli said that after the age of 50, however, when reduced oestrogen levels cause bones to lose calcium and other minerals much faster, women’s dietary and exercise requirements changed.

Dietitian-nutritionist and Dietitians' Association of Australia spokeswoman Dr Kellie Bilinski said the recommended intake of calcium for women after the age of 50 increased by about 30 per cent. The need for vitamin D, critical for the bones’ absorption of calcium, also increased beyond the age of 50, and then again beyond the age of 70, she said.

And hormonal changes after menopause required women to make other dietary adjustments, Dr Bilinski said. “After menopause, the lower levels of oestrogen mean that women have an increased risk of heart disease, so they should eat less saturated fats and more polyunsaturated fats.”

A certain percentage of women experienced weight gain after menopause, which meant they needed to reduce their calorie intake or increase their exercise levels, or both, to stay within their healthy weight range, she said.

“And it’s well known that exercise is really important for increasing bone density and muscle mass, so it’s important for preventing osteoporosis,” Dr Bilinski said.

Both women agree that the maintenance of bladder and bowel control becomes even more critical as women age, providing a greater imperative for a healthy diet and active lifestyle.

They also agree that preventing osteoporosis in the post-child bearing years incorporates a wide spectrum of health, age and lifestyle issues and, as such, needs a holistic approach.

For more information about osteoporosis go to www.osteoporosis.org.au or contact their information line (1800 242 141).

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.