The bladder is an organ that we use every day. And yet for most of us, we don’t really stop to think about our bladder or how it functions. Until it stops working correctly. When this happens, we embark upon a crash course in bladder information, from anatomy and architecture to form and function. For most of us, we are also surprised to learn that some bladder function changes are simply a sign that we ourselves are aging. In this guide, learn about the medical side of bladder change, how the bladder works during different life stages and key signs of bladder change.
The Medical Side of Bladder Change
The bladder itself is in the lower pelvis behind your pelvic bone. It is a muscular, flexible sack-like organ that is only about the size of a pear when fully emptied.
Inside your body, the kidneys connect to the bladder via two slim tubes called the ureters, which are in charge of sending liquid waste to be excreted out of the body.
The bladder, in turn, is connected to the urethra, a slightly thicker tube that transports liquid waste out of your body. Interestingly, the urethra is quite a bit longer in men’s bodies than in women’s bodies – an average of eight inches for men and just 1.5 inches for women.
The bladder empties out through an opening called the urethral orifice. This orifice allows urine to exit through the vagina in women and through the penis in men.
Of course, one of the key jobs of the bladder is to store incoming liquid waste until it becomes full, at which time it sends a signal that it needs to be emptied.
A healthy bladder can store between 400 and 600 millimeters of urine (or between 1.6 and 2.5 cups) before it needs to be emptied.
Things that Change
As time passes, the natural process of aging can cause some changes to occur in the bladder. Some of these changes are ones you can exert some control over, and some of these changes are simply a function of time and an aging body.
The two most important age-related changes that occur are as follows:
- The bladder walls thicken and become less elastic and stretchy.
- The bladder muscles begin to weaken (along with the pelvic floor muscles in many cases).
These two changes are common to all individuals who have begun the natural process of aging.
However, it is also important to note that changes associated with the natural process of aging is not the only reason why you might experience bladder problems such as those outlined below.
Other life experiences and lifestyle choices can also influence how well your bladder continues to do its job as you age.
For women, past pregnancy can injure or weaken the pelvic floor muscles, which support the bladder to stay strong and healthy. For men, developing issues with the prostate gland can cause the same.
Choices you make regarding your diet and weight, daily caffeine intake, use of tobacco products or alcohol, exercise, taking certain medications (including birth control or hormone replacement therapy for men or women), other health conditions and injuries to the pelvic or abdominal region may also influence bladder function as you age.
Signs of Bladder Change
How will you know that your bladder has started to change? There are some signs that can signal bladder that changes due to the natural process of aging are on their way.
These are the most common signs your bladder is changing (although these are not the only signs of a changing bladder):
- You need to urinate more frequently (eight or more times daily).
- You wake up more frequently at night to urinate.
- When you need to urinate, you need to do so urgently.
- You experience urine leakage when you laugh, cough or delay urinating (called “incontinence”).
- You can’t seem to ever get all the urine out of your bladder (called “retention”).
- Your urine comes out slowly even if you really need to go.
- You feel pain, burning, pressure or discomfort while urinating.
- Your urine becomes cloudy or discolored.
Often the signs of a changing bladder are accompanied by other signs of aging, including changes to the flexibility and health of the surrounding structural muscles and ligaments, joints and bones.
Some of these changes may look different from one person to the next depending on genetics as well as lifestyle choices.
How the Bladder Works during Life Stages
You probably don’t remember much (if anything) about your bladder function when you were an infant or a very young child. Perhaps you do remember the toilet training process and the sense of victory you felt when you learned how to properly use that big white ceramic object.
As a refresher, this section gets up close and personal with typical bladder function during each stage of life: baby, child, adult and the elderly. In this section, you will also learn about common bladder function issues that occur more frequently in each life stage.
At birth, most infants emerge with a healthy, intact bladder that functions normally. In some cases, certain tests can even detect bladder dysfunction during pregnancy.
This is especially the case when dysfunction is a known symptom of certain birth defects. That includes heart, genital, abdominal and urinary tract.
In other cases, bladder dysfunction may not reveal itself until after delivery. Urine blockage is one of the most common bladder problems in newborns. Babies can also develop urinary tract infections (UTIs).
Signs and symptoms of bladder dysfunction in newborns may include frequent urination, no urination, disinterest in eating, fever, irritability, nausea or vomiting, diarrhea or constipation, cloudy or discolored urine, strong odor to urine, and swollen bladder or kidneys.
In most cases, a child attains full bladder control between the age of 18 and 30 months. Even so, toilet training can take another few months to master.
More importantly, daytime bladder control will arrive before nighttime bladder control. Full daytime control usually arrives between the ages of three and four years old. While full nighttime control may take another year to arrive.
Genetics can also play a part in how long it takes each child to be able to fully retain urine inside the bladder during the day and at night.
A pediatrician should examine children who are unable to control bladder function during the day and/or at night after the age of four (for daytime incidents) or five (for nighttime incidents) for signs of bladder dysfunction.
As a young adult, your bladder should be in the prime of its life. Moving on towards mid-life, however, all kinds of factors can and do influence the overall health and function of your bladder.
For women, a major factor in declining bladder health is pregnancy and labor. For men, increasing issues with prostate gland can give rise to similar declines in bladder health.
As well, adult-onset health conditions ranging from neuropathy (nerve damage) to multiple sclerosis, Parkinson’s disease to stroke, can impact the health and function of the bladder.
One of the major signs and symptoms of decreasing bladder function in adults is adult incontinence. There are four major types of adult incontinence, each with somewhat overlapping symptoms.
Stress incontinence, as its name suggests, arises primarily in situations of physical stress. That can surprisingly occur when you laugh, cough or sneeze.
Overactive bladder or urge incontinence can also create leakage.
Overflow incontinence is a distressing combination of inability to void completely combined with leakage between visits to the toilet.
Functional incontinence can be traced back to another illness or disease. And it is usually a secondary symptom of that primary diagnosis. Examples can include life-limiting conditions such as Alzheimer’s or rheumatoid arthritis. Which can make getting to the toilet in a timely manner difficult.
Finally, mixed incontinence is typically diagnosed when some or all symptoms are present.
As the natural process of aging continues, changes to the kidneys can also cause bladder change.
For example, as the years pass, the kidneys will often lose some tissue mass naturally and produce less to replace what was lost. As well, the kidney’s main units of filtration, the nephrons, become both less numerous and often less efficient.
As well, the blood vessels that connect the kidneys to the circulatory system can begin to become less elastic and supple. That affects their blood filtering abilities and, in turn, the rate at which urine gets to the bladder.
Bladder prolapse, a condition where the bladder is pushed out of its normal position, is another common issue in older adults. For women, past pregnancy and delivery issues are the most likely culprit. In men, the enlargement of the prostate gland can trigger bladder prolapse.
Nocturia, or nighttime urine release, becomes increasingly common in the elderly. The bladder and pelvic floor muscles continue to weaken and make the bladder less well able to exercise control.
When you are moving from middle adulthood into the senior adult years, there are other widespread systemic changes occurring in your body that have a link to changes in hormone production.
For women, the reproductive system is shutting down, and the production of estrogen and progesterone is steadily decreasing. This, in turn, causes dryness in tissues and increased discomfort and sometimes difficulty with urination.
For men, declines in testosterone can cause similar dryness in tissues and changes to size, shape and overall health of the prostate gland that make urination more of a challenge.
Perhaps the best-known (as well as one of the most feared) bladder change issues among the elderly is incontinence.
With the whole system from the kidneys to the bladder experiencing less elasticity, strength and overall efficiency, urine collects more frequently, but in smaller amounts. That necessitates more trips to the toilet and more likelihood of issues with continence.
Another complicating factor that often interferes with bladder function in the elderly is co-occurring health conditions. Illness and disease often require medication, and many medications can interfere with body and bladder function.
Many older adults increasingly struggle with urinary tract infections (UTIs) which require treatment with antibiotics.
One reason why UTIs are more prevalent in older adults is because of the weakening of the bladder muscles. This weakening can push some urine back into the urethra at the end of the emptying process. This urine may carry bacteria picked up from just outside the urethral opening. That then colonizes the urethra and creates a bacterial infection.
While there is some evidence to suggest that you can maintain bladder health throughout life, medical and aging statistics indicate this goal is difficult for most older adults to achieve.
As the body ages, the kidneys and bladder naturally follow suit. With age-related changing hormone levels, tissues naturally dry out and as a result impact bladder function. Changes to health in other areas can also impact the body’s ability to remain continent as medications or convalescence interferes with normal emptying patterns.
It is important to discuss changes to bladder strength and health with a healthcare provider familiar with geriatric bladder health issues. With knowledgeable, compassionate medical care, many effective options exist to improve bladder function and continence at any age.