If you’ve ever licked a little while sneezing or laughing, you’ve probably been told that it’s just one of the things that comes with having a baby or getting older. But while urinary incontinence is common, it’s not normal, and new research suggests that urinary incontinence (UI) could also be an indication of your heart health.
A University of Iowa study of more than 20,000 women found that current urinary incontinence is linked to cardiovascular risk factors, including type 2 diabetes and dyslipidemia (an unhealthy mix of cholesterol and other fats in the blood), stroke and a history of coronary bypass surgery. The connection remained even after the researchers took into account age, body weight, race and smoking.
The study does not prove that one causes the other, just a connection between the two. The findings give women and their health care providers (HCPs) a reason to consider bladder symptoms as part of the bigger picture of women’s health.
1. Your bladder and heart have the same wiring
The bladder relies on a healthy blood supply and properly functioning nerves to fill, hold, and empty. When blood flow or nerve signals are disrupted, bladder function suffers.
“The bladder is highly vascularized and heavily innervated by nerves, so if that process is disrupted, the bladder is compromised,” said Aleece Fosnight, PA-C, a physician assistant who specializes in urology and sexual medicine.
Fosnight explained that conditions such as type 2 diabetes, high blood pressure and stroke can damage small blood vessels and nerves throughout the body, including those that control the bladder. Diabetes also pushes extra glucose through the kidneys, which can increase urine volume and worsen leakage, she said.
2. New or worsening symptoms are the bigger clue
The Iowa study found the cardiovascular association only with current UI. The most important seem to be the symptoms that appear or worsen over time.
“If someone had urinary incontinence problems in their 30s or 40s and now, in their 40s and 50s, is seeing worsening of that urinary incontinence, we need to be aware of that change,” Fosnight said.
She added that this type of shift can indicate an underlying vascular, metabolic or neurological problem. Fosnight has had patients whose new bladder symptoms led her to refer them to a cardiologist, including a woman in her early 40s who was found to have blocked coronary arteries.
3. Midlife women should pay more attention
Estrogen supports tissue health in the heart, brain, and pelvis. As levels drop during perimenopause and menopause, the risk of both cardiovascular disease and urinary incontinence increases, Fosnight explained.
Women over 40 who have new urinary tract problems, especially along with changes such as higher blood pressure, sleep disorders or a family history of heart disease, should discuss them with their GP. Fosnight recommended keeping a simple bladder diary for a few days to track patterns in frequency, urine volume, and timing.
4. UI can prevent women from taking care of their hearts
There is another side to the connection. Nieca Goldberg, MD, a cardiologist and member of HealthyWomen’s Women’s Health Advisory Council, said that UI can prevent women from doing the very things that protect heart health, such as exercising regularly, staying hydrated and staying socially active.
“Women with incontinence limit their water intake and when they exercise, they are at risk of fainting if they exercise while dehydrated,” Goldberg said. Another danger is that women avoid exercise to prevent their bladder from leaking. “A sedentary lifestyle can lead to elevated blood pressure, cholesterol and glucose, all risk factors for heart disease,” Goldberg said.
According to Fosnight, urinary incontinence can cause women to miss social events, leading to isolation. Fosnight has observed this cycle in her patients. Stress and isolation can also activate the sympathetic nervous system, increasing urination and bladder frequency and making it more difficult to break the cycle.
5. Ask for a heart exam when discussing your bladder
The new research is a reason to bring heart screening into the conversation when women report bladder problems.
“We should always look at studies like this and say this is another way to screen women for the risk of heart disease,” Goldberg said.
Sometimes women feel uncomfortable talking about urinary incontinuity. Therefore, it would be ideal if medical professionals addressed the topic during regular visits. However, if this isn’t the case, it’s important to move past the embarrassment and bring up your bladder symptoms so you can get the treatment you need.
Goldberg recommended that women with urinary incontinence be screened for cardiovascular risk factors such as blood pressure, cholesterol, blood sugar and lifestyle factors such as activity level and smoking.
Talk to your HCP about bladder health and heart health
Bladder leaks aren’t just an embarrassing inconvenience. Treating urinary incontinence as an insight into cardiovascular health gives women the opportunity to prevent heart problems earlier and feel better in everyday life.
If your bladder symptoms are new, worsening, or affecting your quality of life, mention them at your next appointment and also ask about a cardiovascular exam. Your bladder and heart work together, and your care should too.
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