Incontinence & Heart Failure: Is There A Connection?

Affecting millions of people around the world, heart failure is a global health challenge that reduces the heart's ability to pump blood effectively. Since the world's population is rapidly ageing, we can expect to see an increase in the number of people with this condition in the years to come.

Did you know that as many as 50% of heart failure patients may experience some form of urinary incontinence, also known as involuntary urine leakage? While more in-depth studies still need to be conducted, there certainly appears to be a link between these two prevalent conditions.

Here at Jude, we are passionate about shedding light on women's health issues, especially those relating to bladder health. In this article, we'll uncover the links between heart failure and urinary incontinence, telling you important information you need to know about the warning signs, associations, and effective management techniques.

Defining Heart Failure And Urinary Incontinence

Let's take a closer look at heart failure and urinary incontinence so you can gain a better understanding of each condition.

What is heart failure?

Heart failure is a syndrome where the heart struggles to pump blood around the body effectively. Some of the most common symptoms include:

• Shortness of breath

• Dizziness and fatigue

• Rapid heartbeat

• Coughing and wheezing

• Difficulty concentrating

• Swollen legs and ankles (oedema)

While not a classical symptom of heart failure, some people may also experience urinary symptoms such as increased frequency or urgency.

There are three main types of heart failure: left-sided heart failure, right-sided heart failure, and biventricular heart failure (when both sides of the heart are affected).

The risk factors associated with heart failure include smoking, high blood pressure, previous heart attack, high cholesterol, excessive alcohol consumption, obesity, and poor diet.

What is urinary incontinence?

Urinary incontinence is the involuntary leakage of urine. It is a symptom which is common in older adults, but can affect people of all ages. Symptoms can vary from leaking a small amount of urine when sneezing or coughing to completely emptying your bladder without warning. Many people with this condition also experience nocturnal urinary frequency (nocturia), which can disturb their sleep and affect their day-to-day lives.

In many cases, UI is caused by an underlying condition but can also be due to things like acute illness, certain medications or physical limitations preventing timely access to a bathroom.

Around one in three women experience some type of urinary incontinence at some point in their lives, so the condition is far more common than most people may think. Some of the main contributing factors include pregnancy, childbirth, menopause, and weak pelvic floor muscles.

How Heart Failure Can Contribute To Urinary Incontinence

Heart failure can worsen urinary incontinence and exacerbate urinary symptoms in the following ways:

Mobility problems

Due to the shortness of breath and fatigue that's associated with heart failure, many people with the condition struggle to get to the bathroom in time to relieve themselves.

Additionally, reduced exercise tolerance may result in weakened pelvic floor muscles and a higher risk of urinary incontinence. Long periods of inactivity can also worsen existing symptoms.

Fluid retention

With the heart pumping less efficiently than it should be, fluid tends to build up in the legs and ankles (oedema). This excess fluid often results in an increase in urine production, particularly at night when lying down (nocturia), leading to urgency, urinary incontinence and other urinary symptoms.

Changes in kidney function

When the heart isn't functioning properly, the kidneys may not receive enough blood flow or experience congestion, leading to altered fluid and waste handling. The congestion and pressure in the kidneys are another reason why some heart failure patients develop urge incontinence and overactive bladder syndrome.

Impaired kidney function can complicate heart failure management, creating a cycle that can be challenging to treat.

Side effects of medication

Heart failure patients are often given diuretics (water tablets) to help manage their heart failure symptoms (like fluid overload). However, this type of medication is known to worsen urinary symptoms like frequency and urgency, and increase urine production.

Other Factors To Consider

Some of the other factors that may impact the links between heart failure and urinary issues include:

The severity of your condition

The more severe your heart failure is, the higher your risk of urinary incontinence. If you're experiencing the advanced stages of heart failure, it's more likely that you will experience some form of urine leakage or other urinary issues.

Related conditions

Conditions related to heart failure, such as kidney disease and Type 2 diabetes, can also contribute to the onset of urinary incontinence and overactive bladder syndrome. So, if you have any of these related conditions, just be aware that your risk of developing UI may be higher.

Tips For Managing Urinary Incontinence If You Have Heart Failure

If you have heart failure and are experiencing urinary symptoms, you can discuss management options with your healthcare team. Some approaches include:

Speak openly about your symptoms

Many patients feel too embarrassed to talk about urine leakage and increased urinary frequency. However, your doctor or nurse can't help you if you don't speak openly. Just remember that a significant number of people with heart failure experience some type of urinary incontinence.

By providing your general practitioner (GP) or specialist with detailed information about your symptoms, they will be able to discuss potential causes and work with you to develop an effective management plan.

Wear incontinence products

While wearing incontinence products may not solve your urinary issues, things like leak-proof underwear and specialised incontinence pads can give you the confidence to go about your day leak-free and with more comfort.

Additionally, these products can save you from having to change your clothing every time you leak urine, and you won't have to worry about carrying around extra pairs of underwear in your bag.

Reviewing your medication

As we've already mentioned in this article, certain types of heart failure medication can increase urine production. If you're currently taking any diuretics, you may want to ask your doctor or heart failure specialist nurse to review your medication schedule or dosage to see if adjustments are possible or appropriate, without compromising your heart failure treatment. It is important to remember that offloading fluid can be an important part of managing the condition.

Managing fluid intake

Patients with heart failure should follow the specific fluid intake advice given by the heart failure team, as restrictions are common. While staying hydrated is very important, excessive fluid consumption can worsen fluid retention and increase urine production.

If you're unsure how much water to drink, speak to your doctor or specialist nurse for professional advice.

Pelvic floor muscle exercises

In some cases, weak pelvic floor muscles can play a role in contributing to urinary incontinence. You can strengthen your pelvic floor muscles by doing things like Kegel exercises. Guidance from a pelvic floor physiotherapist is often recommended to ensure correct technique. While you can do these exercises with a pelvic floor physiotherapist, you can also do them in the comfort of your own home once you know the correct technique.

Lifestyle changes

Living a healthy and well-balanced lifestyle is good for both your bladder and heart health. Make sure you eat a nutritious diet, often low in salt, filled with plenty of fruits and vegetables, and manage your fluid intake as advised. You should also limit your alcohol consumption and quit smoking if you want to see an improvement in your general health. Maintaining a healthy weight can also be beneficial.

Managing stress

Stress can negatively impact your heart function and potentially worsen your incontinence symptoms, so it is essential that you find ways to relax, which may include hanging out with friends, taking a long bath, meditation, yoga, or simply reading a good book.

FAQs

What is chronic heart failure?

Chronic heart failure is a long-term condition where the heart does not pump blood as effectively as it should. Over time, the heart may struggle to pump enough blood to meet the body's needs. Management often involves medication, lifestyle changes, and sometimes devices like pacemakers or surgery.

What are the different types of urinary incontinence?

There are five main types of urinary incontinence, including:

• Stress incontinence- Caused by physical actions like jumping, laughing, and coughing.

• Urge incontinence- Preceded by a sudden strong urge to pee.

• Mixed incontinence- A combination of urge and stress incontinence

• Overflow incontinence- Leaks happen because the bladder doesn't empty properly.

Functional incontinence- Caused by physical or cognitive barriers to using the bathroom.

Are heart failure and heart disease the same?

No. Heart failure is a specific syndrome resulting from the heart’s inability to pump efficiently, while heart disease is a broad term used to refer to various heart-related conditions (like coronary artery disease, arrhythmias, and valve problems). Heart disease can lead to heart failure.

What are some of the other conditions that cause urinary incontinence?

Some of the other conditions that can cause or contribute to urinary incontinence include diabetes, multiple sclerosis, stroke, Parkinson’s disease, brain tumours, interstitial cystitis, pelvic floor conditions, obesity, menopause, and constipation, among others.

Why is heart failure so common these days?

Heart failure is becoming more common because people are living longer with conditions that can lead to it (like high blood pressure and coronary artery disease), alongside factors like unhealthy diets, obesity rates and socioeconomic factors influencing access to healthcare and healthy lifestyles.

How do I keep my heart healthy?

If you want to look after your heart health, you should exercise regularly (within your capacity), eat a wholesome diet (low in saturated fat, sugar, and salt), quit smoking, stay away from processed food, manage your stress levels, limit alcohol intake and make sure you get enough sleep. Regular check-ups with your GP are also important.

Final Thoughts

If you're a heart failure patient who has experienced any type of urinary incontinence, you are not alone. While urine leakage can be embarrassing and frustrating, there is no reason to feel ashamed as your symptoms are understandable..

However, you should be aware of the ways in which heart failure and its treatments can influence incontinence. Here at Jude, our online blog is filled with all sorts of useful information. Always consult with your doctor and don't let your diagnosis hold you back from living an active and fulfilled life. Take the next steps to manage your condition so you can go about each and every day with confidence.