New research from the University of Adelaide shows middle-aged women are more likely to suffer depression from a common medical problem that they find too embarrassing to talk about: urinary incontinence.
However, help is available for women if they seek medical advice, researchers say.
In a study of the experiences of women with urinary incontinence, researcher Jodie Avery found that middle-aged women with incontinence (aged 43-65) were more likely to be depressed than older women (aged 65-89).
Speaking in the lead up to World Continence Week (24-30 June), Ms Avery says the younger women's self esteem is often hit hard by urinary incontinence, while older women tend to be more resilient and accepting of their condition.
"Women with both incontinence and depression scored lower in all areas of quality of life because of the impact of incontinence on their physical wellbeing," says Ms Avery, a PhD student and Senior Research Associate with the University's School of Population Health and School of Medicine.
"Key issues for younger women affected by incontinence are family, sexual relationships and sport and leisure activities.
"The most common difficulties women express about their incontinence are things like: 'I can't play netball', 'I can't go to the gym', 'I can't go for walks', or 'I can't go dancing', and these are real issues for women who are still in the prime of their lives."
Urinary incontinence affects approximately 35% of the female population. The main cause in women is pregnancy, with the number of children they have increasing their chances of becoming incontinent.
"Our studies show that 20% of the incontinent population has depression, and this is something that we need both sufferers and GPs to better understand," Ms Avery says.
"Sufferers of incontinence are often reluctant to get help, but attitudes are slowly changing. It is very important for them to seek advice about their condition. In some cases, urinary incontinence can be curable with an operation, and this is quite literally a life-changing operation for many women.
"GPs need to be aware that if their patient is suffering from incontinence, this condition is often linked with depression which needs to be treated to increase their quality of life.
"Ultimately, we hope that our research helps to raise awareness in the community about both the mental and physical issues associated with incontinence. We know it's embarrassing, but if you discuss it with your GP, your life really can change."
Explore further: Genes an important factor in urinary incontinence