Urinary incontinence and menopause
Urinary incontinence is an uncomfortable problem that many women try to hide. There's no need to feel embarrassed or to suffer in silence. Urinary incontinence is very common during and after menopause due to reduced levels of oestrogen. What exactly causes urinary incontinence? And what can you do to prevent leaking urine?
After giving birth, I began having issues with bladder control. Since menopause, it has gotten worse. I'm so self-conscious, I never know what to wear. - Karin (age 53)
Some symptoms of menopause, such as hot flashes and sleep problems, are widely known and spoken about. Urinary incontinence is more of a hush-hush topic. Nevertheless, it is a common symptom that many menopausal women experience. According to a 2019 study conducted by Kołodyńska, Zalewski and Rożek-Piechura, urinary incontinence is a serious social problem that affects more than 50 percent of postmenopausal women.
Urinary incontinence can affect people of any age. During perimenopause (around the age of 45), levels of oestrogen start to fluctuate and gradually decrease. A decline in oestrogen levels is associated with the loss of muscle strength and mass. This accelerates after menopause when oestrogen levels are consistently low, increasing the risk of urinary incontinence.
Pelvic floor exercises and muscle training help strengthen the pelvic muscles to prevent or control urinary leaking. Did you know that leakage of urine when you cough, run, jump, laugh or sneeze is called stress incontinence? It happens when pressure from these actions pushes down on the bladder.
What is happening in your body?
Menopausal urinary incontinence is usually due to weak pelvic floor muscles, the muscles that support the bladder, bowel and uterus. When you hold your urine, the pelvic floor muscles are contracted. The pelvic floor muscles also prevent you from unintentionally leaking urine when you sneeze, jump, cough or pick something up. When you have to pee, a sphincter muscle that keeps pee inside your bladder relaxes.
The pelvic floor can be weakened by pregnancy or childbirth. Pelvic floor muscles also tend to get weaker as we get older. As oestrogen and progesterone levels decrease in the years leading up to menopause, the pelvic floor muscles may become even weaker. Oestrogen in particular plays a crucial role in muscle growth and maintaining the strength and elasticity of muscles. The decline in oestrogen can affect the health of muscles, including the pelvic floor. Not only the pelvic floor muscles, but also the connective tissue and urethral sphincter muscles can become weak, resulting in involuntary urine leakage.
Other bladder issues
Weakness of pelvic floor muscles around menopause can also lead to other bladder issues, such as urinary frequency or urgency. This is because low oestrogen levels can result in increased sensitivity to irritants in urine.
A decline in oestrogen can also throw off your vaginal pH and cause a decrease in vaginal blood flow, resulting in thinner, drier and more sensitive vaginal tissues. This allows bacteria and pathogens to enter the urethra more easily, causing a urinary tract infection, bladder infection or vaginal yeast infection.
What can you do?
Urine incontinence, or the involuntary leakage of urine, is a common symptom that affects many women. It does not resolve spontaneously but, thankfully, you can train your pelvic floor muscles to more effectively hold back the leaks. Here are some tips:
- Exercise regularly. Sports activities, such as yoga, Pilates, swimming, cycling and running are important tools, because they strengthen and activate the pelvic floor, engage the muscles with core-focused movements while providing gentle support. Exercise is also good for losing weight. Are you overweight? Being overweight can contribute to stress incontinence by increasing pressure on the abdomen and pelvic floor.
- Avoid jumping and heavy lifting. This puts pressure on the pelvic floor and can make incontinence worse.
- Try using vaginal cones or balls. The balls or cones are inserted into the vagina. They are used to strengthen the pelvic floor by contracting and releasing different muscles.
- Do pelvic floor exercises. You can book a physiotherapy appointment for this purpose, or you can do the exercises at home. There are lots of YouTube videos with pelvic floor exercises as well as pelvic floor exercise apps.
Do you need more support?
A healthy lifestyle can only do so much. Sometimes, supplements can provide that extra boost your body needs. Discover what supplements can support your health during menopause.
What treatments can help?
Pelvic floor exercises can be an effective and long-term solution for urinary incontinence. The pelvic floor muscles support the bladder and are located around the urethra. Doing regular pelvic floor exercises helps strengthen these muscles, reducing the risk of urine leakage.
Doing pelvic floor exercises has helped me control my bladder. The exercise videos on YouTube are now part of my weekly routine. - Anna (age 62)
Can hormone therapy help?
There is not sufficient scientific evidence that hormone therapy can improve incontinence symptoms. However, if you suffer from urinary incontinence as well as other menopausal symptoms, then you may benefit from hormone therapy. Hormone replacement therapy (HRT) replaces the hormones that your body produces less of as you go through menopause. HRT is recommended for women experiencing severe symptoms, such as hot flashes, sleep problems, vaginal dryness and mental health symptoms.
Sources
- Hillard, T. C. (2019). Pelvic floor function around the menopause and how to improve it. Climacteric, 22(3), 213–214. https://doi.org/10.1080/13697137.2019.1583827
- Kołodyńska, G., Zalewski, M., & Rożek-Piechura, K. (2019). Urinary incontinence in postmenopausal women - causes, symptoms, treatment. Przeglad menopauzalny = Menopause review, 18(1), 46–50. https://doi.org/10.5114/pm.2019.84157
- Rekers, H., Drogendijk, A. C., Valkenburg, H. A., & Riphagen, F. (1992). The menopause, urinary incontinence and other symptoms of the genito-urinary tract. *Maturitas, 15*(2), 101-111. https://doi.org/10.1016/0378-5122(92)90244-X
- Trutnovsky, G., Rojas, R. G., Mann, K. P., & Dietz, H. P. (2014). Urinary incontinence: The role of menopause. *Menopause, 21*(4), 399-402. https://doi.org/10.1097/GME.0b013e31829fc68c
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FAQ
What causes urinary incontinence in menopausal women?
Urinary incontinence is usually caused by weakening of the pelvic floor muscles. This muscle weakness means that you're more likely to accidentally leak urine. Oestrogen benefits muscle strength and recovery. As oestrogen levels decrease around menopause women become increasingly prone to urinary incontinence.
Is there anything I can do to manage menopause urine leakage?
Focus on strengthening your pelvic floor so that it's more capable of controlling your bladder. There are exercises that target your pelvic floor. Check YouTube for videos. Dedicate time in your week for these exercises. Activities that don't involve jumping or heavy lifting, such as Pilates, swimming or cycling, can also help to strengthen your pelvic floor muscles.
When should I talk to a doctor about urinary incontinence?
If pelvic floor muscle exercises aren't helping, talk to your doctor and get a referral to a pelvic physiotherapist. Do you also have other bladder issues, such as frequent bladder infections or pain after urinating? Then contact your doctor immediately.
