Symptom Guide: Incontinence

Jun 16, 2022
Medically reviewed by: 
Dr. Leah Millheiser, MD

What is Menopausal Incontinence?

During menopause, some women occasionally lose control of their bladder, resulting in urinary leakage. These accidents, which can be triggered by physical movement, coughs/sneezes, or sudden urges to use the bathroom, can become bothersome and embarrassing. Fortunately, in many cases this condition is temporary and can be managed with pelvic training and lifestyle changes.

What Causes It?

Incontinence during menopause usually comes in three types, differentiated by their causes. The most common, stress incontinence, is caused by physical stress or exertion that puts pressure on the bladder, causing urine to leak. Coughing, laughing, sneezing, exercise, and lifting heavy objects are some activities that can lead to this kind of incontinence.

Another type is urge incontinence—also known as overactive bladder—the symptoms of which are a constant or sudden need to urinate.

The third type is overflow incontinence, which occurs when the bladder doesn’t completely empty during urination. 

What’s Happening Inside Your Body?

The loss of estrogen during menopause affects the muscles and tissues involved in urination, leading to incontinence. It thins the lining of the urethra, the tube that carries urine from the bladder out of the body, making it more prone to leakage. It also causes a weakening of the pelvic muscles, which line the bottom of the pelvis, surround the urethra, and hold up the bladder, bowel, and uterus. When these muscles lose strength, leakage can occur.

Other menopause-related changes in the body can also lead to incontinence. Weight gain, for example, can put additional pressure on the bladder. Chronic constipation can cause large amounts of stool to build up in the colon, which can also apply pressure to the neighboring bladder. In turn, this can cause it to contract unnecessarily or fill or empty improperly.

What Does the Research Say?

  • Research published in the journal Menopause in 2021 found that postmenopausal women between age 45 and 54 are more likely to have overactive bladder syndrome (urge incontinence) than women of other age groups.
  • A review published by Cochrane Library in 2012 found that locally applied estrogen (such as vaginal creams or tablets) showed promise in helping alleviate incontinence. 
  • A small study published in Maturitas in 2019 suggested that pelvic floor muscle training, better known as Kegel exercises, is an effective treatment for urinary incontinence.

How is incontinence addressed?

Treatment usually depends on the type and severity of the incontinence you’re experiencing. If loss of bladder control is caused by weakened pelvic muscles, treatment can involve exercising those muscles to strengthen them. When weight gain puts excess pressure on the bladder, a doctor may recommend weight loss. In cases where the bladder is overactive, medications to control the bladder muscles may be prescribed. 

What are some effective medical treatments?

Anticholinergic drugs: If your incontinence is caused by an overactive bladder, a doctor may prescribe anticholinergic drugs like oxybutynin (Ditropan XL), tolterodine (Detrol), or darifenacin (Enablex). These drugs, which usually come in pill form, counteract the effects of acetylcholine, a chemical messenger in the body involved in abnormal bladder contraction. 

Topical (vaginal) estrogen: This type of treatment, which usually comes in the form of a cream, a tablet, or a vaginal ring, provides a low dose of estrogen to the vagina and urinary tract area. It can help counteract changes in the body that lead to incontinence, such as the weakening of the pelvic muscles and the thinning of the urethral lining. 

Pessaries: A pessary is a soft device that is inserted into the vagina to compress the urethra and support the bladder, helping prevent leakage. These devices are usually made of silicone and are removable; some types are removed nightly, while others are left in for up to three months. For people with serious stress incontinence, pessaries can be a helpful alternative to surgery.

Surgery: When other treatments don’t achieve the desired results, your doctor may recommend surgery that adds support to the bladder and urethra. Some types of surgery move the bladder into a position where it will be less exposed to pressure; other types insert a sling or move other tissues upward to provide physical support to the urethra and bladder. Note that surgical treatment is often used to address stress incontinence and may not be helpful for other types.  

What are some non-medical treatments? 

Kegel exercises: In many cases, stress incontinence is caused by the weakening of the muscles of the pelvic floor, which support the bladder and urethra. Training those muscles using Kegel exercises can help strengthen them, allowing for greater control of the bladder. This is most commonly done by tightening the muscles for 3-5 seconds, relaxing them, and repeating the process ten times, three times a day. 

Watch what (and when) you drink: Consuming caffeine or alcohol can increase activity in the bladder, making incontinence worse. Acidic drinks, like certain fruit juices, and carbonated drinks can have a similar effect by irritating the bladder. Steering clear of these drinks can help curb incontinence. If the urge to urinate or leakage tends to happen overnight, avoid liquids in the evening.

Bladder training: This technique trains the bladder to hold urine for increasingly longer periods of time, helping you regain control over it. Usually, it involves following a urination schedule that dictates when you can empty your bladder. This schedule is adjusted over time as you get used to longer breaks between bathroom visits.  

Weight loss: Excess weight can put pressure on your bladder and lead to incontinence. Your doctor can help you determine whether following a weight loss program or exercise regime can alleviate some of that pressure.

What to do next:

  • Connect with your primary care doctor: Speak with your doctor about the frequency and severity of your incontinence and any other health changes you might be going through. They can determine the type of incontinence you’re experiencing and the best treatment options.
  • Stick to your treatment plan: Incontinence can be frustrating, and techniques like bladder training and Kegel exercises can take a while to show effects. Do your best to stay motivated. Remember that these interventions can go a long way in improving bladder control, but they require consistent effort.
  • Be kind to yourself. Losing bladder control can be a source of embarrassment, but remember that it’s a normal experience for many women, and there’s absolutely nothing to feel ashamed about. Allow yourself to feel good about being proactive and seeking treatment.

Learn more:

Are you experiencing other symptoms that you want to better understand? Check out our following guides:

Disclaimer: This information isn’t a substitute for professional medical advice, diagnosis, or treatment. You should never rely upon this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.