Menopause and Incontinence
What is incontinence in menopause?
Menopausal incontinence is when women occasionally lose control of their bladder, resulting in urinary leakage.
What causes incontinence during and after menopause?
- There are three different types of incontinence during menopause that are differentiated by their causes.
- Stress incontinence. This is caused by physical stress or exertion that puts pressure on the bladder, causing urine to leak. Coughing, laughing, sneezing, exercise, and heavy lifting are some activities that can lead to this type of incontinence.
- Urge incontinence. Also known as overactive bladder, the symptoms are a constant or sudden need to urinate.
- Overflow incontinence. This occurs when the bladder doesn’t completely empty during urination.
What is happening inside your body?
During menopause, estrogen levels decline, affecting the muscles and tissues involved during urination. Lower estrogen levels thin the lining of the urethra, making it more prone to leakage. It also causes a weakening of the pelvic floor muscles, which line the bottom of the pelvis, surround the urethra, and hold up the bladder, bowel, and uterus.
Other menopause-related changes like weight gain and chronic constipation can also apply pressure to the bladder causing it to contract, fill, or empty improperly.
What are some medical-provider-prescribed treatments for incontinence in menopause?
- Anticholinergic drugs: This drug counteracts the effects of acetylcholine, a chemical messenger in the body involved in abnormal bladder contraction, helping incontinence caused by an overactive bladder.
- Topical estrogen: This treatment provides a low dose of estrogen to the vagina and urinary tract area—helping counteract changes like weakening of the pelvic muscles and thinning of the urethral lining.
- Pessaries: This soft device is inserted into the vagina to compress the urethra and support the bladder, helping prevent leakage. For people with severe stress incontinence, pessaries can be a helpful alternative to surgery.
- Surgery: When other treatments do not achieve the desired results, your doctor may recommend surgery that adds support to the bladder and urethra.
What are some non-medical treatments for menopause-related incontinence?
- Kegel exercises: Training your pelvic floor muscles, which support the bladder and urethra, can give you greater bladder control. Kegel exercises are done by tightening the muscles for 3-5 seconds, relaxing them, and repeating the process ten times, three times a day.
- Liquid consumption awareness: Drinking caffeine, alcohol, acidic or carbonated drinks can increase activity in the bladder, making incontinence worse. Steering clear of these drinks can help curb incontinence. If the urge to urinate or leakage tends to happen during the night, 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 is adjusted over time as you get used to longer breaks between bathroom visits.
- Weight loss: Excess weight can put additional pressure on your bladder and lead to incontinence. Talk to your provider to help you determine whether following a weight loss program or exercise regime can alleviate some of that pressure.
What should you do next?
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- 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.