When people think of menopause, hot flashes, mood swings, and changes in libido often come to mind. An issue that doesn't receive nearly as much attention–but is equally significant–is urinary incontinence.
Leaking urine can be embarrassing and, rather than talk about it, many women choose to deal with it alone. Rather than asking for help, they use sanitary pads to manage leakage or avoid activities they normally enjoy like jogging or playing pickleball in order to prevent accidents.
Does that sound like you? If so, read on because, thankfully, there's a better way. In this blog we’ll explore what causes incontinence during menopause and describe the range of treatments and management strategies that are available to help control it.
Does Menopause Really Cause Urinary Incontinence?
During menopause, estrogen levels naturally decline, often triggering something called genitourinary syndrome of menopause, of GSM (1). Genitourinary syndrome of menopause is a term used to describe a whole cluster of symptoms that affect the genital areas (vagina and vulva) and urinary tract, all of which are associated with the loss of estrogen.
Vaginal dryness and irritation, pain with intercourse, and urinary incontinence are among the most common symptoms of GSM. This means that blood flow to genitals and urinary tract will decrease, causing tissues to thin and become less elastic, which can affect continence in two ways:
1. Weakening of the Pelvic Floor
The pelvic floor is a group of muscles and ligaments that support the bladder, bowel, and uterus. When estrogen levels are low, these tissues weaken causing the pelvic organs to drop (also known as prolapse).
This can cause a number of urinary issues, including:
- The need to pee more frequently.
- The need to pee during the night (a condition called nocturia).
- The urge to pee suddenly and unexpectedly.
- The inability to hold pee.
2. Decreased bladder capacity
Lower estrogen levels also appear to affect the bladder. The bladder tends to lose elasticity during menopause, reducing its capacity to collect and store urine and triggering the need to urinate more frequently (and sometimes more urgently).
Other Factors That Contribute to Incontinence
In addition to declining estrogen levels, there are several other things that can exacerbate incontinence:
Constipation. Constipation can put additional pressure on the bladder, making you feel like you need to pee more frequently and sometimes more urgently.
Weight Gain. Many women gain a bit of weight around the time of menopause. This extra weight can put added pressure on the pelvic floor, causing it to weaken and leading to loss of bladder control.
Medications. Medications can contribute to incontinence in a variety of ways. Some, for example, lead to incontinence by relaxing the bladder, while others do it by increasing the amount of urine that is produced. Some of the most common culprits include (3):
- Diuretics e.g. Esidrix, Lasix, Bumex, Maxzide.
- High-blood pressure medication e.g. Hytrin, Cardura
- Pain-killers e.g. Percocet, Demerol
- Antidepressants and sedatives e.g. Valium, Librium, Ativan.
- Antihistamines e.g. Benadryl, Chlor-Trimeton
Nerve Damage. If the nerves that control the bladder become damaged, it can lead to a condition known as neurogenic bladder and cause issues with bladder control (4).
Conditions that may cause neurogenic bladder include:
- Diabetes
- Stroke
- Parkinson's disease
- Multiple sclerosis
- Spinal cord injury
Surgery. Sometimes pelvic surgery can result in injury to pelvic organs, muscles, or nerves and lead to incontinence. The most common examples are:
- C-section
- Hysterectomy
- Prolapse repair
Common Types of Incontinence During Menopause (And Their Symptoms)
There are several different types of incontinence. Use the information below to help identify the type of incontinence you’re experiencing.
Stress Incontinence
- Symptoms: Leakage of urine when coughing, sneezing, laughing, or during physical activities.
- Triggers: Physical activities, coughing, sneezing, or laughing.
- Prevention & Treatment Options: Pelvic floor exercises, maintaining a healthy weight, avoiding heavy lifting, pelvic floor muscle training, surgery in severe cases, biofeedback.
Learn more about stress incontinence.
Urgency Incontinence
- Symptoms: Sudden, intense urge to urinate followed by an involuntary loss of urine.
- Sudden changes in position, the sound of running water, drinking fluids.
- Prevention & Treatment Options: Bladder training, reducing intake of diuretics, managing fluid intake, medication, bladder retraining, pelvic floor muscle training.
Overflow Incontinence
- Symptoms: Frequent or constant dribbling of urine due to a bladder that doesn't empty completely.
- Triggers: Bladder being too full, often without a strong urge to urinate.
- Prevention & Treatment Options: Scheduled toileting, managing chronic conditions, pelvic floor exercises, catheterization in some cases, medication to improve bladder emptying.
Learn more about overflow incontinence.
If your symptoms seem to fall into more than one of these categories, you may be experiencing “mixed incontinence.” Mixed incontinence affects 30% of women with urinary issues (6) and, while its treatment is more complex, solutions are still possible.
Breaking the Stigma Behind Menopause Incontinence
60% of women experience incontinence at some point in their lives, but only around 34% seek help (7).
If you’re experiencing urinary problems, you might be reluctant to speak to your doctor about them. Some of the most common reasons women cite for not discussing it include:
- Embarrassment.
- Belief that there are not effective treatment options.
- Concern that treatments pose unreasonable risks.
What every woman needs to know however is that there are effective treatments and management strategies, and one of the best ways to learn about them is by talking openly with a healthcare provider.
How Do I Talk to My Doctor About Incontinence Without Feeling Embarrassed?
Keep a Diary of Symptoms
Start by keeping a diary of your symptoms and the things that trigger them. This will not only frame your conversation, it will also provide your doctor with important information about your symptoms and help them determine what treatments might work.
Other notable events to discuss with your doctor:
- Any pelvic surgeries that you’ve had.
- A list of your current medications and existing medical conditions.
Prepare Your Conversation Starters
At your appointment, it’s a good idea to use a pre-prepared conversation opener. This will help you to overcome any nervousness.
Here are some ideas to get you started:
- "I’ve been experiencing some issues with bladder leakage that I think might be related to menopause. I’ve kept a diary of my symptoms that I’d like to show you."
- "I’m a little embarrassed to talk about it, but I’ve been experiencing incontinence, and I’d like to discuss causes and potential treatments. "
After speaking with your doctor, you may be referred to a specialist called a urogynecologist.
Unlike traditional urologists, urogynecologists only treat women and have a particular focus on the pelvic floor.
It’s a specialty that’s only been around since 2013 and has made great strides in treating post-menopausal incontinence.
Treatment for Incontinence
Once your physician determines what type of incontinence you are experiencing and evaluates its severity, they will likely discuss a variety of treatment options (8):
Behavioral Modification
There are a number of behavioral tricks that many people find useful. Leaks due to overflow incontinence (overfilling of the bladder) for example can often be avoided by urinating at regular intervals, say every 2 to 3 hours. Double voiding (urinating and then urinating again just a few minutes later) on the other hand can benefit people with overactive bladder who have difficulty emptying completely.
Bladder Retraining
Bladder retraining involves gradually increasing the amount of time between bathroom trips in order to teach the bladder to hold more urine for longer stretches.
Biofeedback
Techniques like biofeedback can be useful in teaching Kegels and other exercises that help strengthen the pelvic floor.
Medication
There are several medications that can be helpful in managing some of the symptoms of incontinence, including urinary urgency and frequency. These include medications called anticholinergics and beta-3 adrenergic agonist medications.
For some types of incontinence, topical estrogen can also be helpful.
Electrical Stimulation
Temporary electrodes can be used in the vagina or rectum to stimulate and strengthen the pelvic floor.
Injections
Sometimes incontinence, stress incontinence in particular, is treated by injecting a bulking material into the wall of the urethra (the tube that carries urine out of the body).
Surgical Options
Depending on the cause and severity of incontinence, surgery is sometimes warranted. The type of surgery that is needed depends largely on the underlying cause of the urinary leakage. If the problem is uterine prolapse (the uterus has dropped into the vagina), then repair of the prolapse might be indicated; if on the other hand the issue is a stiff (inelastic) bladder, a procedure to make the bladder larger may be what’s necessary.
Lifestyle Modifications for Managing Symptoms
Alongside any treatment your doctor can provide, some key lifestyle modifications may also help alleviate your symptoms of incontinence.
Dietary and Fluid Intake Adjustments. Track your water intake. Drinking too much can cause you to pee too often, while drinking too little isn’t good for your kidneys and can lead to dehydration. Try tracking your symptoms for several days to find a balance that works well for you.
Reduce Caffeine Intake. Caffeine is a mild diuretic; for some people, it can also irritate the bladder and aggravate symptoms of incontinence.
Avoid Alcohol. Alcohol can increase the amount of urine your body produces; it can also reduce control over your bladder leading to accidents..
Pelvic Floor Exercises. Work on strengthening your pelvic floor with Kegels or body-weight exercises like squats, bridges, and lunges.
Physical Activity. Regular walking, yoga, pilates, and other low-impact activities will strengthen your core and pelvic floor.
Weight Loss. Losing a bit of weight can reduce stress on your pelvic floor and may help improve, incontinence.
Keep in mind that evidence (9) for the effectiveness of these lifestyle changes is limited. So, try one at a time, and keep a diary to see how it affects your symptoms. You don’t want to put in the time and effort unless it works!
Daily Management Tips and Tricks
There are a variety of incontinence products available that can help you manage your incontinence and reduce its impact on your life day-to-day.
Incontinence Pads. Disposable pads and liners are thin and discreet and are designed to absorb light to moderate urinary leakage.
Absorbent Underwear. Absorbent underwear are great for all-day, everyday use. Consider a product like Boom Absorbent Underwear which are just as stylish and comfortable as regular panties but also absorb small bladder leaks.
Underpads. Protect your bed, car, and furnishings with absorbent pads for incontinence. They come in a range of sizes, styles, and absorbency levels to meet all needs.
Female Urinals. Sometimes it’s simply difficult to make it to the bathroom in time. Having a female urinal, like Loona, handy ensures you always have a quick and accessible way to relieve yourself.
What to Do Next
Now that you know how common, treatable, and manageable incontinence is, we hope you feel more comfortable seeking support. Help is out there that can ensure that life after menopause is rich and enjoyable.
References
1. https://www.ccjm.org/content/85/5/390
2. Yoav Baruch et al, Pre- versus Post-Menopausal Onset of Overactive Bladder and the Response to Vaginal Estrogen Therapy: A Prospective Study
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9963172/
3. Harvard Health Publishing, Medications That Can Cause Urinary Incontinence
https://www.health.harvard.edu/bladder-and-bowel/medications-that-can-cause-urinary-incontinence
4. Cleveland Clinic, Neurogenic Bladder https://my.clevelandclinic.org/health/diseases/15133-neurogenic-bladder
5. Gabriela Kołodyńska et al, Urinary Incontinence in Postmenopausal Women – Causes, Symptoms, Treatment
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528037/
6. Alex Gomelsky, Treatment of Mixed Urinary Incontinence https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3921730/
7. Giulia I Lane et al, Patient-Provider Discussions About Urinary Incontinence Among Older Women
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907491/
8. The Mayo Clinic, Urinary Incontinence
https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/diagnosis-treatment/drc-20352814
9. Imamura M, Williams K, Wells M, McGrother C, Lifestyle interventions for the treatment of urinary incontinence in adults
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8612696/
