How to manage incontinence and overactive bladder during menopause

1. Incontinence symptoms
2. Lower your intake of caffeine
3. Regular bladder schedule
4. Kegel exercises
5. Healthy weight
6. Panty liners
7. Cream

As we age, our bodies undergo many changes, particularly after menopause. Some of these changes require medical intervention, while others are simply part of the normal aging process and, ultimately, things that we have to learn to live with. 

Unfortunately, many age-related changes come hand-in-hand with uncomfortable or embarrassing symptoms. Urinary problems are one of the best examples of this 
(consider this list of female urinals to help with incontinence ). When women are in their late 40s, production of the hormones estrogen and progesterone begins to slow, and by the time they are in their early 50s, hormone levels have typically fallen dramatically. In some women, for instance, estrogen levels can be as much as 10 times lower following their last menstrual cycle than just a few years earlier.

Declining hormone levels have far-reaching effects throughout the body that involve the heart and blood vessels, bones, skin and hair, brain, and, yes, the urinary tract.

Incontinence Symptoms

• Leakage of urine with coughs, sneezes, or exercise
• Leakage of urine on the way to the toilet
• The urge to urinate frequently
• Getting up one or more times per night to pass urine (nocturia)
• Frequent urinary tract infections

In the United States, close to 40 percent of women aged 60 and older experience urinary incontinence. Some develop what is referred to as urge incontinence, or the involuntary loss of urine associated with strong, unexpected urges to urinate; others suffer from stress incontinence, or a loss of urine associated with activities like running, jumping, sneezing, and coughing. Some women with incontinence have a condition called overactive bladder, or OAB. Women with OAB experience frequent and sudden urges to urinate that are difficult or impossible to control; they also typically need to urinate many times during the day and night.

The good news is that there are a number of ways to help manage incontinence without the use of medications or surgery. Lifestyle changes can make a big difference for many women. The following approaches are simple and safe, and most of them do not require a prescription from a doctor.

Lower your intake of caffeine 

Our bodies are sensitive to what we put in them. This includes the foods we eat, the medications we take, and even the beverages we drink. When it comes to urinary symptoms and incontinence, research suggests caffeine, and caffeinated drinks in particular, can be a real issue. Authors of an article published in the Journal of Urology in 2017 examined the association between caffeine intake and urinary symptoms. After reviewing 20 different studies on the topic, they concluded that people who consumed caffeine were significantly more likely to experience urinary frequency and urgency than individuals who remained largely caffeine-free. The fact that caffeinated drinks are a mild diuretic and increase the need to urinate could, at least in part, contribute to this finding. There is also some evidence that caffeine acts directly on the bladder, irritating it and potentially causing involuntary contractions.

Regardless of how caffeine triggers urinary symptoms, it is probably best to limit your consumption of coffee, soda, and energy drinks if you suffer from incontinence or OAB. Keep in mind that eliminating caffeine entirely is probably unnecessary, and it is probably just fine to continue to enjoy your regular morning cup of coffee or tea. But, if you are someone who drinks caffeinated beverages throughout the day, cutting back to see if your urinary symptoms improve is worthwhile. 

Put your bladder on a regular schedule

Bladder training is an important technique that can help women with urinary frequency, urge incontinence, and OAB. The technique teaches the bladder to hold more urine for longer periods of time, ultimately reducing the number of trips that need to be made to the bathroom.

Urinating too frequently, when the bladder is relatively empty, establishes an unhealthy pattern that is reinforced the longer it goes on. Bladder training breaks that cycle by establishing regular, fixed times throughout the day to use the bathroom. Even when you have a very strong urge to urinate, you need to wait until the designated time to void. Gradually, the length of time between bathroom breaks is extended and new, healthier habits are formed.

Do Kegel exercises

Kegel exercises are simple maneuvers that strengthen the muscles of the pelvic floor. The pelvic floor is a group of muscles and ligaments that extend across the pelvis and support the pelvic organs, including the bowel, uterus, and bladder. When the pelvic floor becomes weakened, it can create problems with bladder control and lead to incontinence.

Kegel exercises involve squeezing, holding, and then relaxing the pelvic muscles. Although that sounds straightforward, when attempting to do Kegels, many women have trouble isolating the correct muscles, contracting the inner thighs or buttocks instead of the pelvis. To properly exercise the pelvic muscles, try squeezing the muscles you would use if you wanted to stop yourself from passing gas or urinating. Alternatively, when you are on the toilet, try stopping your urine mid-stream and then releasing it. As with any strength-training routine, to be effective, Kegels need to be done regularly. Ideally, you can find a few minutes to practice them intermittently throughout the day. Doing eight or 10 repetitions of Kegels three or four times a day can go a long way in preventing bladder leakage.  

Maintain a healthy weight

While everyone benefits from maintaining a healthy weight, for women with incontinence doing so provides unique benefits.  Being overweight not only increases the risk of diabetes, high blood pressure, heart disease, and cancer, it also exacerbates symptoms of urinary incontinence. Although physicians do not completely understand why, some believe that abdominal fat puts excess pressure on the bladder; others hypothesize that being overweight strains tissues in the pelvic area, including the bladder, causing them to weaken. 

The good news is that weight loss appears to alleviate symptoms of urinary incontinence. A study performed in 2020 by the American Urogynecologic Society found that behavioral weight loss that includes diet and exercise leads to moderate reductions in the risk of urinary incontinence among women, particularly in the short-term.

Use pantyliners

Panty liners are thin, absorbent pads worn inside underwear. Most have a sticky adhesive backing to secure them in place, and some have “wings” that wrap around the sides of underwear and provide additional security and protection. While panty liners are not a solution to incontinence, they are a simple and practical way to help  manage many of the inconveniences associated with it.

Unfortunately, women frequently shy away from using panty liners because they think liners feel bulky or are concerned that they can be seen through their clothes; others prefer not to use liners because they think they are unhygienic. Fortunately, panty liners now come in a wide variety of shapes and sizes, many of which are very small and thin, making them both comfortable and unobtrusive. And, as long as they are changed regularly, using patty liners is likely more hygenic–and far more comfortable–than being stuck wearing moist clothing. 

Talk to you doctor about vaginal estrogen cream

When behavioral and lifestyle changes fail to work, there are prescription options that can be used to help alleviate symptoms of incontinence and overactive bladder. There is, for example, some evidence to suggest that vaginal estrogen can strengthen the muscles and connective tissue in the pelvic floor and help improve urinary symptoms, including urinary frequency and urgency. (Interestingly, estrogen taken by mouth does not seem to have this beneficial effect.)

Although lifestyle and behavioral techniques should almost always be tried first, it is important to know there are effective medical and surgical options for treating urinary problems if you need them.

This article was written by Dr. Shani Saks