Urinary Incontinence in Perimenopause and Menopause
During all three of my pregnancies, I carried my children low, as they say in fertility and pregnancy circles. Not only did I carry them low, but with my third child, her head was resting squarely on my bladder throughout the entire pregnancy.
When you are about to give birth, a baby with its head facing downward is a perfect scenario for labor and delivery. But, a baby twisting and turning its head right on top of your bladder is – well, you get the picture. Whenever I felt a sneeze coming on, I would quickly squeeze my legs together, and for good measure, throw a hand down there to hold everything in place. It was effective. I know, because on those rare occasions when I didn’t do that, well, you get that picture too.
Urinary incontinence is great fodder for humor during pregnancy. But, once you reach menopause, urinary incontinence is not so funny anymore. If you thought that adult incontinence products were primarily marketed to the elderly and the infirm, think again. 30 to 70% of all women in perimenopause and menopause suffer with urinary incontinence in some form: stress incontinence, urgency incontinence, and incontinence due to a loss of estrogen.
Stress incontinence is bladder leakage which occurs during physical activity – sneezing, laughing, running, jumping, or just lifting or bending over. Stress incontinence is common during pregnancy because of the pressure placed on the bladder, and after giving birth, because of the weakening of the pelvic floor muscles during vaginal deliveries. It’s no surprise then that stress incontinence occurs twice as much in women than it does in men.
Stress incontinence can usually be remedied by strengthening the pelvic floor muscles with Kegel exercises. Finding the muscles, however, is not always easy. If you have problems with the method of Kegel exercises, as a lot of women do, you can actually purchases special weights which you insert like a tampon. The muscles you use to hold the weight in place are the muscles which are targeted by the Kegel exercises. When strengthened, the pelvic floor muscles can hold the bladder in position, and help keep the urethra closed.
Urgency incontinence occurs when you have a sudden urge to urinate and cannot hold it in. It is caused in part by an over-active bladder. It is common among women who have had C-sections, people who are obese, men who have had prostate surgery, and even for people with diabetes, or who have had a stroke and have incurred nerve damage.
Like stress incontinence, urgency incontinence can also be treated with Kegel exercises, but sometimes requires medication and surgery.
Incontinence Due to Loss of Estrogen
Like vaginal tissue, the muscle tissue in and surrounding the bladder and urethra requires estrogen to remain strong and supple. When estrogen levels drop in menopause, the muscle tissue around the bladder and urethra become thin and weakened, which can lead to incontinence. If you are suffering from incontinence due to a loss of estrogen, the urethral tissue, when examined, will appear pale or white, instead of pink and moist.
Again, Kegel exercise can strengthen the pelvic muscles and provide structural support to the bladder and help close off the urethra. Estrogen therapy can also help, sometimes with topical estrogen applied directly to the muscle tissue, in addition to dietary changes which can help your body produce more estrogen as well.
While it may sound contradictory, drinking plenty of fluids and emptying your bladder often, is also helpful for incontinence. The sheer act of holding the urine helps to strengthen the muscles around your bladder and urethra.
In extreme cases where hormone therapy, exercise, and diet changes are not effective, surgical options may be necessary.
Magnolia Miller is a certified healthcare consumer advocate in women’s health and a women’s freelance health writer and blogger at The Perimenopause Blog.