Menopause and Urinary Incontinence
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Menopause and Urinary Incontinence

Overview

You don’t have to accept occasional bladder leakage as another side effect of menopause or aging. In many cases, there are things you can do to stop and even prevent urinary incontinence.

Urinary incontinence (UI) is also known as “loss of bladder control” or “involuntary urinary leakage.” Millions of women experience it, and the frequency of UI tends to increase as you get older. The loss of control can be very minor. For example, you might only leak a few drops of urine when you laugh, exercise, cough, or pick up heavy objects. Or you might experience a sudden urge to urinate and be unable to keep it in before reaching the restroom, resulting in an accident.

You can experience UI throughout your life, but most episodes are the result of pressure or stress on the muscles that help you hold or pass urine. Hormone changes can also affect your muscle strength in the pelvic region. Therefore, UI is more common in women who are pregnant, giving birth, or going through menopause.

Estrogen is a hormone that helps regulate your menstruation. It may protect against heart disease and slow bone loss. It also helps keep your bladder and urethra healthy and functioning properly. As you near menopause, your estrogen levels begin dropping. This lack of estrogen may cause your pelvic muscles to weaken. They may no longer be able to control your bladder as they did before. As your estrogen levels continue to drop throughout and after menopause, your UI symptoms may become worse. 

Causes of Urinary Incontinence

Causes Icon

A few different types of urinary incontinence are associated with menopause. These include:

Stress Incontinence

The most common kind of bladder control problem in older women is stress incontinence. Weakened muscles can’t hold back urine when you cough, exercise, sneeze, laugh, or lift something heavy. The result can be a small leakage of urine or a complete loss of control. This type of incontinence is most often caused by physical changes that result from pregnancy, childbirth, or menopause.

Urge Incontinence

When your bladder muscles squeeze incorrectly or lose the ability to relax, you may feel a constant urge to urinate, even when your bladder is empty. You may also experience leaking of urine or loss of control. This is sometimes called an “overactive bladder.”

Overflow incontinence

When your bladder does not empty fully, this type of UI can show as continuous urine dribbling. You can have a weak urinary stream, feel like urinating at night (nocturia), and increased urinary hesitancy. This can be caused by underactivity of the bladder muscle.

Understanding Your Risk

Risk Factors

Menopause isn’t the only cause of bladder control problems. If you have menopause along with one of the following conditions, your risk of developing UI increases.

Drinking Alcohol or Caffeine

Beverages with alcohol or caffeine fill your bladder quickly, causing you to urinate more often.

Infections

Infections of your urinary tract or bladder may cause temporary UI. When the infection is cleared, your UI will likely resolve or improve.

Nerve Damage

Nerve damage can interrupt signals from your bladder to your brain so you don’t experience the urge to urinate. This can negatively impact your ability to control urination.

Certain Medications

UI can be a side effect of some medicines, such as diuretics or steroids.

Constipation

Chronic, or long-term, constipation can affect your bladder control. It can also weaken your pelvic floor muscles, making it harder to hold in urine.

Being Overweight

Carrying excess weight increases your risk of UI. The extra weight puts pressure on your bladder. It can cause UI or make it worse.

Treatment Options

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Your treatment for UI depends on several factors, including the type of incontinence you’re experiencing and what is causing your UI. Your doctor might start by suggesting lifestyle changes. For example, they might encourage you to:

  • cut back on your caffeine and alcohol consumption
  • gradually retrain your bladder to hold more urine by only urinating at certain preplanned times of the day
  • lose weight to reduce the pressure on your bladder and muscles
  • use Kegel exercises, or pelvic floor exercises, to strengthen your pelvic muscles

Kegel exercises involve squeezing and relaxing the muscles in your pelvic and genital areas to strengthen them. This may help you develop better bladder control.

Your doctor may also recommend more involved treatment options, especially if they don’t think that lifestyle changes are helping. These treatment options are described below.

Medications

Certain medication may help reduce your symptoms and treat some types of UI. For example, your doctor may prescribe anticholinergics to calm your bladder if it’s overactive. They may prescribe Mirabegron (Myrbetriq), a special type of medication called a beta-3 adrenergic receptor agonist, to increase the amount of urine your bladder can hold. Topic estrogen products may also help to tone your urethra and vaginal areas.

Nerve Stimulation

Electrical stimulation of your pelvic muscles may help your regain control of your bladder if your UI is related to nerve impairment.

Devices

A number of devices are available to treat women with UI. A pessary is the most commonly used device for the treatment of stress incontinence. It’s a stiff ring that’s inserted into your vagina to help reposition your urethra in order to reduce leakage. Your doctor may also prescribe a urethral insert, a small disposable device that you can insert into your urethra to plug leakage.

Biofeedback

You can work with a therapist to better understand how your body works. In biofeedback, a wire is connected to an electrical patch over your bladder and urethral muscles. It sends signals to a monitor, which alerts you when your muscles are contracting. By learning when your muscles contract, you may be able to gain better control over them.

Surgery

Surgery to repair and lift your bladder into a better position is often the last resort for UI treatment. It’s considered for people who can’t be helped by other forms of treatment.

Long-Term Outlook

Icon Outlook

Many types of UI are temporary or improve with treatment. However, in some cases, your UI may be permanent or difficult to treat.

Even if your UI is permanent, you can take steps to better improve your management of your symptoms. For example, you can check your local drugstore for absorbent pads and protective undergarments for adults with UI. Most of these products are thin and easy to wear under your clothes, without anyone noticing. There’s no reason you can’t enjoy an active and confident life with UI.

Speak with your doctor to learn more about your condition, treatment options, and outlook.

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