Urinary incontinence in perimenopause and menopause – what you need to know

Today's Topic

Today on A.Vogel Talks Menopause,  I'm going to be talking about urinary incontinence in perimenopause and menopause and what you need to know about it.

Now, it's actually staggering that in the UK, 40% of women in perimenopause, menopause, and post menopause will end up experiencing urinary incontinence (According to a study by the University of Birmingham about 40% are affected by the condition)¹. That's a huge number of women that are going to find a lot of discomfort over the years. So, let's look at the causes, what happens, and also, the things you can do to help yourself.

What causes urinary incontinence in menopausal women

We know if oestrogen levels start to fall, this can affect bladder function generally. Your bladder can get weaker, meaning it can't hold as much. The bladder valve may get weaker, so you leak a little bit. It can also become more sensitive, so it can be more easily irritated by the things that you're eating and drinking.

It can also be caused by pelvic floor weakness. The pelvic floor muscles hold your bladder up. And we know that having children can be a long-term, contributory factor to this as well.

What are the different types of urinary incontinence?

Here are 3 types of urinary incontinence and the symptoms that can be experienced:

1. Stress incontinence

This is very often due to the weakening of the pelvic floor muscles. The bladder can shift position, meaning it can be more affected by any muscle action that goes on in the abdominal and pelvic areas.

With stress incontinence, you may find that you leak if you laugh, if you're doing sports, if you're coughing, if you're lifting objects; because, if you're lifting or coughing, everything you're doing is working on the whole abdominal area. And that can actually cause your abdominal muscles and your diaphragm to press down. And all it's doing is squeezing the bladder, which just can't cope with that; hence, you end up dribbling or leaking.

2. Urge incontinence

This is a very sudden, intense feeling that you have got to go to the toilet. Very often, there is no warning with this. It can happen when your bladder is overactive or irritated. It's a really common symptom after a bladder infection such as cystitis, before the bladder gets rebalanced again.

It often happens when you're sleeping, which is disconcerting. It will often be exacerbated by drinking alcohol; and also, it's one of these psychological ones: if you're listening maybe to meditation music and you can hear water tinkling, or you see a fountain, or you're walking by a river, just the sound of water can suddenly make you want to run to the toilet.

3. Overflow bladder / Overflow incontinence

This can occur when your bladder is underactive. The valve is not opening when it should, so you feel you have a full bladder, but don't feel like you're able to empty it properly.

If you've had a damaged bladder, maybe during childbirth, or due to some operation, the bladder's maybe now not functioning particularly well and has lost some of its nerve function.

It can also be that you've got a blocked urethra, although this can be quite serious.

So, with this particular one, you keep needing to go to the toilet, but, after you've been, you feel like you haven't emptied your bladder. And when you do go to the toilet, it tends to be just a little dribble or a weak stream rather than emptying your bladder.

This one can also be caused by a prolapse. If your bladder shifts and ends up being in a completely different position, then the whole physical mechanism of the bladder may be affected.

What can help urinary incontinence in perimenopause and menopause?

So, what can you do to help yourself? Here are a few things that I recommend:

Stay well hydrated: I know, this sounds a bit counterproductive, doesn't it? Here you are leaking and dribbling, and having problems with your bladder, and I'm telling you to drink more water.

The problem is, if you get dehydrated, this is going to affect your bladder. Your urine is going to get very acidic, which is going to irritate your bladder, and this will make all these symptoms worse.

And the other really important thing here is you need to keep the integrity and the size of your bladder. The more dehydrated you get, the more your bladder can shrink, and the worse your symptoms are going to get. So, keeping your bladder well flushed with water can be really, really helpful.

If you haven't started drinking a lot of water and you want to start, do it slowly; because in these conditions, if you drink a lot of water all at once, yes, you're going to be running to the toilet again and again. So, just introduce the water slowly over a few weeks, and that should make a positive difference.

Exercises to strengthen pelvic floor muscles: Exercising the pelvic floor muscles is so important. These muscles support your bladder, your womb, and your bowel. If they get weaker, you can end up with a complete prolapse. So, your bladder, bowel, and uterus can all shift position and that can cause a lot of problems, both with periods if you're still menstruating, but also bowel function as well.

There are loads of exercises on YouTube, but I would really recommend going to see a practitioner. A few years ago, I actually went to a lecture by an experienced Pilates instructor who focused on women's pelvic health. She said that she would get a lot of clients coming to her who had followed YouTube instructions, had got it completely wrong, had focused on the wrong muscles, and had actually ended up making things worse.

So, consult a Pilates instructor. You may only need one or two lessons. They can teach you which muscles to use and how to practice exercises on a regular basis. And this can actually reverse some of the bladder conditions.

For those of you who are just hitting perimenopause, start these exercises, now because the stronger your pelvic girdle muscles are as you go through menopause, the less likely you are going to end up with any bladder problems. It's really important to start this as early as you possibly can.

Cut back on your caffeine and alcohol consumption: You don't want to be drinking a lot of drinks that are going to irritate your bladder further.

When should you consult your doctor?

The problem with this particular condition is that there aren't really any over-the-counter remedies that are going to help. It's very much a structural issue. So, this is why doing things like Pilates is absolutely vital, because it's basically the only real way you're going to get good results in this situation.

There are some situations when we do advise that you speak to your doctor. If you find that you're getting constant pressure, it feels like your bladder's pressurised the whole time, that could be a prolapse, which does need investigating. Also, if you find that you're in constant pain with this, either just general bladder pain, or irritation, or it's painful when you urinate, and also if you get blood in your urine, these are not situations where you should just be self-medicating. Please get this checked out by your doctor first.

I hope you found this one helpful. It's not really talked about often in perimenopause and menopause. But if 40% of women are getting this, then it's something that really needs to be brought to the fore.

So, if any of you have any tips on things that you've done to help this symptom if you've had it, then please do share because this is one that we really all need to talk about.

Until then, I will see you next time for another edition of A.Vogel Talks Menopause.

You may also find these topics helpful:

6 vaginal and urinary symptoms of menopause

How menopause affects your bladder & signs of bladder problems

How does menopause affect your pelvic floor muscles?