Whether it’s needing to go more often or accidentally weeing yourself, urinary incontinence is really common during perimenopause and menopause — but unfortunately, it’s not spoken about enough.
Some signs you may be experiencing incontinence during menopause are:
Leaking urine when you cough, sneeze, laugh or exercise (stress incontinence)
Feeling a sudden, intense need to pass urine (urge incontinence or overactive bladder)
getting up often during the night to pass urine (nocturia)
frequent urinary tract infections (UTIs)
Although incontinence is often a byproduct of menopause, bladder leaks don’t have to be a “normal part of ageing”. Menopause may be unavoidable - but you don't have to suffer the symptoms of this life phase in silence.
So why is incontinence so common during menopause - and how can you manage bladder leaks?
Why does menopause make your bladder weaker?
During perimenopause and menopause, your body naturally stops producing the hormone oestrogen and over time, your levels decline until post menopause.
Oestrogen plays a key role in the health of your urinary and reproductive systems. The vagina, vulva, and urinary tract are packed with estrogen receptors, so as oestrogen levels drop your pelvic organs can really suffer. Declining estrogen can mean that:
The lining of your bladder and urethra become thinner and less elastic
Pelvic floor muscles become weaker
Vaginal tissues become thinner, drier and less elastic
As the lining of your bladder and urinary tract become thinner and your pelvic floor weakens, it becomes harder to hold in urine, making you more susceptible to bladder leaks.
Declining levels of oestrogen can cause other problems, such as:
Pelvic organ prolapse. This is when the muscles in your pelvic floor weaken, causing the uterus or bladder to move out of place and bulge on your vaginal wall.
UTIs. Lower levels of estrogen can thin the lining of your vagina and urinary tract, making it more susceptible to harmful bacteria. It can also affect your vaginal pH, making your urinary tract more vulnerable to infection-causing bacteria.
Vaginal atrophy. This is when the lining of the vagina becomes thinner, less elastic and loses its natural lubrication. Vaginal atrophy can cause pain and discomfort, especially during sex.
What are the most common types of incontinence during menopause?
There are a number of different types of incontinence that you might experience during this midlife phase of your life. Here's the most common:
Stress Incontinence
Stress incontinence is the most common form of incontinence during menopause. It occurs when pressure on the bladder increases (think coughing, sneezing, laughing, or lifting something heavy). With the drop in oestrogen levels, the tissues around the bladder and urethra can weaken, making it harder to control urine during these everyday activities.
How can stress incontinence be treated?
The good news is that stress incontinence can be usually managed and treated through a variety of methods that may suit you and your lifestyle. Here are some of the most common approaches to help alleviate symptoms of stress incontinence:
Pelvic Floor Exercises: Strengthening the pelvic floor muscles with Kegel exercises can help improve bladder control and reduce leakage.
Lifestyle Changes: Staying hydrated, maintaining a healthy weight, and avoiding bladder irritants like caffeine can reduce pressure on the bladder.
Physiotherapy: A pelvic health physiotherapist can guide you through targeted exercises and biofeedback to strengthen your pelvic muscles.
Pessary Device: For more severe cases, a pessary can be used to support the bladder and reduce leakage.
Medications: Topical oestrogen creams can improve tissue strength and elasticity, especially if oestrogen deficiency is a factor.
Surgery: If other treatments don’t work, surgical options like sling surgery may be considered for more lasting relief.
It's worth discussing options with your GP or specialist to help you find the right treatment plan for you.
Other types of incontinence women experience during midlife are:
Urge Incontinence
Urge incontinence happens when you experience a sudden, intense need to urinate, often followed by leakage. It’s typically linked to an overactive bladder. Oestrogen loss can also affect the bladder’s ability to hold urine, and muscles around the bladder may contract involuntarily, causing that “gotta-go-now” feeling.
Mixed Incontinence
As the name suggests, mixed incontinence is a combination of both stress and urge incontinence. This means you might experience leaking during physical activities and also feel the urgent need to urinate more frequently or with less warning. It’s common during menopause because of the hormonal fluctuations affecting both the pelvic floor and bladder function.
Overflow Incontinence
Although less common, overflow incontinence can occur when the bladder doesn’t empty completely, causing leaks. The weakening of pelvic muscles and changes in nerve function due to menopause can sometimes contribute to this issue, leaving you with the sensation of always being "full" or needing to urinate more frequently.
Treatment for urinary incontinence during menopause
Bladder leaks don’t have to be an inevitable part of ageing, regardless of their severity.
Luckily, there are plenty of things you can do to improve bladder control during perimenopause and menopause.
Bladder training
Bladder training is a type of behaviour therapy done with the help of a specially trained expert used to treat incontinence.
Bladder training teaches you to gradually hold in pee to prevent unwanted leaks.
Pelvic floor exercises
Pelvic floor exercises can be done from the comfort of your own home, without the supervision of a doctor. Check out our expert tips on how to strengthen your pelvic floor muscles.
Medication
Oxybutynin, mirabegron and Botox (yes, you read that correctly!) help your bladder relax and stop it from being overactive. However, medication can have undesired side-effects and should be a last resort to be considered under medical supervision and only after having first explored natural remedies.
Lifestyle changes
Small changes like eating more fibre, staying hydrated, cutting back on bladder irritants (like caffeine, alcohol, and artificial sweeteners) and exercising regularly can all help improve bladder health.
Oh, and proper peeing etiquette is essential, too!
Hormone replacement therapy (HRT)
Although HRT is not usually prescribed as a treatment for incontinence, speak to your doctor about HRT if you’re experiencing other bothersome symptoms of menopause, like hot flashes or vaginal dryness.
Surgery
In very rare cases, procedures like mesh surgery or sling surgery may be considered when other treatment options haven’t worked.
Frequently Asked Questions:
What are the symptoms of incontinence during menopause?
Incontinence symptoms during menopause often include frequent urination, leakage when coughing or sneezing, and a sudden urge to urinate. These symptoms can vary depending on the type of incontinence you experience, such as stress or urge incontinence.
Can menopause cause bladder problems and how is it related to oestrogen levels?
Yes, the hormonal changes during menopause, particularly the drop in oestrogen levels, can weaken the pelvic floor muscles and bladder tissues, contributing to incontinence. This hormonal shift is one of the primary causes of bladder issues during this stage of life.
What are the most effective treatments for incontinence after menopause?
Effective treatments for menopause-related incontinence include pelvic floor exercises, lifestyle changes, bladder training, and, in some cases, medications or surgery.
Is incontinence after menopause temporary or long-lasting?
Incontinence after menopause can be both temporary and long-lasting. While some women experience improvements with lifestyle changes and treatments, others may have ongoing symptoms.
