As you go through menopause, it may become harder to control your bladder. That's a common issue. Changes in your body can cause it.
Here's what you can do to take charge of the problem.
Why Does Menopause Make Your Bladder Weaker?
Your ovaries stop making estrogen during this time in your life. That hormone is essential to women as it kicks in for puberty, as it controls your menstrual cycle, and during pregnancy. When it’s gone, your body gets to have a break from working so hard at all these stages.
You may know this life shift comes with hot flashes, night sweats, and mood changes. But some other changes can lead to bladder control issues for some women.
- Your vaginal tissue becomes less elastic.
- The lining of your urethra, the tube that empties urine from your bladder, begins to thin.
- Your pelvic floor, the group of muscles that supports both your urethra and bladder, weakens.
What Bladder Issue Do You Have?
The most common ones women face during and after menopause are:
Stress incontinence. You might lose a few drops of urine when you’re coughing, sneezing, or laughing. Or you might notice leaking when you’re lifting something heavy or doing something that puts pressure on your bladder.
Urge incontinence. The need to pee comes on fast and unexpectedly. You might not make it to a bathroom in time. This is sometimes called an “irritable” or “overactive” bladder.
Nocturia. Some women wake up several times in the middle of the night with an urge to pee.
Painful urination. After menopause, women are more likely to have urinary tract infections (UTIs). They can give you a burning sensation while peeing.
What Else Can Cause Leakage?
Menopause isn’t always the reason why your bladder is acting up. Your muscles may have naturally weakened due to age. Or you might have had injuries as a result of giving birth to a child, or several children.
Condition like diabetes or multiple sclerosis can cause nerve damage, which in turn can also cause bladder problems.
Think about any medicines you take, too. Some antidepressants and pain meds can keep your bladder from emptying. Your doctor may be able to change your dose or prescription.
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What Can You Expect at the Doctor’s Office?
Your family doctor or OB/GYN may be able to help you find out what's going on. Or they may refer you to a urologist -- a doctor who specializes in urinary tract problems, or a urogynecologist -- a specialist in pelvic floor disorders.
You'll get a pelvic exam, and a test to see if there's an infection. If so, treating the infection may help your incontinence problems.
Your doctor may want to check your bladder and pelvic floor. The tests you may have include:
Physical urine stress test. Your bladder is filled with water, then you're asked to stand up and cough, or to walk to see if any urine leaks.
Bladder ultrasound. This painless imaging test lets a doctor see how fully your bladder empties.
Cystoscopy. This test looks inside your bladder. You'll be given anesthesia so you won't have any pain. After it takes effect, a doctor slides a long, thin, lighted tube with a lens into your urethra.
Urodynamic testing. This can check how well your bladder stores and releases urine. You'll be asked to empty your bladder, and then a thin tube will be inserted through your urethra into your bladder to check for any remaining urine.
What Can You Do?
That depends on the type of incontinence you have, but small changes may help you regain control of your bladder.
Tighten your pelvic floor. Kegel exercises involve repeatedly tightening and releasing your pelvic floor muscles for a few seconds. You can get the idea of how to do them by stopping your urine, but don’t do that routinely. If you block the flow of pee, it might lead to an infection. Aim to do three sets of 10 Kegels each day.
Watch what you drink. Coffee, tea, soda, and alcoholic drinks may cause your bladder to fill quickly, then leak.
Limit liquids later in the day. If you usually wake at night needing to go, cut back on the amount of fluids you drink during the evening.
Keep a healthy weight. Extra pounds put more pressure on your bladder.
Time your bathroom trips. If you make bathroom breaks on a set schedule -- for instance, every hour -- it can help you regain control of your bladder muscles. Once you see improvement, try slowly extending the time you head to the toilet.
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How's It Treated?
Your doctor may discuss some incontinence treatment options with you:
Prescription medicine. A group of drugs called antispasmodics can block the signals that cause the muscles in your bladder to spasm and urine to leak.
Vaginal estrogen cream. A low dose applied to the inside of your vagina or urethra may help ease stress or urge incontinence. Estrogen patches or pills taken by mouth won’t work as well.
Biofeedback therapy. A trained therapist can use computer graphs and audio tones to show you when you’re exercising your pelvic floor muscles correctly. Over time, this can help you strengthen the muscles around your bladder and urethra.
Electrical stimulation. A tampon-like sensor is inserted into your vagina, then low electrical currents stimulate your pelvic floor to contract. Over time, this device can help you get better at holding in your pee.
A pessary. Your doctor can fit you for this ring-shaped device, which is inserted into your vagina. It presses against your urethra, helping you avoid leakage.
Surgery. If other treatments don’t work, your doctor may suggest an operation to lift your bladder or help support your urethra. This is best to treat stress incontinence, though. It may not help if you have an overactive bladder.