woman with urinary incontinence in menopause drinking water

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What to do if you have urinary incontinence in menopause is a question asked in hushed tones or not at all. It's time those of us comfortable with the subject help to highlight the issue that it may become a little less off-limits.

In a nutshell there are several different types of urinary incontinence and there is a lot you can do to regain control of your bladder.

Does this sound familiar? You've hit menopause, everything is ticking along nicely. You’re sitting there minding your own business and you feel your bladder contract. Just a little bit. Almost as if it was going to let go but not quite. 

I've certainly had this happen. It's sudden and there's no warning. I've been lucky and nothing more than the contraction happened but I've been left wondering if this is a sign of things to come or if it could have been so much worse.

After a comment from my gynecologist last year warning me that my pelvic floor was okay but was showing the early signs of prolapse, he sent me to a specialist physiotherapist to help me fix it.

I have to say I filed it in the "too hard" basket for quite a while. I had all sorts of images about how a physio was going to help me fix my pelvic floor. However, I eventually paid her a visit and am so glad I did.

She helped me isolate the muscles that I needed to exercise and sent me on my way. After a few visits, she was pleased with my progress and gave me a vaginal egg that I could open up and gradually add weights to.

I had to practice holding it in while I was doing normal daily functions. It was a little bit hilarious. I wasn't sure how I was going to explain it dropping out on the floor if I lost control. Spoiler alert! It didn't.

What to do first

Sometimes when you have contractions there is no leakage but the signs are there or there can be the smallest leakage of just a few drops or worse you could suddenly feel the urge to go and not get to the restroom in time. It depends on how weak your pelvic floor muscles have become.

You’ve heard about this happening to women your age and it’s pretty scary to think you might have lost control of your own bladder.

It's even worse to consider that you may have to start using incontinence aids like pads or adult underwear.

First of all, you are not alone because bladder weakness or urinary incontinence is common in menopause. Even still, you don't want to be one of them. I get it.

Read on because there are things you can do to have a red hot chance of fixing it or at least improving it.

3 Types Of Bladder Problems Or Urinary Incontinence

Stress Incontinence

This is the more common and maybe the less severe version.

Stress is put on the bladder through sneezing, coughing, laughing. Anything that puts pressure on a bladder with a weak pelvic floor may cause it to leak. This is usually on a few drops of urine but this can deteriorate into full loss of control.

Urge incontinence

This is when you get the sudden urge to pee and your bladder contracts and you might not make it to the bathroom in time.

Nocturia 

You may wake several times in the night needing to pee.

What Is The Pelvic Floor?

The pelvic floor is the bottom of a hammock-like group of muscles stretching from the tailbone to the pubic bone – it supports the bladder, bowel and womb. These muscles are meant to contract to stop any flow of urine and along with other muscles support your spine.

Why does menopause make your bladder weaker?

As you approach menopause your estrogen levels begin to fall. This is a major factor in many of the menopause symptoms you may experience. Estrogen is the hormone that keeps your bladder healthy and happy and your pelvic muscles strong.

With menopause comes the usual issues that you may experience,

  • Night sweats
  • Hot flashes
  • Weight gain 

Your vaginal tissue becomes less elastic

Your pelvic floor muscles that hold everything together begin to weaken.

Other factors that can affect the strength of your pelvic floor are:

Significant weight gain

Your pelvic floor muscles support much of your weight. Extra weight can further strain these muscles causing them to become weak.

WEIGHT LOSS MISTAKES WOMEN IN MIDLIFE MAKE

  • WHICH EXERCISE TO STOP DOING
  • NO COUNTING CALORIES OR SCALE WATCHING
  • FIT BACK INTO THOSE JEANS YOU LOVE

Diabetes

Having diabetes can significantly increase your chances of urinary incontinence as the nerve damage that can be a factor of diabetes may also affect the nerves to the bladder and bowel.

Chronic constipation

Straining on the toilet can cause your muscles in that area to become weak.

Surgery

A repair to damaged muscles or a hysterectomy can cause bladder control issues. This could possibly be due to nerve damage.

Medications

Steroids and diuretics can have a negative impact on your bladder control.

Worst of All

Drinking too much caffeine or alcohol

Your Gynecologist is your first stop to find out what the cause of losing your bladder control is.

woman with urinary incontinence in menopause visiting her doctor


Firstly there needs to be a diagnosis and this will be done by taking a full patient history and physical exam. Secondly, a cough test may also be undertaken.

Sadly, there are few women that have their incontinence diagnosed by a physician. 

They may feel it is not severe enough to seek advice, or they could be embarrassed to talk about it. In addition, many women also believe that it is just a result of having children and as such, it is something they have to put up with.

It is important if you are struggling with bladder problems that you speak to a professional no matter how insignificant you think it is. As with anything the earlier you catch it the more chance there is that you will be able to correct it.

In truth there are many treatment options.

Prevention and Management Of Urinary Incontinence In Menopause

Limit caffeine, alcohol and colored fizzy drinks

as they can worsen symptoms and cause increased frequency

Include plenty of fibre in your diet

Constipation can make bladder leakage worse. Good sources fibre are nuts, seeds (especially chia and linseed) and vegetables.

Regular physical activity

Keep your muscles active and functioning by making them move regularly. Go to Pelvic Floor First for a list of exercises that are pelvic floor friendly.

Fluid restriction

Women, in particular, are encouraged to drink huge amounts of water. However, sticking to the recommended 6-8 cups of fluid per day is important. Try not to drink more than 2 liters of fluid in a day to avoid overloading your bladder and before your evening meal to avoid having to get up too often in the night.

Weight loss

If you are overweight, losing even a little bit can make a difference to the load being put on your pelvic floor.

Peeing more often

Some women go forever between toilet stops. I myself am guilty of holding until I can’t anymore. If you have been struggling with bladder leakage this can increase the risk of an accident. Make it a point of going to the toilet a little more often.

Coughing

If you've been coughing, whatever your reason I would encourage you to find a fix especially if you already suffer from stress incontinence. If that means giving up smoking, having your asthma treated or taking medicine for a virus it is worth the pain of embarrassment of peeing a little bit or worse each time you cough.

Avoid heavy lifting

This can weaken your pelvic floor; especially be careful if you are lifting children or weights. . Learn to 'brace' your pelvic floor muscles prior to any lifting.

Incontinence pads

Not a treatment but they can give women with stress incontinence some comfort until leakage symptoms improve or are fixed with treatment. 

Warning: menstrual pads do not have the absorbency and skin protection that incontinence pads do. Using menstrual pads could result in a skin irritation.

While trying some of these at-home treatments to help yourself you can explore the options for further non-surgical, natural treatments.

Treatment For Urge Incontinence 

Medications 

Your doctor may prescribe medications to calm an overactive bladder.

Treatment For Stress Incontinence

Top of the natural treatments list is:

a group of women talking and laughing about urinary incontinence in menopause

Pelvic floor exercises

Commonly known as “Kegels”. Exercising the right muscles through repeated contractions several times a day can strengthen your pelvic floor but is reliant upon you being consistent with the exercises. 

In addition, it is important when doing these exercises that you know which muscles to isolate. Strengthening the wrong muscles could result in making things worse for you.

A physical therapist with experience in this area can help you to isolate the right muscles and monitor that the exercises are working. 

As my gorgeous mum used to say leave your pride at the front door and pick it up on the way out.

You would think that one of the rewards that would come with age would be the wonderful ability to keep our pants on when we go to the doctor. However, if it means I’m not going to pee my pants every time I cough or laugh, a little loss of pride is fine with me.

Vaginal weights can also be used to isolate and strengthen the correct muscles.

Surgery - Various surgeries can be carried out depending on where you are having problems. It is generally a minor surgery but as usual all surgery comes with risks which you will be made aware of by your surgeon.

Vaginal insert (pessary)

Meant to support the urethra, these removable vaginal inserts can be inserted by yourself or a doctor and can help prevent stress incontinence.

Products To Aid In Strengthening Your Pelvic Floor

I have listed here some of the products that are avaible on the market to aid you in your at-home treatment and included images in case you have no idea what the heck something is. I have purposely left incontinence pads of this list as I know they are readily available in the supermarket and usually at a reasonable price.

Pelvic Yoga: An Integrated Program of Pelvic Floor Exercise to Support Overall Pelvic Floor Health

In conclusion

Urinary incontinence in menopause significantly impacts both quality of life and physical health. Moreover, women with incontinence often shy away from social and physical activities, which can lead to social isolation, depression, and decreased exercise. 

It is important that this often taboo subject is not swept under the rug and is talked about. That those women who can talk about it encourage and support those that can't.

If you are having any problems in this area at all no matter how significant you think they are I urge you to see a doctor. If you are embarassed maybe there is a support person you would like to take or hunt around for a doctor you feel comfortable with.

woman with urinary incontinence in menopause looking worried
woman with urinary incontinence looking worried
An oler woman in contemplation
a group of women laughing and talking

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