Menopause and urine incontinence

The Menopause Charity

The decline in oestrogen levels during menopause can weaken the muscles and tissues in the pelvic area, including those that support the bladder and urethra. This weakening can result in urinary incontinence, which is the involuntary leakage of urine. 

Urine incontinence affects up to half of all adult women and can negatively impact a person’s physical, social and psychological well-being. Yet few seek help.  A common misconception is that this is a normal consequence of aging. But, with lifestyle changes and access to the right support, pelvic floor dysfunction is often curable, or made more manageable.   

Urinary incontinence 

Menopause can contribute to two primary types of urinary incontinence: 

• Stress incontinence occurs when the muscles supporting the bladder and urethra are weakened.  This leads to leakage during activities that put pressure on the bladder, such as coughing, sneezing, laughing, or exercising. 
• Urge incontinence is also known as overactive bladder. This involves a sudden and intense urge to wee, often followed by leakage. The pelvic floor muscles may contract involuntarily, leading to an urgent need to urinate and potential leakage. 

Vaginal dryness  

As oestrogen levels decline during perimenopause and menopause, the vagina, vulva and urinary tract can suffer from dryness and thinning. This can result in vaginal dryness and thinning of the vaginal walls (vaginal atrophy). This can make intercourse uncomfortable or painful, leading to a decrease in sexual activity and potential changes in pelvic floor muscle tone. Your bladder and the tubes running from it (urethra) become weaker and this makes you feel the need to pass urine more frequently and urgently. This can make you prone to urine infections.  

Treatment options 

Several treatments and lifestyle changes can help manage continence issues during menopause: 

• Pelvic floor exercises: Strengthening your pelvic floor muscles through exercises such as Kegels can help improve bladder control. It is good to get professional guidance on this.  

• Lifestyle changes: Avoiding foods that irritate the bladder like caffeine, alcohol, and spicy foods, maintaining a healthy weight, and quitting smoking can help reduce the risk of incontinence. 
• Stay hydrated: Though it may sound counter-intuitive, drinking enough water will be a positive step for your overactive bladder. Restricting fluids makes your urine more concentrated, and more of an irritant to your bladder. 
• Vaginal oestrogen: Vaginal oestrogen (in the form of creams, rings, or tablets) can help restore vaginal moisture and elasticity, and for many, improve bladder function and continence. Vaginal oestrogen works locally in the pelvic area and at maintenance dose has hardly any bloodstream absorption, so this is very low risk. Vaginal oestrogen is a great treatment option for most women, even those who may not be able to take other forms of HRT. 
• Medical/surgical procedures: Under specialist guidance, procedures can be considered to address continence issues.  

Seeking medical advice 

If you are experiencing bladder control problems or any other symptoms related to menopause, please don’t feel embarrassed or alone. Take the step to consult a healthcare professional as they can evaluate your symptoms, provide a proper diagnosis, and recommend appropriate treatment options based on your specific situation. 

Speaking with your doctor and adopting healthy lifestyle habits are crucial steps toward maintaining a good quality of life during and after menopause.