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Menopause
Symptoms
Problems with urination

Problems with urination

Roughly a third of women will experience some for of urinary problem during menopause - whether it's needing to go more, or having less control over your bladder. This explains what urinary incontinence is; why it’s common at menopause; and the ways you can manage it.
Problems with Urination

What is incontinence?

Problems with urinary incontinence are really common - but not talked about enough. It basically means problems with your ability to control when you pass urine, which leads to unwanted ‘leaking’ . For many women, their first experience of incontinence is after having a baby, when it is common to leak when you cough or sneeze (stress incontinence), and this can be improved by pelvic floor exercises. But for large numbers of women, new symptoms of incontinence also arrive with the menopause, or as their periods are stopping.

There are three main types of incontinence. You may have just one, or a combination of different types. It is important to know what the problem is, as different types of incontinence need different treatments. The good thing is that there are things you can do to help yourself if you are suffering. It is important to discuss your problems with a doctor, as you may need a urine test, physical examination, and sometimes further investigation to find out what type of incontinence you have. No need to be embarrassed, this is a common problem.

The three main types of incontinence:

Urge incontinence - This is when you will have a strong sense of urgency to pass urine and then pass urine involuntarily

Stress incontinence - You pass urine sometimes when you laugh, sneeze, run or do any form of physical exertion

Mixed incontinence - This is when you have a mixture of types of incontinence, which can also include an overactive bladder. Many women have a mixed type of incontinence.

There are other conditions that may be associated with incontinence

  • Overactive Bladder Syndrome - This is when you have changes to urgency, both in the day and at night, which may or may not be accompanied by incontinence. This term is used when there’s no infection present which could cause this symptom.
  • ‘Prolapse’ - This is when the vaginal wall becomes lax, and may also be associated with the womb slipping down towards the vaginal entrance. This affects the support of the bladder and ureter (water passage) and can be associated with leakage of urine. Overflow incontinence when the bladder is permanently full, and small amounts of urine leak out frequently (this is more common in men with prostate problems).
  • Also some medications such as diuretics may make the problem worse.

So why does incontinence arrive with menopause?

The falling estrogen levels that accompany menopause have a part to play. There are many estrogen receptors in the lower urinary tract and so changes to the amount of the hormone estrogen can affect the way this area functions. The muscles of the pelvic floor have also been shown to be sensitive to estrogen levels. As estrogen levels fall the pelvic floor muscles can become weaker.

Age also has an impact. The muscles that control the bladder and urethral function become less efficient and effective with age. Most muscles will weaken with age, and training these muscles to strengthen them back up is an important part of managing your urinary health.

Mechanical factors, such as increasing weight also increase the risk of incontinence.

So, what can I do to help with incontinence?

This depends on the type of incontinence and its cause.

A review of when you leak, how often you pass urine, and any other symptoms such as pain passing urine or blood in the urine will help your doctor decide what type of incontinence you have. It might be helpful to keep a diary of symptoms, and show it to your doctor. A physical examination can find out if you have a prolapse or vaginal dryness. A urine sample should be checked for blood, sugar (a sign of possible diabetes) and infection.

There are various options including bladder training, medication, and surgical treatments available for the different types of incontinence, and these should be discussed with a doctor.

Cutting down on caffeine and alcohol may help. Some people find that spicy or acidic foods, such as citrus fruits also make the symptoms worse. If you are overweight then losing weight may help.

What can I do if the symptoms are related only to the menopause?

Locally applied low dose estrogen's can be a helpful way to manage overall vaginal health during menopause. Low dose estrogen's help to treat vaginal dryness, and also reduce the risk of recurrent urinary tract infections (UTI’s). Some women find that this also helps with the feeling of urgency and lack of control.

Using a trainer to strengthen your pelvic floor muscles can also be a very effective way to manage stress incontinence. There are free apps which teach you how to train your pelvic floor, and remind you to do it daily. Check out Squeezy. Physical products that can help you train your pelvic floor, like Elvie can actually be prescribed through the NHS too (note, there are other brands and we have no partnerships). Slight warning - training your pelvic floor takes time, consistency and persistence. Stick with it though, and the results can be amazing.

What else can change my urinary patterns?

Common infections (UTIs) or sexually transmitted infections (STIs) can affect your need to urinate. Things to look out for which signal an infection (and therefore not necessarily incontinence) are blood in your urine, extreme pain passing urine and burning with urination. Becoming very thirsty and drinking much more, and passing large amounts of urine can be a sign of developing diabetes.If you have any of these symptoms, you should speak to your GP for testing and treatment.

Where can I get more information?

The NHS website offers advice on urinary incontinence

The International Urogynaecological Association produces some helpful patient leaflets including information on stress incontinence and pelvic floor exercises.

Looking for advice or treatment?
Take our free consultation and get access to treatment, or speak to one of our doctors to discuss your options.
References
  1. Hillard, T., Abernathy, K., Hamoda, H., Shaw, I., Everett, M., Ayres, J. and Currie, H., 2017. Management Of The Menopause. 6th ed. British Menopause Society. (p27-8).

  2. Urinary incontinence and pelvic organ prolapse in women: management NICE guideline Published: 2 April 2019 www.nice.org.uk/guidance/ng123.