Menopause Incontinence

TEAM KNIX / MENOPAUSE

While it is possible to experience urinary incontinence at any age, and for many different reasons, your chances increase as during menopause.

This is connected with the profound hormonal changes that are happening in your body, but also with aging more generally. Let’s get into it...

Can Menopause Cause Urinary Incontinence?

Menopause is a critical stage in a woman’s life. It marks the end of reproductive years. You are officially deemed to be in menopause (versus perimenopause) when you’ve gone 12 months without a menstrual period.

Like most events in a women’s reproductive cycle, changes in hormone levels play a crucial role in menopause. In particular, estrogen levels drop. Low estrogen levels may also make you more vulnerable to urinary or vaginal infections. Loss of tissue strength may contribute to urinary incontinence.

6 Causes of Bladder Leaks During Menopause

There are many changes connected to menopause that can cause urinary incontinence. And, of course, there may be events that occurred earlier in life (such as pregnancy, childbirth, surgery) that also contribute to incontinence that does not manifest until menopause. These changes start during perimenopause.

Let’s look at some of the main causes of bladder leaks during menopause:

1. Weak Pelvic Floor Muscles

The pelvic floor muscles span the bottom of the pelvis and support the pelvic organs—bladder, bowel and uterus (or womb). 

As we age, our pelvic floor muscles start to relax. Weak pelvic floor muscles can also be exacerbated by past events, like pregnancy, childbirth and certain abdominal surgeries (e.g. hysterectomy).

Often those past traumas begin to manifest at menopause if they haven’t earlier as your pelvic floor muscles naturally weaken at menopause. When pelvic floor muscles are weakened they can create problems with bladder and bowel control.

2. Estrogen Depletion

When your ovaries stop producing estrogen, you get a break from the monthly menstrual cycle you’ve likely lived with since puberty.

However, this isn’t the only impact a drop in estrogen has for women at menopause. While it might be nice to get a break from periods, your body may go through some turmoil as it adjusts, including:

  • Hot flashes
  • Vaginal atrophy
  • Accelerated skin aging
  • Vaginal dryness
  • Bone loss

Bladder control issues also belong on this list for many women.

3. Pelvic Organ Prolapse

Prolapse is the descending or drooping of pelvic floor organs. It can impact the:

  • Bladder
  • Uterus
  • Vagina
  • Small bowel
  • Rectum

About one-third of women are affected by prolapse at some point in their lives. Prolapse causes further strain to your pelvic floor and may result in urinary or fecal incontinence, among other complications.

4. Thinning of the Lining of the Urethra

Another marked impact of the estrogen depletion that occurs during menopause is that your urethra (the short tube that connects the bladder to the outside of your body and through which urine leaves the body) becomes thinner.

The thinning of the urethra makes it easier for bacteria to enter the bladder. This can cause urinary tract infections, which can also lead to urinary incontinence. For this reason, urinary tract infections are more common as women age. 

5. Decreased Bladder Elasticity 

Another change during menopause is that the bladder can become less elastic. This means it cannot expand and contract to hold as much urine as it used to, which can result in more frequent trips to the washroom, nocturia (waking up during the night because you need to use the bathroom) and even urinary incontinence.

6. Weight Gain

Some of us gain weight during menopause, and while we’re never going to body-shame, weight gain can add to the pressure on your pelvic floor, exacerbating any stress that might cause bladder control issues.

What Are the Different Types of Urinary Incontinence?

At a high level, there are 5 types of urinary incontinence that can impact women. While these can impact at any time and for many reasons, your chances of experiencing any form increase as you age. The types of bladder control problems most often directly associated with menopause are:

  • Stress incontinence
  • Urge incontinence
  • Mixed incontinence
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Type of Incontinence

How / When it Manifests

Some Possible Causes

Treatment May Include

Stress Incontinence

Stress incontinence is urine loss during physical exertion, whether it be exercise or more physical reactions like coughing, sneezing, laughing etc.

  • Childbirth
  • Trauma from surgery (e.g. hysterectomy)
  • Weak bladder muscles
  • Weak pelvic floor muscles 
  • Menopause
  • Pelvic floor exercises (Kegel exercises) to strengthen the pelvic floor muscles
  • Surgery

Urge Incontinence

An impossible-to-ignore urge to urinate, even if you just went or felt fine just minutes before.

  • Neurological conditions like Parkinson’s or multiple sclerosis (MS)
  • Overactive bladder (OAB)
  • Pregnancy
  • Childbirth
  • Menopause
  • Trauma to the bladder and urethra from surgery
  • Weak bladder muscles
  • Weak pelvic floor muscles 
  • Biofeedback therapy
  • Pelvic floor exercises (Kegel exercises) to strengthen the pelvic floor muscles
  • Surgery

Mixed Incontinence

A combination of stress and urge incontinence.

  • The same causes as stress and urge incontinence
  • Lifestyle changes
  • Medication
  • Bladder botox injections

Overflow Incontinence

If the flow of urine “dribbles” or is unsteady, you may have overflow incontinence. The inability to completely empty your bladder can lead it to overflow and cause unexpected urine leaks.

  • Weak bladder muscles
  • Underactive bladder
  • Blockages in the urinary tract
  • Lifestyle changes
  • Surgery to remove blockages
  • Use of catheter

Functional Incontinence

This is when you experience urine loss, but the cause is not associated with any problems with the urinary system.

  • Neurological or psychological problems or conditions
  • Physical impairments like spinal cord injuries
  • Nursing assistance
  • Changing physical settings
  • Medications and therapies to address underlying medical condition


Other Causes of Urinary Incontinence During Menopause

In addition to the main types of urinary incontinence listed above, there are other reasons you may experience bladder control issues during menopause.

UTIs

As mentioned earlier, you become more susceptible to urinary tract infections (UTIs) as you age. Incontinence is one symptom of urinary tract infection (UTI). Another symptom is a stinging or burning sensation when you pee and a decreased or irregular flow of urine. If you experience this, you should visit your doctor. UTIs are treated with antibiotics for 3 to 7 days.

Ways to prevent UTIs include:

  • Drink plenty of water
  • Urinate before and after having sex
  • Wipe from front to back after you pee
  • Wear breathable, natural underwear and clothing, changing your underwear daily

Other Diseases

As you can see there are many possible and very different explanations for menopausal incontinence. Not to make matters even more complicated, but it can also be connected with the following:

  • Diabetes
  • Urinary tract stones
  • Neurological disorders
  • Anatomical abnormalities
  • Urinary tract calculi
  • Bladder cancer
  • Obstructive sleep apnea

This just underscores the importance of seeing your doctor to uncover the real reason and the appropriate treatment if you’re experiencing involuntary urine leakage.

Certain Medications

Certain medications irritate the bladder. If you suspect this is the case with a current prescription, work with your doctor or pharmacist to see if there are alternatives or if the timing of taking medication can be altered to minimize its impact on your sleep.

Treatments Options

Do Pelvic Floor Muscle Exercises

These exercises strengthen the pelvic floor muscles, which support the uterus, bladder, small intestine and rectum. You don’t need to wait for menopause to begin. Kegel or pelvic floor exercises can be done any time, either sitting or lying down. You can even do them when you are eating, sitting at your desk, or when you are resting or binging your favourite show on Netflix!

If you’re unsure how to do Kegel exercises, your doctor or physiotherapist can help you. But basically it’s like pretending you have to urinate and then holding it. You relax and tighten the muscles that control urine flow. 

One way to learn the muscles you should activate is to pay attention when you pee: Start to pee and then stop. You should feel the muscles in your vagina (for women), bladder, and anus get tight and move up. These are the pelvic floor muscles. If you feel them tighten, you have done the pelvic floor muscle training right. Your thighs, buttock muscles, and abdomen should remain relaxed.

Adjust Food & Beverage Consumption

Certain foods and drinks irritate the bladder, including spicy and excessively sugary foods. You may also wish to cut back on caffeinated, carbonated beverages and/or alcohol. If these simple changes have an effect, it will be a personal decision whether to make more permanent dietary changes. If you experience incontinence more often at bedtime, you can think about reducing your fluid intake closer to bedtime.

Try Bladder Training

Bladder training involves taking bathroom breaks at regularly timed intervals. By ensuring your bladder is emptied frequently, you minimize the chances of leakages. Over time, the duration of time between breaks can be increased. 

Discover Leakproof Underwear

These sorts of changes will likely take a while to show any effect. So, while you wait, you can also explore products to help you stay active and social. Leakproof underwear comes with different absorbency levels. 

Super absorbent Knix leakproof underwear can hold up to 8 tsp of liquid (whether that’s sweat, blood or urine). Products like these can be a game changer for those experiencing female urinary incontinence, allowing them to remain active and social while exploring treatment options.

Further Medical Treatment Options for Urinary Incontinence

We do advocate talking to your doctor if you experience urinary incontinence. Beyond what’s mentioned above, there may be medical treatments and surgeries to help. Some options you might explore with them may include:

  • Hormone replacement therapy (HRT)
  • Vaginal pessary or urinary insert
  • Botox
  • Medications

Surgical options for urinary incontinence may include:

  • Sling procedure
  • Injectable bulking agents
  • Retropubic colposuspension

While it’s no doubt scary to navigate all of these changes during menopause, hang in there. Assemble a support team, including your doctor, and know you’re not alone.