Bladder Problems During Perimenopause And Menopause

Bladder problems such as leakage, increased frequency, and infections can cause a problem for some women during perimenopause and after menopause itself. It’s certainly not uncommon for women to experience some sort of issue with their waterworks at this stage of their lives. I’m sure you’ve seen those TV adverts advertising various forms of protection for ‘sensitive bladder’. I’m really pleased that the need for these products is openly acknowledged and is being advertised in a fun but life affirming way.

What Causes Bladder Problems In Perimenopause And Menopause?

The simple answer is the dramatic drop in oestrogen levels.Before perimenopause begins to disrupt your oestrogen levels, your pelvic floor and pelvic organs are being given a steady supply of oestrogen. This regular supply of oestrogen helps to keep your pelvic floor tissues/muscles strong and flexible. It also helps to preserve the strength of your bladder, which holds the urine, and your urethra, the tube that lets the urine exit your body.

The dramatic drop in oestrogen levels that you experience when perimenopause begins means that the support the oestrogen was supplying drops dramatically too. This can cause a weakening of the tissues and a thinning of the membranes. This deterioration of the urinary tract and vagina is known as Urogenital Atrophy and can happen due to aging as well as hormonal change. The loss of oestrogen can cause the bladder and the urethra to become weakened and the pelvic floor muscles to become lax and less supportive of the pelvic organs. 

If the bladder and urethra are weakened it will affect their ability to control their normal urinary functions. The severity of the symptoms from this will vary from woman to woman and whether there are any other contributing factors present. Unfortunately, unlike some other menopausal symptoms, such as hot flushes and night sweats, urinary problems won’t improve with age and are likely to get worse as a woman gets older.

While researching this particular area of the menopause I found several bladder related issues that women can experience during perimenopause and after menopause. They range from being a little bit embarrassing to extremely distressing for the women who are experiencing them. As I’m not a doctor or health professional I have done my best to give you an overview of a few of the most common problems that women may find they have to tackle when it comes to their waterworks. I’ve also added some Tips and Tricks for bladder leaks and recurrent UTIs. 

Take a look at the information and tips below. I hope you find it useful.

I feel it’s important to add, that if you are suffering with any issue regarding this area of your health and wellbeing. Whether your symptoms are mild or severe, please see your doctor for some professional help and advice.

Don’t suffer in silence.

Stress Incontinence

Stress incontinence is probably the first bladder related issue that springs to mind for most women. Even if a woman hasn’t reached perimenopause or menopause yet, but has had children, she may have experienced urine leakage due to extra pressure on her bladder.  Leakage is common during pregnancy due to the extra pressure on the bladder and after childbirth when the pelvic floor muscles haven’t yet regained their tightness after labour and delivery.

Whether you’ve had children or not, the drop in oestrogen during perimenopause and menopause can leave your urinary tract weakened and more prone to leakage when extra pressure is applied. Laughing, coughing, sneezing, lifting things and sudden movements, particularly during exercise, all put extra pressure on your bladder and increase the chance of a small leak. 

Urge Incontinence (OverActive Bladder)

Urge incontinence, also known as overactive bladder (OAB), causes a frequent and sudden urge to urinate. This can take you unawares and can happen at inopportune moments which can cause extreme discomfort and even embarrassment. The last thing you need in an interview or during an evening at the cinema is the urge to rush off to the loo. 

Women who suffer urge incontinence often find that they leak a little urine if they don’t make it to the toilet quick enough. This can add to the distress of urge incontinence.

Mixed Incontinence

As the name suggests mixed incontinence is a combination of more than one type of urinary incontinence. The term mixed incontinence is generally used to describe a combination of stress incontinence and urge incontinence which are being experienced at the same time.

Women who suffer mixed incontinence usually find that one type is more dominant than the other. For example, the stress incontinence that happens when you sneeze or exercise may be more frequent and troubling than the sudden urge to go to the loo, or vice versa.

Problem Urinating

Having a problem with urine leakage is a more well known issue than having a problem getting the flow of urine to start in the first place. A lot of us may have experienced this on occasion. If you’ve ever waited far too long to go to the loo, and then found once you got there it seemed to take an age for the flow to kick in, you will know what I mean. It’s extremely uncomfortable at the time but is usually only temporary and due to waiting far too long before heading for the bathroom.

Some women can develop a voiding difficulty due to the hormonal effects weakening the bladder and urethra during perimenopause and menopause. The weakening and thinning of muscles and membranes can create a mechanical problem which affects the coordination between the bladder muscle and the urethra. In turn this can cause trouble with getting the flow of urine started.

Urination not only becomes difficult but can also be painful. You can be left feeling that your bladder hasn’t been emptied properly and you get the sensation that you need to do more even though the flow of urine has stopped.

If you experience problems starting the flow or urine you need to see your doctor. The hormonal changes during perimenopause and menopause can cause this kind of urination problem, but so can infections and a prolapsed bladder, so it’s important to get yourself checked out by your doctor or health professional. Whatever the cause is, you need to seek help, advice and appropriate treatment.

N.B  If you find that you can’t get the flow of urine to start at all, get medical help immediately.Inability to pass urine is a medical emergency and requires medical treatment as soon as possible. 

Can Menopausal Bladder Leaks Be Treated?

There are several ways that urine leakage can be addressed or treated during perimenopause, menopause and in later years. What can be done about it will depend on the cause and severity of the problem. 

For example, small occasional leaks caused by stress incontinence can be dealt with by wearing a discreet panty pad. It can also be helped by doing pelvic floor exercises (kegels) to strengthen your pelvic muscles. Strengthening your pelvic floor is beneficial for your bladder and other pelvic organs at any time of your life, but the benefits become more apparent when you develop a problem in that area. 

Some urinary issues need more attention when it comes to relieving the symptoms or fixing the problem. The methods used can include: bladder muscle conditioning/training, oestrogen vaginal creams, pessaries or rings, implant devices or even surgery. 

Medical help for Mixed Incontinence can include a combination of approaches and may depend on which type of urinary incontinence is dominant. Advice and treatment for mixed incontinence is something that is worked out between you and your doctor to suit your particular needs.

As you can see, some urinary incontinence problems do need professional medical attention. So it’s important to see your doctor if you feel that your bladder leakage is not something you can cope with or it’s spoiling your quality of life.  

Tips and Tricks

Bladder leakage is not inevitable but is very common. If I say don’t be embarrassed I know it’s easier said than done. But don’t be! Leakage seems to be more common in women who have had children. Let’s face it, that pelvic floor took a considerable strain during childbirth!  I’m sure we’re all wishing we’d kept up those pelvic floor exercises. It’s not too late to start them again. By strengthening your pelvic floor muscles you’ll help to prevent leakage. 

Pelvic Floor Exercises

There are some pelvic floor (kegels) exercises on my ‘Easy Exercise’ article that you can try. Remember that strengthening your pelvic floor takes time. You may not notice a difference for 2 or 3 months or so. It’s worth persevering because the benefits are worthwhile. You need to do the exercises several times a day every day. They’re really easy to do and take up very little of your time.

Wear protection 

While you’re still working on those pelvic floor muscles. Not only will you feel more confident when you’re out and about you’ll feel fresher and cleaner too. There is a wide range of products on the market, from light pads to disposable knickers that have built in protection. You may need to try a few different ones to find which are right for you.

Mattress protector 

You can put a mattress protector on your bed as well, again, it’s one less thing to worry about and you will feel more relaxed. You won’t sleep well if you’re worrying about leaking while you’re asleep. 

Avoid drinking

Avoid fluid intake some time before going to bed. I haven’t found any hard and fast rules about how long before bedtime you should stop drinking but it’s worth doing your own experimenting, it’s your body after all and we’re all different.

Don’t strain 

Don’t strain to empty your bladder when you go to the toilet. Relax and let your bladder empty naturally. Also don’t wait too long before going or go too often in an effort to prevent leakage. None of this will help and could make things worse. Unless you’re advised to do so by your doctor as part of treatment.

Maintain a healthy weight 

Being overweight puts extra pressure on your bladder and increases the chance of leaks.

Recurrent Urinary Tract Infections (UTIs)

UTIs can become more frequent during your journey through the menopause and the years that follow. Because your pelvic floor and your pelvic organs have been weakened by the drop in oestrogen they can be more prone to infection. The reduction in oestrogen levels can also alter the acidity levels of the vulva and the vagina. This not only makes the area more prone to bacterial infection but also to yeast infection.

UTIs are usually an infection caused by bacterial growth in the urethra and bladder. And sometimes in the ureters (ducts that the urine passes through on the way from the kidneys to the bladder) and/or the kidneys themselves.

In general terms you are considered to suffer from recurrent urinary tract infection if you have 2 or more in 6 months or 3 or more within a year.

Common symptoms of a UTI in the urethra and bladder include:

• Strong and frequent urge to urinate
• Frequent urination in small amounts, often accompanied by a burning sensation as you pass water
• Cloudy urine
• Urine with an unpleasant/strong smell
• Pain and/or pressure in your pelvic area

Common symptoms of a severe infection or infection in the kidneys include one or more of the above symptoms of infection in the urethra and bladder plus:

• High temperature
• Chills
• Nausea
• Vomiting
• Back pain below your ribs and usually on one side

Treatment For Urinary Tract Infections

Treatment for UTIs usually comes in the form of a course of antibiotics so you will need to see your doctor if you think you have a urine infection. More severe cases of infection, infection in the kidneys for example, may be treated by antibiotics but sometimes will need hospital treatment. So, depending on the severity and location of your infection your doctor may refer you to your local hospital for the appropriate course of  treatment. 

Can You Prevent Recurrent UTIs?

While it may not be possible to prevent UTIs completely, if you’re prone to them there are a few simple things that you can do that might help to reduce the regularity of the infections. Try out the Tips and Tricks below and you should notice a difference over time.

• Drink plenty of water. It helps to keep your system hydrated and helps to dilute and flush out the buildup of the bacteria that can cause an infection.
• Cranberry juice is a traditional and popular drink for people who tend to suffer from UTIs. It’s considered effective and is widely available in supermarkets.
• Cut down on your sugar intake. Sugar can feed the infection so if you have an infection or are prone to them reduce or cut out any unnecessary sugars in your diet.
• Wipe from front to back. When you go to the toilet, even if it’s just for a wee get into the habit of wiping from front to back. This helps to stop bacteria from the anus being transferred to your urethra and so helps to reduce the risk of bacterial infection in your urinary tract.
• Don’t wait too long before going to the toilet. The longer you leave it to empty your bladder the more time the bacteria in the bladder has to build up and cause you problems. Go to the loo as soon as you feel the urge.
• After sex you need to empty your bladder as soon as possible. Bacteria can be transferred to the urethra during intercourse which can then make it’s way up to the bladder. Go to the loo as soon as you comfortably can after sex. This way you’re helping to flush the bacteria back out before it causes you any problems.
• Personal hygiene is important in the battle against bacteria. Make sure you’re clean before sex and clean yourself again afterwards. Be careful what products you use to clean your intimate areas though. Avoid fragranced soaps and shower gels etc as they can irritate the urethra and vagina which not only causes discomfort but also increases your chances of a UTI. Use gentle unfragranced products and don’t aggravate the area by cleaning too vigorously.
• Water-based lubrication during sex will reduce friction on the vagina and urethra. Even if you don’t need a lube because of vaginal dryness, but tend to get urinary tract infections, the friction during sex will aggravate the area making it sore and more prone to infection. So by using a good water-based lubricant it will help to reduce the risk.

Urinary Incontinence And Sex

It’s not unusual for a woman to pass a little urine during sexual arousal or orgasm, regardless of what stage of her life she’s at, and it doesn’t necessarily indicate incontinence issues. 

Sexual stimulation can put extra pressure on the bladder, urethra and pelvic floor muscles. So for women who are experiencing incontinence issues on a regular basis the extra pressure during sex is likely to increase the chances of a leak during arousal and intercourse.

The worry about leaking urine during sex can have a negative effect on a woman’s desire for sexual intimacy. If you can’t relax and enjoy sex with your partner because you’re worrying about leaking it will put you off of having sex. 

So is there anything you can do to solve the problem of urine leaks during sex?

There are a few things you could try that can help to reduce the incidence of leakage during sex, for example:

• If you’ve got a romantic evening planned, that’s likely to lead to the bedroom, cut out your fluid intake for an hour or so before you are likely to head off upstairs. Make sure you don’t dehydrate though and have a drink after sex. Fluid intake after sex will keep you hydrated and help to flush out bacteria, which is important if you’re prone to UTIs.
• Sex is often spontaneous so stopping fluid intake beforehand is not always an option. Go to the toilet to empty your bladder before things get really passionate. This also helps if you have planned a romantic evening too.
• Experimenting with sexual positions can also help to lessen the chance of a leak during intercourse. Some positions put more pressure on the bladder than others so try a few different ones. You could have a lot of fun trying them out.
• Pelvic floor exercises (Kegels) and bladder training techniques will also help to reduce bladder leakage. Not just during sex but in everyday life. You do need to keep these up to get the benefit but they can make a big difference.
• Talk to your partner about your worries and how they’re affecting your sex life. Good communication, especially about sex, is important in any relationship. Misunderstandings in the bedroom can also affect other aspects of your relationship. Be open with each other and talk it through.
• Medical advice from your doctor can also be a great help. Particularly if urinary issues are affecting your everyday life and not just your more intimate moments. Don’t be afraid or embarrassed to seek help. Your doctor will be able to offer professional advice and, if needed, appropriate treatment​.