• Ruby Forbes

All you need to know about incontinence and menopause

Updated: Jul 19


Toilet sign with plants in background
Have those impromptu toilet breaks become more frequent? Menopause might be to blame.

Getting older seems to usher in a whole host of interesting developments. You don’t move quite as fast as you used to, and remembering where you left your glasses has turned into a daily Sisyphean quest. And now, quite on top of everything else, you might have noticed an increasing urge to use the bathroom.


Perhaps those emergency toilet breaks are more frequent than before. Nighttime trips across the hallway have become a regular occurrence. Worst of all, you’re bent double howling with laughter when suddenly, something leaks!


In the depths of your mind, tucked away behind decades of school appointments and work meetings, the murky spectre of something called Kegels comes slowly into view. As those blurry contours begin to take shape, you also remember the vague yet insistent nudge of this being something that you always meant to get started on. As is so often the way, those well-placed intentions got happily lost in the mists of time, never to be disturbed again...


Until today. When we yanked it out of the shadows for you.


It’s not uncommon for those bothersome pelvic floor exercises to fall by the wayside as life follows its own idiosyncratic path. However, this can lead to unwelcome problems later in life. What’s known as incontinence impacts many women worldwide, and postmenopausal women are the most affected. Typical symptoms include:

  • Needing to wee frequently

  • Having an urgent need to wee

  • Leaking urine whilst coughing, sneezing, exercising, laughing, etc

  • Getting up once or more during the night to use the bathroom (nocturia)

  • Frequent UTIs

  • Unable to control wind

  • Constipation

What is urinary incontinence?

Incontinence happens when the pelvic floor muscle is weakened or damaged. The pelvic floor muscle surrounds the bladder and urethra (the tube carrying urine out of the body from the bladder) and it can be imagined as a hammock stretching from the pubic bone to the tailbone. These muscles are in charge of urine flow, so when they become damaged or weakened, you can lose control over your bladder.


Here are the different types of urinary incontinence:

  • Stress urinary incontinence: leakages occur due to pressure on the abdomen during coughing, laughing, exercise, etc. Stress urinary incontinence is often due to weakened or damaged pelvic floor muscles or urethral sphincter

  • Urge urinary incontinence: a sudden desire to wee that cannot be put off. It is often due to the overuse of detructor muscles, which are the muscles that control the bladder

  • Mixed urinary incontinence: a combination of both stress and urinary incontinence

  • Overflow incontinence: you are unable to fully empty your bladder, which can cause frequent leakages. It is often caused by a blocked bladder.

As you can see, urinary incontinence can take a variety of forms. But what are the different causes?

pregnant woman holding belly with partner
It is not uncommon for pregnancy and childbirth to damage pelvic floor muscles
  • Pregnancy and childbirth. Your pelvic floor muscles may have been damaged or put under pressure during this time, without you even realising. Damaged tissue can become weaker over time, meaning any childbirth trauma may have repercussions years later

  • Extra weight. Only you and your doctor know what your ideal, healthy weight is, and BMI is not an accurate indication of health. However, extra weight can put pressure on your bladder and weaken the pelvic floor muscles

  • Family history of incontinence

  • Frequent UTIs

  • Drinking lots of liquids

  • Certain medications, such as diuretics, alpha-blockers, ACE inhibitors

  • Ageing. Muscle mass peaks between the ages of 20 to 30, and then declines 5% per decade

  • Decreasing oestrogen levels.

Yes, you read that last one right. If you’ve been hanging out on the Olivia blog for any amount of time, you’ll know that declining oestrogen levels are the main culprit behind many menopausal symptoms.


Menopause sees an incredible 95% reduction in oestrogen production. Low oestrogen can lead to a certain subset of symptoms that can be grouped under the name Genitourinary Syndrome of Menopause. GSM is the new term for vaginal atrophy and it affects around half of postmenopausal women.


Symptoms of GSM include vaginal dryness, itching, dyspareunia (experiencing painful intercourse), urinary tract infections and the need to pee urgently or more frequently.


But how exactly does low oestrogen lead to urinary incontinence?


The link between oestrogen and urinary incontinence

Oestrogen receptors in your vagina, vulva, urethra and bladder help regulate normal blood flow, tissue thickness and elasticity as well as tissue lubrication. Declining oestrogen levels in the perimenopausal years result in the bladder and urethra lining becoming thinner and less elastic, as do the vaginal and vulva tissue.


Combined with pelvic floor muscles that weaken with age, the result is a diminished ability to properly hold urine in the body. In addition to this, less oestrogen results in a less optimum acidic environment for your vagina, which increases the risk of infections.


But we don’t mean to be all doom and gloom. As with many things in menopause, there are plenty of different options and treatments to explore if you want to maintain a healthy pelvic floor. Shall we take a look?


Pelvic floor exercises

Aka, time to get your Kegels on! Pelvic floor exercises help strengthen the muscles around the bladder, bottom and vagina, and can help with urinary incontinence and pelvic organ prolapse. These exercises may even improve sex by increasing sensitivity, leading to stronger orgasms.


You can feel your pelvic floor muscles if you try to stop the flow of urine when on the toilet. However, it is not recommended to do this often, as it may harm your bladder. To strengthen these muscles, you can squeeze them 10-15 times a day, whilst making sure not to tense your stomach, bottom or thigh muscles. You can add more squeezes each week, but don’t overdo it, and make sure to always rest in between exercises.


Pelvic floor exercises are easy to do at home, or even out and about. If you feel like you would benefit from extra guidance, there are many different vaginal weights and pelvic floor trainers on the market and they can help you perform these exercises correctly.


As always, remember to consult a doctor first before performing any pelvic floor exercises. A doctor can diagnose what type of incontinence you have, as well as how to correctly perform these exercises.

Water bottle, lemon and glass
Though it might seem counter-intuitive, it's important to drink enough liquids if you struggle with incontinence. Drinking too little can reduce how much liquid your bladder can hold.

Lifestyle changes to manage incontinence

  • Losing weight is one suggestion for combatting urinary incontinence, due to extra weight adding pressure on the bladder and weakening the pelvic floor muscles. Make sure to talk to a doctor that you trust in order to see if this is relevant for you

  • Caffeine increases the amount of urine that your body makes as well as irritating your bladder. Coffee is the worst offender here, but you should also avoid carbonated drinks, teas, energy drinks and hot chocolate

  • Avoid spicy and acidic foods as they irritate the bladder

  • Avoid alcohol as this is a diuretic, making you wee more

  • Make sure to drink enough liquids, with 6-8 glasses of water a day the optimum amount. Restricting fluid intake might seem logical when faced with leakages, but doing so can worsen the issue by reducing bladder capability and potentially causing constipation

  • Bladder training. This should be done under the guidance of a healthcare professional. You learn how to wait longer between needing to wee and using the bathroom

  • Stop smoking. Coughing strains the pelvic floor muscles

  • Change exercise. HIIT and sit-ups put a particular strain on your pelvic floor. Opt instead for strengthening exercises like pilates. Anything that builds up your core will benefit the pelvic floor muscle

  • Avoid straining during bowel movements, as this can harm the pelvic floor muscle. Eating more fibre, exercising and sitting correctly on the toilet will help here

Medical and surgical options to manage incontinence

  • Midurethral slings are considered a safe and effective surgical option if lifestyle changes do not work. During this procedure, a ‘sling’ is placed around the neck of the bladder to support it and prevent leakages. This sling is often made from tissue from another part of your body

  • Low doses of vaginal oestrogen are also seen as a safe alternative, though survivors of hormone-sensitive cancers should be cautious about this option

  • Possible medicines to investigate include duloxetine, antimuscarinics and mirabegron. All three have possible side effects, which you can read about on the NHS website under their ‘Non-surgical treatment’ page for urinary incontinence

  • Other surgical treatments, though less popular, include colposuspension, vaginal mesh surgery and urethral bulking agents. Midurethral sling surgery is generally preferred to these options, though a doctor can help you explore which option is best for you

Products to manage incontinence

  • There are special incontinence pads available to help contain leakages. Although sanitary pads might appear to be a cheaper option, these often have the wrong technology for containing urine leakages, meaning they will stay damp and irritate the skin

  • Washable bed pads are available that go on top of the mattress and stay dry to the touch, helping reduce the impact of overnight leaks.

  • Bladder support products can help with stress urinary incontinence. The Swedish brand Efemia have created a device that is inserted into the vagina and helps to reduce or prevent leakages by supporting the mid-urethra.

On top of everything else, emergency toilet breaks and inconvenient leakages can have a considerable impact on your quality of life. It’s understandable if the whole thing has left you feeling self-conscious and not quite in control of your own body.


Thankfully, as you’ve just read, there are many different options to explore for managing urinary incontinence. Maybe it's committing to those weekly kegel exercises, stocking up on special incontinence pads or speaking to your doctor about surgical options. Either way, we hope you find something that gets you feeling back in control in no time. After all, haven’t you got that very important job of enjoying your life to get back to?


References:

“Genitourinary Syndrome of Menopause: Management Strategies for the Clinician.” n.d. PubMed. Accessed March 28, 2022. https://pubmed.ncbi.nlm.nih.gov/29202940/.


Lee, Judith. 2009. “The menopause: effects on the pelvic floor, symptoms and treatment options.” Nursing Times. https://www.nursingtimes.net/archive/the-menopause-effects-on-the-pelvic-floor-symptoms-and-treatment-options-04-12-2009/.


“Management of urinary incontinence in postmenopausal women: An EMAS clinical guide.” 2020. PubMed. https://pubmed.ncbi.nlm.nih.gov/33008675/.


“Menopause and Incontinence.” 2021. Continence Foundation of Australia. https://www.continence.org.au/who-it-affects/women/menopause.


“surgery and procedures for urinary incontinence.” n.d. NHS. Accessed March 28, 2022. https://www.nhs.uk/conditions/urinary-incontinence/surgery/.


“Urinary incontinence.” n.d. NHS. Accessed March 28, 2022. https://www.nhs.uk/conditions/urinary-incontinence/.


“Urinary Incontinence - how to help a weak bladder.” n.d. NHS. Accessed March 28, 2022. https://www.nhs.uk/conditions/urinary-incontinence/10-ways-to-stop-leaks/.


“Urinary incontinence - Non-surgical treatment.” n.d. NHS. Accessed March 28, 2022. https://www.nhs.uk/conditions/urinary-incontinence/treatment/.


“Vaginal Atrophy - StatPearls.” 2021. NCBI. https://www.ncbi.nlm.nih.gov/books/NBK559297/.


“What are pelvic floor exercises?” n.d. NHS. Accessed March 28, 2022. https://www.nhs.uk/common-health-questions/womens-health/what-are-pelvic-floor-exercises/.

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