Menopause comes with its own set of challenges. Aside from the onset of irregular periods, women have to deal with vaginal dryness, which can make sexual intercourse uncomfortable or, worse, painful. Other symptoms that this stage brings about are chills, hot flashes, night sweats, and a slowed metabolism.
Another condition that’s associated with menopause is incontinence. It might sound like a surprise for some, but this issue actually affects a majority of women who are over 50 years old. (1)
Although it’s a relatively common issue, a lot of women are embarrassed to talk to their doctors about their problems. It can cause bacterial vaginosis as well. Fortunately, newer products have been developed to provide specialized support to women, such as incontinence underwear from brands like Knix. There are also resources online that can help you navigate through this stage of your life.
Here are five things you should know about incontinence during menopause:
- The connection between menopause and incontinence
When people think about incontinence, it actually refers to urinary incontinence (UI). As mentioned above, it describes the tendency of urine to leak at inopportune moments. The loss of bladder control can be caused by many factors, including performing daily activities such as exercising, laughing, and even coughing.
Incontinence for women in menopause is primarily caused by hormone changes, particularly in the levels of estrogen present in the body. As you get older, your estrogen starts to drop. This leads to the weakening of your pelvic muscles, which plays a significant role in bladder control. Additionally, your vaginal tissue’s elasticity deteriorates, and your urethra’s lining starts to thin. As your age advances, so may the incontinence issues that you experience.
- Types of incontinence associated with menopause
Urinary incontinence is an umbrella term, which encompasses various types of bladder control loss. These are the specific kinds that women face during and after menopause:
Stress urinary incontinence (SUI)—This is the most common type, which affects up to 88% of urinary incontinence. It refers to urine leakage brought about by increased pressure in the abdomen. Common situations that lead to SUI are sneezing, bending, and lifting heavy objects. It’s typically caused by childbirth, hormonal disorders, and major surgical operations. It has three stages, with the third level manifesting symptoms even with minimal physical exertion and a slight increase in intra-abdominal pressure. (2)
Urge urinary incontinence (UUI)—Also known as having an irritable or overactive bladder, UUI occurs when there’s an imbalance between the inhibitory and excitatory mechanisms of the detrusor muscle in the urinary bladder. The most common cause of this problem is damage to the central nervous system (CNS), particularly the spinal cord. Of course, it can also be a result of hormonal changes. This type of incontinence is characterized by having a sudden and unexpected urge to pee, which often leads to accidents.
Overflow incontinence—Loss of bladder control in this type of incontinence manifests when the organ collects more urine than it can handle. Consequently, the pressure increases and results in leakage. Another possible scenario is when the bladder doesn’t empty itself fully, which leads to continuous urethral dribbling. In this situation, symptoms include having a low-pressure urinary stream, nocturia, or feeling the need to urinate frequently at night, and a surge in urinary hesitancy.
Mixed urinary incontinence (MUI)—If you’ve experienced various symptoms of the different types of UI, it’s highly likely that you have MUI.
Transient incontinence – On the other hand, if the symptoms are short-lived, you may just be experiencing transient incontinence.
- Risk factors to consider
For incontinence and menopause, the most significant risk factor is age. As stated earlier, advancing in years leads to hormonal changes that affect the strength of the bladder and related organs. Additionally, reproductive situations, like pregnancy, childbirth, and miscarriages, can also lead to minor internal injuries that might’ve been overlooked through the years.
There are also other risk factors that can compound your incontinence problem when they happen along with menopause:
Overconsumption of alcohol or caffeine—Alcoholic and caffeinated beverages can fill one’s bladder relatively quickly. When you drink these heavily during your menopausal stage, you might feel the urge to urinate more often.
Infections—Incontinence can also be a consequence of an infection of the urinary tract or bladder. Once the infections are gone, you might be able to ease your UI.
Damage to the nerve—A malfunction in the nervous system, particularly when nerve damage interrupts the communication between your bladder and brain, can hinder your ability to control urination. Illnesses like diabetes and multiple sclerosis can damage nerves.
Medications—If you’re also advised by your doctor to take diuretics or steroids, you might experience symptoms of UI. This is because these medications are intended to hasten the elimination of water and salt from the body naturally. On the other hand, antidepressants and pain medication can also prevent your bladder from emptying fully, which can lead to issues with incontinence.
Constipation—Long-term bowel problems can have an adverse impact on your bladder control. Chronic constipation, in particular, can make your pelvic floor muscles weak, which significantly affects your ability to hold in urine.
Excess weight—Being overweight or obese can put additional pressure on your bladder, which makes it more challenging to control your pee. Having excess weight in your old age can lead to UI or exacerbate the problem.
High-Impact Sports—Physical movement doesn’t necessarily lead to incontinence. However, intense activities, such as running and jumping, can put additional strain on the bladder and cause urinary leaks.
- Symptoms to note
The most recognizable symptom of UI is urine leakage even when doing the simplest tasks, such as lifting, bending, and even coughing. However, another sign that you may have developed the condition is when you always feel sudden and strong pressure or spasms in your pelvic area, so much so that you might not urinate at the right place in time.
Another tell-tale indicator would be going to the bathroom frequently. The normal number of trips to the toilet is eight times a day and no more than twice a night. If you exceed this figure, then you might have UI. Bedwetting, also known as urinating while asleep, is a symptom of menopausal-caused incontinence as well. (3)
- Treatment options
Mild cases of incontinence merely require positive lifestyle changes. For instance, eating healthy, especially cutting back on alcohol and caffeine, can significantly improve your body’s ability to hold in urine.
Exercising can also strengthen your pelvic floor muscles and, in turn, boost your bladder control. Yoga can help you lose weight and remove the additional pressure on your bladder. Kegel exercises, in particular, specifically target the pelvic floor muscles. Doing these daily can increase your strength in, and awareness of, that area.
For UI cases that heavily interfere with your daily activities, it’s recommended that you go through conservative therapy first before considering surgery. The former would include maximizing medications, physical therapy, and counseling. The latter, on the other hand, could be attempted if lifestyle changes are ineffective.
Fortunately, less invasive procedures have now been developed, such as tension-free vaginal tapes (TVTs). This method provides support for a sagging urethra and keeps it closed when performing everyday tasks.
Meanwhile, to determine the type and severity of UI, your doctor may ask you to do the following:
Bladder diary—You may be asked to keep track of how many bathroom trips you make in a day. You’ll also need to take note of your fluid intake and output, which may require the use of a calibrated container.
Tests—You may also have to go through urinalysis and blood exams. These will allow your doctor to see if there are infections, traces of blood, chemicals, and substances in your body. Additionally, you might need to go through a stress test, where the physical examiner will ask you to cough or tense your midsection vigorously and check for any urine leaks. Another possible option would be postvoid residual (PVR) measurement, where you’ll be asked to empty your bladder completely, and the physician measures how much urine is left in your body.
Ultrasound / X-rays—The doctor can also recommend an imaging test called a “pelvic ultrasound” so that they can see how your bladder and urinary tract look. A cystogram may also be in order, depending on the discretion of your physician. In this process, a dye will be injected into your bladder, and the doctor will take an x-ray of the organ. The coloring would reveal possible abnormalities in the urinary system.
Conclusion
Incontinence affects a majority of women who are going through or who have experienced menopause. It’s brought about by the body’s natural deterioration, specifically with the weakening of the pelvic floor muscles and thinning of the urethral lining. Reproductive situations, such as pregnancy, childbirth, and miscarriages, are also part of the reason that the condition affects more women than men.
There are several types of UI, including stress, urge, and mixed incontinence, among others. Your susceptibility to developing this condition in your later years is influenced by risk factors, like your diet and lifestyle habits. It’s best to adopt a healthy way of life as early as you can to reduce the risk of being incontinent in the future. To learn more about menopause, click here or simply visit the nearest clinic of your choice.
References:
- “Half of women over 50 experience incontinence, but most haven’t talked to a doctor, poll finds,” Source: https://www.sciencedaily.com/releases/2018/11/181101085113.htm
- “Urinary incontinence in postmenopausal women – causes, symptoms, treatment,” Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528037/
- “Urinary incontinence,” Source: https://www.womenshealth.gov/a-z-topics/urinary-incontinence