Menopause doesn’t only affect your vagina — it can also impact your bladder, which acts as the roof of your vagina. Ever pee when you sneeze? Urinary issues are a common indicator that you’re entering or in menopause. Urinary incontinence symptoms can actually worsen as women age — it’s a fact of life.
Consider this: Researchers at the University of Michigan Institute for Healthcare Policy and Innovation polled over 1,000 women and found that 43 percent of women in their 50s and early 60s said they had experienced urinary incontinence. (Note: This number may be inflated by women who have had a hysterectomy, which destabilizes both the vagina and the bladder.)
“Most women know that menopause is defined by hormonal changes which affect the vagina and uterus,” says Linda M. Nicoll, a gynecologist and surgeon at NYU Langone Health. “But we sometimes forget these changes also affect the bladder [where urine is stored] and the urethra [where urine exits the body], as well as the pelvic floor muscles.”
Why am I having urinary issues during menopause?
Many age-related factors can affect the bladder, including your hormones. Reduced levels of estrogen can cause thinning of the lining of the urethra (the short tube that passes urine from the bladder out of the body), according to the North American Menopause Society (NAMS). The surrounding pelvic muscles also may weaken with aging.
There are three common kinds of urinary issues in menopausal women.
Urinary urge incontinence (UUI)
UUI is part of a broader entity known as overactive bladder syndrome (OAB), which is defined as urinary urgency with or without urgency incontinence. In healthy patients, OAB is frequently associated with increased daytime frequency and nocturia (in layperson’s terms, waking up in the middle of the night to pee).
Women in menopause may have episodes of urinary urgency, described as an irresistible urge to urinate. In simpler terms, NAMS defines UUI as the involuntary loss of urine associated with the urge to urinate. Ever have a leak while racing to get to the bathroom? That’s UUI.
Stress incontinence (SUI)
Ever laugh so hard that you literally pee your pants? That’s SUI.
SUI is a leakage of urine during moments of physical activity that increase abdominal pressure, such as coughing, sneezing, laughing, or exercise. SUI can also occur when bending over, lifting heavy objects, running, or having sex. While occasional stress incontinence can occur at any age, more women will experience it as they enter menopause and midlife. SUI tends to get better after your hormones settle post-menopause, especially if you work on strengthening your pelvic floor.
Some factor that can contribute to the likelihood of developing SUI are:
Age. Physical changes, such as the weakening of muscles, can contribute to stress incontinence.
Type of childbirth delivery. Women who’ve had a vaginal delivery are more likely to develop urinary incontinence than women who’ve delivered via cesarean section, according to the Mayo Clinic. Women who’ve had a forceps delivery may also have a greater risk of SUI versus women who undergo vacuum-assisted delivery. SUI related to childbirth usually goes away over time, especially with pelvic floor therapy.
Body weight. Excess weight increases pressure on the abdominal and pelvic organs.
Previous pelvic surgery. If you’ve undergone a hysterectomy, you may experience a weakening in the muscles that support the bladder and urethra, increasing the risk of SUI. The vast majority of women who have had a hysterectomy leak urine later in life.
Urinary tract infection (UTI)
Most of us have experienced the agonizing sensation of lower belly pain combined with the desperate need to urinate. Painful dryness during sex can cause a dreaded UTI.
“Women in menopause are more prone to urinary tract infections, especially if they are sexually active,” says Nicoll. You can prevent urinary tract infections after menopause without antibiotics by “Using lubricant, peeing after sex, and taking a cranberry-based supplement like those made by AZO.”
What can I do about urinary issues during menopause?Work that pelvic floor: Urinary issues may respond favorably to pelvic floor exercises (such as Kegels) or store-bought vaginal support products (like Poise Impressa), says Nicoll.
Lifestyle changes: Avoiding bladder irritants like caffeine and alcohol and not waiting too long to visit the restroom can help. Your doctor may also prescribe medicines that inhibit involuntary contraction of the bladder muscles.
Don’t be embarrassed! According to numerous studies, the shame and anxiety around urinary issues can cause women to isolate, avoid public events where they are unsure where the restroom is, or, worst of all, avoid seeking help. Remember that these issues — and their solutions — are totally common, and experiment freely until you hit upon a good fix.
Don’t limit your liquid intake: Staying hydrated is an essential part of menopause (and life) care. Avoiding drinking water or other liquids can cause dehydration.
When should I talk to my doctor?
Women experiencing urinary issues during menopause often suffer in silence. Two-thirds of the women polled in the University of Michigan Institute for Healthcare Policy and Innovation study said they hadn’t talked to a doctor about their urinary issues.
If you’ve been avoiding sports, have anxiety about leaving the house, or feel like your life is negatively impacted by urinary issues, you should absolutely consult your doctor for advice, medication (if necessary), or further intervention.