Urinary problems
Urinary symptoms refers to a group of different (unpleasant) physical problems you may experience during (peri) menopause. Symptoms range from commonly-reported stress-induced incontinence and urinary leakage during peri- and post-menopause, to symptoms more common in the later stages of peri- and post-menopause, such as urinary tract problems, changes in bladder control, frequent night waking (noctoria), and increased urinary tract infection (UTI) frequency.
Urinary tract and incontinence problems are reported by 43% of women during menopause
The majority of symptoms go away on their own, although some (UTIs, for example) require prescription-based medication. There are good solutions and treatment options available, and there is really no need to suffer from any aspect of this symptom any longer.
Why is this happening?
Menopause-related incontinence relates to leakage issues that stem from pelvic organ prolapse and other factors related to reproductive aging. It is also directly affected by the hormonal changes involved in menopause, with the reduction in natural levels of estrogen production affecting your body’s ability to regulate urination. There are three types of urinary symptoms, and each occurs for slightly different reasons:
- Urge incontinence (referred to medically as “an overactive bladder” or AOB) is caused by overly active or irritated bladder muscles. You may have the frequent and sudden urge to urinate, with occasional leakage of urine if you can’t reach the bathroom in time.
A different type of urinary symptom can be experienced at any age and is often experienced by women after vaginal deliveries:
- Stress incontinence is caused by weak pelvic floor muscles and it can result in leakage of urine when coughing, laughing, sneezing, lifting objects, playing sports, etc. Stress incontinence is common during the peri-menopause phase and doesn’t typically worsen during post-menopause.
Finally, there is a type of urinary symptom that affects women in the menopause phase of their lives at a greater rate than at other ages. This type of symptom also tends to become worse as a woman ages and if preventative treatments are not undertaken:
- Urinary Tract Infections (UTIs) are more likely to happen as your estrogen declines. Estrogen helps naturally-occurring, “good” bacteria (lactobacilli) within the vagina to thrive. Lactobacilli produces an acid that lowers the pH in your vagina, controlling infection-causing bacteria present in the vagina. When estrogen levels decline, the infection-causing bacteria multiply and increase your risk of UTI.
Generally, urinary symptoms do not improve when a woman enters post-menopause and her hormone levels stabilize. This means that early diagnosis and effective treatment is important. It’s important to see a doctor if you are experiencing these symptoms. Urinary symptoms are common and you have nothing to be worried or embarrassed about.
Other impacted areas
Incontinence has the risk of becoming an amplifying and hidden symptom. Particularly if you are suffering from stress incontinence, you may be tempted to avoid activities such as sports, social gatherings, or being intimate with your partner.
It is estimated that 25% of women will experience leakage during sex at some point. Our recommendation is that you view urinary symptoms as a common occurrence during menopause and that you refuse to allow it to damage your emotional energy or stop you from your normal activities. Easier said than done of course. But there are treatments available that provide immediate temporary relief, in addition to permanent solutions.
Diagnosis
Symptoms of incontinence are self-reported, although the presence of UTIs is detected through routine laboratory tests. When speaking to a healthcare provider about your concerns, make sure to mention if you have endured any of the following:
- Changes in urination frequency
- Frequent night waking to urinate
- Incidents of lack of control and urine leakage
- Dryness or itchiness in the vaginal area
- Pain during urination
Possible triggers or risk factors
Studies have shown that women who gave birth by vaginal delivery suffer from stress incontinence at three times the rate of women who haven’t. In addition, it is worth noting that incontinence is directly correlated with excess weight. Women who are assessed obese or heavily over-weight are more likely to suffer from menopause-related incontinence symptoms.
For UTIs specifically, you are at a greater risk if you are experiencing one of the following conditions:
- Thinning and dryness of vaginal tissue
- Pelvic organ prolapse demonstrated by a weakening of the pelvic floor and drooping pelvic organs
- Urinary leakage (incontinence)
- Difficulty emptying the bladder
Want to speak with a Menopause doctor?
Treatments & remedies
Treatment for incontinence related symptoms may include dietary recommendations, pelvic floor exercises, topical prescription medication, or surgery. Laser and radio frequency vaginal procedures are available for women suffering from recurrent UTIs but the efficacy of these new treatments has not been established through quality research as yet.
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Nutrition
Throughout menopause, it is essential to stay adequately hydrated at all times. If nighttime urination frequency is a problem, you may want to consider reducing liquid intake during the later parts of the day. Also, alcohol and caffeine are both directly related to the increased production of urine (they are “diuretics”). It is wise to limit your consumption of alcohol and caffeinated beverages if you are experiencing incontinence symptoms.
Exercise
Exercises can help strengthen your pelvic floor and help to drastically reduce incontinence and urine leakage symptoms. Although you may benefit from a professional consultation with a physical therapist regarding pelvic floor strengthening exercises, there are also some easily accessible, proven home-based methods:
- Yoga (particularly poses targeting the pelvic floor)
- Kegel exercises
- Pelvic floor physical therapy
Mindset
A healthy lifestyle promotes optimal urinary tract function. We know that aging affects urination patterns and that carrying excessive body weight puts a woman at increased risk. Lifestyle changes which promote optimal nutrition and health are easy ways to promote your best-possible results during treatment for incontinence.
Supplements
- DHEA (dehydroepiandrosterone) is available in supplemental form for incontinence during peri-menopause. Very low doses of DHEA were reported to improve the quality-of-life for women suffering from menopausal incontinence. Application is topical and suppositories are available for intravaginal estradiol DHEA supplementation.
- Cranberry extract and juice. Although an urban myth suggests that cranberry juice is useful for supplemental treatment of UTIs, evidence shows that cranberry extract may be beneficial. Cranberry juice on the other hand can be counter-productive, as it contains high levels of refined sugar.
- Probiotic supplements have shown mixed results in preventing UTIs, according to recent studies. However, taking them can’t hurt and may help. Look for probiotics containing the bacteria Lactobacillus rhamnosus and Lactobacillus reuteri.
OTC Products
In the immediate, an over-the-counter product which will provide instant help (and allows time for a doctor’s diagnosis and treatment) is absorbent underwear. We have come a LONG way from adult diapers and the current designs look just like normal underwear and are unnoticeable under your normal clothes. Although period underwear may seem similar, it doesn’t normally include the special anti-odor advantages of designs recommended for urinary symptoms, so it’s important to look for absorbent and anti-odor product features.
Prescription
- Non-hormonal treatments for urinary tract problems during menopause normally focus on the management and elimination of UTIs. Antibiotics will be recommended based on the test (culture) of lab urine samples. Generally, laboratory testing is required before antibiotics can be prescribed.
- In addition, if you are diagnosed with An Overactive Bladder, there are several medications that may be prescribed. Tolterodine, oxybutynin, and mirabegron are all used to treat urgency of urination and too-frequent urination concerns.
- Vaginal pessaries can be effective if the underlying cause is pelvic organ prolapse. A pessary will support the bladder wall and urethra (the ‘tube’ that is connected to your bladder and allows urine to leave your body) and provides a gentle compression of the urethra against the pubic bone. It is made of silicone or rubber and needs to be placed transvaginally by a medical professional to ensure proper fitting.
Hormone Treatment
Incontinence related to peri-menopause can be treated with HRT (Hormone Replacement Therapy) treatment. Vaginal estrogen replacement (and progesterone, depending on a woman’s previous health history) is prescribed in pill, insert, or ring formats. HRT can also help with other symptoms a woman might be suffering during menopause.
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FAQ
What are the symptoms of Menopause?
There are roughly 34 symptoms of Menopause with the most commonly experienced being:
- Irregular periods
- Vaginal dryness
- Hot flashes
- Night sweats
- Fatigue
- Sleep problems
- Mood changes and irritability
- Weight gain
- Thinning hair and dry skin
Medically reviewed and detailed symptom fact sheets can be found here, and a general overview of what (peri) menopause is and entails can be found here.
References
Altarac, S., & Papeš, D. (2013). Use of d-mannose in prophylaxis of recurrent urinary tract infections (UTIs) in women. BJU International, 113(1), 9–10.
Clark, Amanda L. MD, MCR, NCMP Overactive bladder, stress urinary incontinence, and menopause—what are the associations?, Menopause: February 2022 - Volume 29 - Issue 2 - p 125-126
doi: 10.1097/GME.0000000000001929
Danforth KN, Townsend MK, Lifford K, Curhan GC, Resnick NM, Grodstein F. Risk factors for urinary incontinence among middle-aged women. Am J Obstet Gynecol. 2006;194(2):339-345. doi:10.1016/j.ajog.2005.07.051
Jones, H. J., Huang, A. J., Subak, L. L., Brown, J. S., & Lee, K. A. (2016). Bladder Symptoms in the Early Menopausal Transition. Journal of Women’s Health, 25(5), 457–463.
La Rosa, Valentina Lucia et al. “Treatment of genitourinary syndrome of menopause: the potential effects of intravaginal ultralow-concentration oestriol and intravaginal dehydroepiandrosterone on quality of life and sexual function.” Przeglad menopauzalny = Menopause review vol. 18,2 (2019): 116-122. doi:10.5114/pm.2019.86836
University of Gothenburg. (2012, March 25). Incontinence 20 years after child birth three times more common after vaginal delivery. ScienceDaily. Retrieved May 17, 2022 from www.sciencedaily.com/releases/2012/03/120325102613.htm
Al-Shaikh G, Syed S, Osman S, Bogis A, Al-Badr A. Pessary use in stress urinary incontinence: a review of advantages, complications, patient satisfaction, and quality of life. Int J Womens Health. 2018 Apr 17;10:195-201. doi: 10.2147/IJWH.S152616. PMID: 29713205; PMCID: PMC5909791.
Wakamatsu, M. (2019, July 10). 4 behavioral changes to tame urinary incontinence. Harvard Health Blog.
Nichols, H. (2018, March 1). Coping with urinary incontinence. Medical News Today.
Flaherty, B. (2019, July 31). 7 Yoga Poses for a Healthy Pelvic Floor. Thinx Inc.
Migala, J., & Sinha, S. (2020, March 6). Kegel Exercises for Menopause | Everyday Health. EverydayHealth.Com.
https://urogyn.coloradowomenshealth.com/conditions/bladder/menopause-urinary-symptoms.html
Urinary problems
Urinary symptoms refers to a group of different (unpleasant) physical problems you may experience during (peri) menopause. Symptoms range from commonly-reported stress-induced incontinence and urinary leakage during peri- and post-menopause, to symptoms more common in the later stages of peri- and post-menopause, such as urinary tract problems, changes in bladder control, frequent night waking (noctoria), and increased urinary tract infection (UTI) frequency.
Urinary tract and incontinence problems are reported by 43% of women during menopause
The majority of symptoms go away on their own, although some (UTIs, for example) require prescription-based medication. There are good solutions and treatment options available, and there is really no need to suffer from any aspect of this symptom any longer.
Dr. June Tan Sheren
Why this is happening
Menopause-related incontinence relates to leakage issues that stem from pelvic organ prolapse and other factors related to reproductive aging. It is also directly affected by the hormonal changes involved in menopause, with the reduction in natural levels of estrogen production affecting your body’s ability to regulate urination. There are three types of urinary symptoms, and each occurs for slightly different reasons:
- Urge incontinence (referred to medically as “an overactive bladder” or AOB) is caused by overly active or irritated bladder muscles. You may have the frequent and sudden urge to urinate, with occasional leakage of urine if you can’t reach the bathroom in time.
A different type of urinary symptom can be experienced at any age and is often experienced by women after vaginal deliveries:
- Stress incontinence is caused by weak pelvic floor muscles and it can result in leakage of urine when coughing, laughing, sneezing, lifting objects, playing sports, etc. Stress incontinence is common during the peri-menopause phase and doesn’t typically worsen during post-menopause.
Finally, there is a type of urinary symptom that affects women in the menopause phase of their lives at a greater rate than at other ages. This type of symptom also tends to become worse as a woman ages and if preventative treatments are not undertaken:
- Urinary Tract Infections (UTIs) are more likely to happen as your estrogen declines. Estrogen helps naturally-occurring, “good” bacteria (lactobacilli) within the vagina to thrive. Lactobacilli produces an acid that lowers the pH in your vagina, controlling infection-causing bacteria present in the vagina. When estrogen levels decline, the infection-causing bacteria multiply and increase your risk of UTI.
Generally, urinary symptoms do not improve when a woman enters post-menopause and her hormone levels stabilize. This means that early diagnosis and effective treatment is important. It’s important to see a doctor if you are experiencing these symptoms. Urinary symptoms are common and you have nothing to be worried or embarrassed about.
Other impacted areas
Incontinence has the risk of becoming an amplifying and hidden symptom. Particularly if you are suffering from stress incontinence, you may be tempted to avoid activities such as sports, social gatherings, or being intimate with your partner.
It is estimated that 25% of women will experience leakage during sex at some point. Our recommendation is that you view urinary symptoms as a common occurrence during menopause and that you refuse to allow it to damage your emotional energy or stop you from your normal activities. Easier said than done of course. But there are treatments available that provide immediate temporary relief, in addition to permanent solutions.
Diagnosis
Symptoms of incontinence are self-reported, although the presence of UTIs is detected through routine laboratory tests. When speaking to a healthcare provider about your concerns, make sure to mention if you have endured any of the following:
- Changes in urination frequency
- Frequent night waking to urinate
- Incidents of lack of control and urine leakage
- Dryness or itchiness in the vaginal area
- Pain during urination
Possible triggers or risk factors
Studies have shown that women who gave birth by vaginal delivery suffer from stress incontinence at three times the rate of women who haven’t. In addition, it is worth noting that incontinence is directly correlated with excess weight. Women who are assessed obese or heavily over-weight are more likely to suffer from menopause-related incontinence symptoms.
For UTIs specifically, you are at a greater risk if you are experiencing one of the following conditions:
- Thinning and dryness of vaginal tissue
- Pelvic organ prolapse demonstrated by a weakening of the pelvic floor and drooping pelvic organs
- Urinary leakage (incontinence)
- Difficulty emptying the bladder
Treatments & Remedies
Treatment for incontinence related symptoms may include dietary recommendations, pelvic floor exercises, topical prescription medication, or surgery. Laser and radio frequency vaginal procedures are available for women suffering from recurrent UTIs but the efficacy of these new treatments has not been established through quality research as yet.
Products
- DHEA (dehydroepiandrosterone) is available in supplemental form for incontinence during peri-menopause. Very low doses of DHEA were reported to improve the quality-of-life for women suffering from menopausal incontinence. Application is topical and suppositories are available for intravaginal estradiol DHEA supplementation.
- Cranberry extract and juice. Although an urban myth suggests that cranberry juice is useful for supplemental treatment of UTIs, evidence shows that cranberry extract may be beneficial. Cranberry juice on the other hand can be counter-productive, as it contains high levels of refined sugar.
- Probiotic supplements have shown mixed results in preventing UTIs, according to recent studies. However, taking them can’t hurt and may help. Look for probiotics containing the bacteria Lactobacillus rhamnosus and Lactobacillus reuteri.
In the immediate, an over-the-counter product which will provide instant help (and allows time for a doctor’s diagnosis and treatment) is absorbent underwear. We have come a LONG way from adult diapers and the current designs look just like normal underwear and are unnoticeable under your normal clothes. Although period underwear may seem similar, it doesn’t normally include the special anti-odor advantages of designs recommended for urinary symptoms, so it’s important to look for absorbent and anti-odor product features.
- Non-hormonal treatments for urinary tract problems during menopause normally focus on the management and elimination of UTIs. Antibiotics will be recommended based on the test (culture) of lab urine samples. Generally, laboratory testing is required before antibiotics can be prescribed.
- In addition, if you are diagnosed with An Overactive Bladder, there are several medications that may be prescribed. Tolterodine, oxybutynin, and mirabegron are all used to treat urgency of urination and too-frequent urination concerns.
- Vaginal pessaries can be effective if the underlying cause is pelvic organ prolapse. A pessary will support the bladder wall and urethra (the ‘tube’ that is connected to your bladder and allows urine to leave your body) and provides a gentle compression of the urethra against the pubic bone. It is made of silicone or rubber and needs to be placed transvaginally by a medical professional to ensure proper fitting.
Lifestyle
Throughout menopause, it is essential to stay adequately hydrated at all times. If nighttime urination frequency is a problem, you may want to consider reducing liquid intake during the later parts of the day. Also, alcohol and caffeine are both directly related to the increased production of urine (they are “diuretics”). It is wise to limit your consumption of alcohol and caffeinated beverages if you are experiencing incontinence symptoms.
Exercises can help strengthen your pelvic floor and help to drastically reduce incontinence and urine leakage symptoms. Although you may benefit from a professional consultation with a physical therapist regarding pelvic floor strengthening exercises, there are also some easily accessible, proven home-based methods:
- Yoga (particularly poses targeting the pelvic floor)
- Kegel exercises
- Pelvic floor physical therapy
A healthy lifestyle promotes optimal urinary tract function. We know that aging affects urination patterns and that carrying excessive body weight puts a woman at increased risk. Lifestyle changes which promote optimal nutrition and health are easy ways to promote your best-possible results during treatment for incontinence.
Holistic
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