Maybe you’ve come to expect a trickle of urine while you’re laughing, lifting a heavy bag of groceries, or even having sex. Or perhaps you always research the bathroom situation ahead of time when you’re out and about, because you know the urge to go might strike at a moment’s notice.
If these sorts of situations have become par for the course, you’re part of a very large group. Urinary incontinence affects up to half of menopausal women, research shows.1 But even though it’s common, it’s not something you should simply accept. “Urinary incontinence is not an inevitable result of aging and should not be considered normal, according to the North American Menopause Society (NAMS),” says Bonafide Chief Medical Officer, Dr. Alyssa Dweck.
So how can you tell if what you’re dealing with is really incontinence – and what can you do to regain control? Here’s what you need to know.
How Can Menopause Cause Urinary Incontinence?
The chances for urinary incontinence generally increase with age. As we get older, the muscles supporting the urethra and bladder naturally grow weaker, which can make it harder to hold urine in.2
Menopause can exacerbate the condition, since declining levels of the hormone estrogen can cause the lining of the urethra – the tube that sends urine from the bladder out of the body – to become thinner.3
Together, these two factors can add up to a greater likelihood that a woman will experience urine leakage during perimenopause or menopause.
Symptoms of Urinary Incontinence
Urinary incontinence has several types but there are two notable forms. The symptoms a woman experiences can tell a lot about which type she has, as well as what can be done to manage the problem.
- Stress incontinence is the most common type of incontinence, affecting up to 88% of those with urine leakage.4 Caused by weakened pelvic floor muscles, stress incontinence is marked by leakage that occurs from increased abdominal pressure – think sneezing, coughing, laughing, bending, or lifting heavy objects.
- Urge incontinence or overactive bladder is caused by overly active or irritated bladder muscles. It’s characterized by sudden, frequent urges to urinate.
In addition to leakage, some women with incontinence experience other changes to the way they urinate too. “Some may notice a change in the stream force or direction of their urine, as well as urinary spraying or a sensation of relaxation of the bladder or urethra,” Dr. Dweck says.
Managing Urinary Incontinence During Menopause
Incontinence may be common after menopause, but it’s not something you have to live with. Depending on your symptoms and personal preferences, urine leakage can be managed with lifestyle changes, medication, surgery, or a combination approach.
To find the right strategy for you, start by talking with your healthcare provider. While bringing up urine leakage can be uncomfortable, your doctor can be an ally for finding effective, personalized solutions. “You’re not alone in this incredibly common complaint,” says Dr. Dweck.
For many women, Kegel exercises are an effective way to strengthen the pelvic floor muscles. Giving the bladder more pelvic floor support can help prevent leakage as well as provide other benefits, like more satisfying sex and preventing pelvic organ prolapse. Experts recommend performing Kegels on an empty bladder and working up to five sets of 10 repetitions per day.5
Another simple strategy: Taking a proactive approach with your drinking and bathroom habits. Both alcohol and caffeine can act as diuretics and cutting back on your consumption can mean having to go less often. Slowly lengthening the time in between bathroom trips and double voiding – a technique whereby you urinate, then waiting a few minutes to urinate again to make sure the bladder is completely empty – can also be helpful.
When lifestyle changes aren’t enough, other options can help. Working with a pelvic floor therapist is another option for naturally strengthening pelvic floor muscles to help hold urine in. Your provider might also recommend urethral inserts or a pessary – a flexible silicone ring inserted into the vagina – to prevent leaks.6
In some cases, low-dose topical estrogen creams can be helpful. For urge incontinence in particular, Botox injections can also be used to encourage overactive bladder muscles to relax.7
Your primary care provider or gynecologist can be a good first resource for helping you put together an action plan based on your symptoms and preferences. But if the strategies you’re trying aren’t helping enough, consider seeing a specialist like a urogynecologist. “Urogynecologists manage this issue on a day-to-day basis,” notes Dr. Dweck, so they may be able to offer more effective treatment options.