When it comes to bladder health, declining estrogen levels, due to age, menopause or other reasons, can lead to noticeable changes for women. In fact, urinary system changes related to menopause are so common that the verbiage used by the medical community has been updated.
We in the gynecology world have abandoned the term “vulvovaginal atrophy” and now use “genitourinary syndrome of menopause” (GSM) to include a broader collection of genital and urinary symptoms that can occur during this life stage, rather than just limiting it to vaginal dryness.
Here are some of the more common changes menopausal women may experience when it comes to the bladder, a main organ of the genitourinary tract.
Overactive bladder (OAB) is poorly understood but involves involuntary bladder muscle contractions followed by an intense urge to urinate, even if the bladder isn’t full. OAB symptoms are quite commonplace, affecting millions of women, and they tend to become more common during menopause or with age.
Typical symptoms of menopausal and age-related OAB include:
- A sudden and frequent urge to urinate with or without involuntary leakage of urine
- Urinary frequency (or the need to urinate) more than 8 times in a 24-hour period
- The need to awaken from sleep multiple times at night to urinate
These symptoms can be disruptive to day-to-day activities, possibly leading to the avoidance of exercise and intimacy and even potentially social isolation.
Addressing OAB, with or without urinary symptoms, might include lifestyle and behavior modifications, but it’s always important to check with your healthcare provider to see what options are best for you. Some modifications can include fluid restriction (especially before bedtime) and limiting caffeine and alcohol, which have diuretic properties and can act as bladder irritants. Prescription medications or local Botox injections are options for some. If your symptoms related to OAB persist or worsen, surgical intervention or nerve stimulation are more aggressive measures that can be discussed with your healthcare provider.
Did you know bladder infections are the most common type of urinary tract infection (UTI)? Also known as cystitis, this type of UTI is caused by bacteria and can have symptoms similar to OAB. Frequent and urgent urination are hallmarks of both. The official diagnosis of a bladder infection can be confirmed with a urinalysis and culture, and symptoms typically resolve with a short course of antibiotics.
Declining estrogen levels during menopause can make women more prone to UTIs, cystitis or bladder infections. The genital tissues become inelastic, less supple, thinner, and more prone to micro-abrasions during sexual activity, which can also lead to UTIs. As women age, it can also become harder to fully empty the bladder when using the bathroom, which can make this type of infection more likely.
Maintaining already healthy tissue with a regular vaginal moisturizer can help avoid UTIs in general. Optimizing the vaginal microbiome by avoiding disruptors (such as douching) and taking a probiotic geared towards vaginal health may also help.
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Urinary incontinence (UI) refers to the involuntary leakage of urine. There are several types of urinary incontinence that are related to bladder health and may become more prevalent during menopause. Stress incontinence is a mechanical issue in which coughing, sneezing, or straining puts pressure on the urethra and bladder, causing leakage to occur. Pelvic organ relaxation — which can happen as women age — commonly leads to these symptoms. Stress incontinence is not associated with OAB or UTIs, but they can be present at the same time (often referred to as mixed incontinence).
In contrast, urge incontinence occurs when the sudden urge to urinate is so overwhelming that reaching the toilet becomes a challenge and leakage occurs. Both menopausal OAB and UTIs may involve this form of incontinence.
Working with your healthcare provider to determine what type of urinary incontinence you have is the first step in treatment. Next steps may vary depending on the underlying causes behind incontinence, but pelvic floor physical therapy, timed voiding, and bladder training often help.
When it comes to bladder issues in older women patients, the question always arises, is it age-related or is it menopause? In short, the answer is that it’s probably both. Either way, tools are available to help manage and prevent symptoms and any disruption they’re causing to your quality of life.