How menopause can cause changes in the bladder

If you have patients going through menopause, they might be finding it harder to control their bladder. This is a common problem – but there’s advice you can give them to help make them feel more in charge.

Why does incontinence occur during menopause?

A woman’s bladder may get weaker during menopause because her ovaries stop making oestrogen, the hormone that controls her menstrual cycle. This can cause her vaginal tissue become less elastic, the lining of her urethra to thin and her pelvic floor muscles (which support her urethra and bladder) to reduce.

It can also make her bladder less elastic and overstretched, so that it gets irritated when it fills up with urine and becomes ‘overactive.’

Oestrogen loss can result in vaginal and urethra dryness, which can put women at higher risk of developing a urinary tract infection as a result of normal bowel bacteria moving into the urethra.

Postmenopausal weight gain is common, putting extra strain on a woman’s bladder and weakening her pelvic floor muscles, creating stress incontinence. Plus great risk of diabetes can create nerve damage (neuropathy), which means loss of sensation in the bladder, poor emptying and constipation.

Many women who have given birth and have had damage to their anal sphincter (muscle around the anus) may also find bowel control problems occur with the onset of menopause.

What are the warning signs?

The most common problems women face during and after menopause are:

  • Stress incontinence. She might complain she’s losing a few drops of urine when coughing, sneezing, or laughing, or leaking when she’s lifting something heavy or doing something that puts pressure on her bladder.
  • Urge incontinence. The need to urinate comes on fast and unexpectedly. She might complain that she’s not making it to a bathroom in time. This is sometimes called an “irritable” or “overactive” bladder.
  • Nocturia. Some women wake up several times in the middle of the night with an urge to urinate.
  • Painful urination. After menopause, women are more likely to have urinary tract infections (UTIs).

Any of these problems can interfere with work, social activities, and sexual and personal relationships. Without medical help, they rarely go away and usually get worse over time.

The good news is incontinence during and post menopause can be treated, managed and often cured.

Five things you can suggest to help female patients regain control of their bladder:

  1. “Eat well.” Extra kilos put more pressure on the bladder. Suggest your patient maintains a healthy, low fat diet to combat the tendency to put on weight during menopause.
  2. “Drink well.” Coffee, tea, fizzy and alcoholic drinks cause the bladder to fill quickly and then leak. If your patient usually wakes in the night night needing to go, tell them to cut back on the amount of fluids they drink during the evening.
  3. “Exercise regularly.” Keeping fit and healthy reduces the potential for weight gain, lowers stress and maintains muscle tone.
  4. “Tone up your pelvic floor muscles.” Refer her to the “Work that floor” article in this newsletter!
  5. “Practice good toilet habits.” Suggest she set scheduled bathroom breaks – say, every hour – to help regain control of her bladder muscles. Once she sees improvement, she should try slowly extending the time she heads to the toilet.

For more information, contact our Urology and Continence nurse by clicking here. Alternatively, you can visit the Continence Foundation website.