How Menopause Affects Bladder Control and What to Do

The Impact of Menopause on Bladder Health - Uncovering the Causes

Various causes impact bladder health. Here are some common causes that impact bladder health during menopause. 

1. Hormonal Changes

a) Reduced Oestrogen
Beyond its role in reproductive health, did you know oestrogen also helps in the functioning of the lower urinary tract? 

Oestrogen plays a main role in maintaining the health and strength of the urinary bladder (a pouch-like structure that stores urine), urethra ( a pipe-like structure that carries urine from the bladder to outside), and pelvic muscles (muscles that support the pelvic organs like uterus and bladder).

A decline in oestrogen levels during menopause weakens these structures, making it difficult for them to hold the urine. This leads to bladder leakage or overactive bladder symptoms.

A study states that around 70% of menopausal women experience urinary incontinence in the form of increased frequency, urgency, nocturia (passing more urine at night) or urgency incontinence due to atrophic changes of these structures. 

b) Impact on Bladder Function
Reduced oestrogen levels impact the integrity of bladder and urethral tissues. These tissues lose elasticity and strength, resulting in a frequent urge to urinate, reduced capacity of the bladder, and increased risk of incontinence.

2. Physical Changes

a) Pelvic Floor Weakness
Ageing and hormonal shifts naturally weaken the pelvic floor muscles that support the bladder, uterus and rectum. 

This reduces their ability to the bladder and position and controls the release of urine. 

b) Reduced Bladder Capacity
Ageing reduces the bladder’s capacity to store urine. The reduced capacity, along with the weaker pelvic muscles, often leads to frequent urge of urination or an urgency to use the restroom.

3. Other Contributing Factors

a) Sleep Disturbances
Menopause-related hot flashes and night sweats can significantly impact your sleep pattern, causing you to wake up frequently. 

When sleep disturbance is coupled with bladder control issues, it can result in multiple night-time trips to the restroom. This condition is known as nocturia.

b) Weight Gain
The hormonal changes during menopause cause weight gain. An excessive gain in weight creates extra pressure on your bladder and pelvic muscles, leading to increased frequency or urgency. 

Menopausal women tend to accumulate 15-18% of their total fat in the belly area. This increases the abdominal pressure, further straining the already weakened muscles.

Types of Bladder Control Issues Experienced by Menopausal Women

You’re about to enter menopause! Are you wondering what bladder issues you should be aware of? Keep reading to learn more.

a) Stress Incontinence
The most common type of bladder issue faced by older women is stress incontinence.

Weakened pelvic floor muscles can’t hold back the urine when you cough, sneeze, laugh or lift something heavy. This can lead to leakage of a few drops of urine or complete loss of control under pressure. 

b) Urge Incontinence
Imagine - you badly have to pee, and you can’t hold it back anymore! You’re running to the bathroom, but before you reach the restroom, you experience an unexpected leakage.

When the bladder muscles squeeze abnormally or lose the ability to relax due to the influence of hormones, you may feel a constant urge to urinate, even when your bladder is empty. It leads to unexpected urine or loss of bladder control. This condition is called an ‘overactive bladder’.

c) Mixed Incontinence
A combination of weak pelvic floor muscles and bladder muscle overactivity causes mixed incontinence.

d) Overflow Incontinence
When your bladder does not fully empty, you might experience continuous dribbling of urine. Sometimes, you can have a weak urinary stream or experience difficulty in initiating the process (urinary hesitancy). This condition occurs due to the underactive bladder muscles.

e) Nocturia
Do you wake up several times from your sleep just to pee? Frequent urination at night time is called nocturia. 

The condition occurs due to reduced bladder capacity, hormonal changes, or other age-related changes.

Understanding the Risk Factors

Menopause is not the sole reason for developing urinary incontinence. If menopause is accompanied by any of the following conditions, your risk of developing urinary incontinence increases.

a) Alcohol and Caffeine 
Caffeine stimulates the nervous system, irritating the lining of the bladder and increasing the urge to urinate. It also stimulates your kidneys to produce more urine.

A study states that caffeine causes diuresis, promoting early urgency and frequency of urination.

Alcohol leads to dehydration, which can make your pee more concentrated and irritate the bladder. This causes increased frequency and urgency.

b) Infections
Temporary urinary incontinence is caused due to infections of the bladder or urinary tract. It gets resolved once the infection is cleared.

c) Nerve Damage
A nerve sends a signal from your bladder to the brain and vice-versa. When the nerve is damaged, it interrupts the signals, so you do not experience the urge to urinate. This impacts your ability to control urination.

d) Constipation
Long-term constipation can weaken the pelvic floor muscles. Weakened pelvic floor muscles make it harder to hold in urine.

e) Medications
Some medicines, such as diuretics or steroids, show a common side effect of urinary incontinence.

Tips and Strategies for Managing Bladder Control Issues During Menopause

Bladder issues during menopause can be prevented. Here are some tips that help you control bladder issues.

1. Pelvic Floor Exercises

a) Kegel Exercises
Kegel exercise focuses on contracting and relaxing the pubococcygeus or pelvic floor muscles. It strengthens the ability of the urethra and pelvic muscles to contract and stretch.

By doing Kegels every day, you strengthen your pelvic muscles, which improves your ability to hold urine and reduce leakage episodes.

Click here to learn more about kegel exercise.

Incorporate kegels into your daily routine to see noticeable results in a few weeks.

2. Lifestyle Adjustments

Bladder control during menopause is a common concern which can be managed by appropriate approaches and treatment solutions.

Our experts at Nirva Health work together by combining the wisdom of Ayurveda and Yoga to improve both physical and emotional health during this transition.

Understanding the root causes empowers you to stay provocative. So ladies! Why wait? Book a consultation right away.

a) Regulate Fluid Intake
Manage your fluid intake, especially in the evening, to minimize your night-time trips to the restroom. Avoid excessive consumption of bladder irritants like caffeine, alcohol or sugary drinks.

b) Weight Management
Maintaining a good and healthy weight reduces abdominal fat. Reduced abdominal fat decreases the abdominal pressure on the bladder and pelvic muscles. 

Tap here to learn more about weight management remedies during menopause.

c) Regular Physical Exercise
Low-impact exercises such as yoga or walking promote overall strength and circulation, aiding in better bladder health.

3. Bladder Training

a) Scheduled Bathroom Visits
Set a proper schedule or time to visit the bathroom rather than going at every urge. This increases the capacity of the bladder to hold urine for longer periods.

b) Gradual Delay Technique
Slowly and gradually increase the time gap between urinations. This helps build bladder capacity and control.

4. Dietary Regulations

a) Stay Hydrated
While managing fluid intake is essential, it is also necessary to stay hydrated to avoid concentrated urine. Concentrated urine irritates the lining of your bladder, which can increase the frequency and urge to urinate.

b) Incorporate Bladder Friendly Foods
Consume foods which are rich in water content to keep yourself hydrated. Foods like watermelon, cucumbers, berries, and celery keep you hydrated without overloading the bladder. Limit foods with excessive spice, salt and artificial sweeteners, as they can trigger bladder irritation.

5. Lifestyle and Behavioural Changes

a) Mindful Bathroom Habits
Do not rush to the restroom if you feel the urge to urinate. Instead, stay calm and composed. This helps train your bladder. 

b) Use of Absorbent Products
Are you worried that incontinence is going to embarrass you when you are out with your friends or at a social event? Don’t worry; you can rely on pads or absorbable underwear to feel comfortable and confident.  

6. Medical Treatment 

a) Over-the-counter Medications

Supplements that improve bladder control, such as cranberry extracts, probiotics or bladder control vitamins, can help reduce your symptoms.

b) Prescription Medication

Medications such as anticholinergics or beta-2 agonists help relax bladder muscles, reducing urgency and frequency.

c) Physical Therapy
Consult a physical therapist who will provide a tailored plan of exercises and techniques to strengthen pelvic muscles.

d) Devices 
Pessaries are one of the most common devices used in the treatment of urinary incontinence. It is a stiff ring that is inserted into your vagina to help reposition your urethra in order to reduce leakage

e) Nerve Stimulation
If urinary incontinence is due to nerve impairment, electrical stimulation of the nerve can help restore its normal functioning.

f) Biofeedback
An electrical patch connects your bladder and urethra muscles through a wire. It sends signals to the monitor, which alerts you when your muscles are contracting. By understanding when your muscles contract, you can gain better control over them.

7. Surgical and Advanced Treatment Options

a) Minimally Invasive Procedures
In moderate cases of urinary incontinence, sling surgery or botox injections can be recommended to improve bladder strength when other treatment options have failed.

b) Surgical Procedures
In moderate to severe cases, bladder neck suspension surgery helps treat urinary incontinence by supporting the bladder and the urethra.

Appropriate Time to See A Doctor

When should you see a doctor? This is a common question that always arises. Knowing your symptoms and seeking a healthcare professional’s help at the appropriate time is very essential. 

• Symptoms Worsen: If you are experiencing frequent leaks, unable to hold the urine or severe nocturia, it is better to see a doctor.
• Signs of Complication: If the increased frequency or urgency of urination is associated with painful urination (dysuria), blood in the urine (hematuria) or a recurrent urinary tract or bladder infection, seek medical help.
• Emotional Distress: If the bladder issues are making you uncomfortable and embarrassed to step out of your house or attend social events, visit your doctor.

Preventive Measures for Maintaining Bladder Health During Menopause 

Here are some tips you can follow to maintain bladder health during menopause,

• Regular Exercise: Keep yourself active! Regular exercise and physical activity improve circulation in the body. Good and healthy circulation also improves the strength of pelvic muscles. You can include Kegels, yoga or walking in your routine to improve the strength of pelvic muscles.

Need a quick guide for menopause fitness? Click here.

• Balanced Diet: Foods which are high in water content can maintain the pH of the urine and avoid irritation of the bladder lining. Food rich in fibres reduces constipation, which indirectly strains the bladder.
• Routine Medical Checkups: Prevention is better than cure. Regular health evaluations with your urologist or gynaecologists help in the early detection of changes and address them proactively.

Wrapping Up

Menopause transition can be pretty annoying with all the hot flashes, night sweats, anger issues and whatnot. A leaky bladder can add to this frustration.