Incontinence After Menopause

Menopause definitively occurs when a woman goes 12 full months without having a menstrual cycle. It’s a completely normal side effect of the natural aging process, but often presents uncomfortable symptoms, including hot flashes, irritability, and sleep disturbances. Another common symptom is incontinence after menopause.

Researchers estimate more than 50% of postmenopausal women experience urinary incontinence, or loss of bladder control, yet few seek treatment due to feelings of shame or embarrassment.

Incontinence after menopause can be a challenging subject to discuss, but it’s important to do so. There are various treatment options and products available that can reduce urinary leakage and improve your quality of life.

When transitioning to menopause, the female body experiences significant hormonal fluctuations. These changes affect the body in several ways but are particularly noticeable in terms of gynecologic health. 

During the onset of menopause:

• Vaginal tissue becomes less elastic

• The urethra begins to thin

• Pelvic floor muscles weaken

You might also experience vaginal dryness and loss of libido. Even though these symptoms are common, many women don’t realize they’re related to menopause. Knowing that these issues result from a hormonal imbalance can help you take proactive steps to manage them.

The most common types of incontinence that postmenopausal women experience include:

Stress incontinence. Stress incontinence occurs due to excess pressure on the bladder. If you have stress incontinence, you might urinate while coughing, laughing, sneezing, or lifting something heavy. 

Urge incontinence. Urge incontinence occurs due to abnormal bladder contractions. It causes a sudden, intense urge to urinate, followed by a void. 

Nocturia. Nocturia refers to waking up at night with an urge to urinate. It isn’t a type of incontinence per se but is a common bladder-related symptom of menopause.

Climacturia. Climacturia refers to urine leakage that occurs during sexual intercourse or orgasm. Often, it’s due to weak pelvic floor muscles, pelvic prolapse, or a miscommunication between the pelvic floor muscles and bladder. 

If you experience urinary leakage on a daily or weekly basis, make an appointment with your primary care physician or OB/GYN. Having routine accidents may indicate an underlying health problem. Plus, urinary incontinence isn’t something you have to “live with.” There are various treatment options that are both easy and effective.

Sara Reardon, PT, DPT, WCS, BCB-PMD, owner, and founder of The Vagina Whisperer and NOLA Pelvic Health says “step one is starting to talk about incontinence and then seeking help. This issue is common, but shouldn’t be accepted as ‘a normal part of aging.’”

To determine the source of postmenopausal incontinence, your primary care physician or OB/GYN reviews your medical history and conducts a pelvic exam. Afterward, they ask about your symptoms, including when they started, their severity, and if any activities like consuming caffeine or alcohol make them worse.

Most of the time, a pelvic exam, a discussion of your symptoms, and a review of your medical history are enough to make a diagnosis. However, if your doctor suspects an issue other than hormonal fluctuations, they might recommend additional tests, including:

• Urine stress testing. During a urine stress test, your doctor uses a catheter to fill your bladder with water. The catheter is then removed and you’re asked to cough.

• Bladder ultrasound. A bladder ultrasound uses high-frequency sound waves to capture images of your bladder. Your doctor uses an ultrasound to determine if your bladder empties completely.

• Cystoscopy. Cystoscopy is a minimally invasive procedure that uses an endoscope—a thin tube with a camera on the end—to assess the lining of your bladder and urethra. It occurs under local anesthesia, so you don’t experience any discomfort.

• Urodynamic testing. Urodynamic testing measures how well your bladder holds and releases urine. 

One of the most common treatments for incontinence after menopause is Kegel exercises or Kegels. 

“Kegels are contractions of your pelvic floor muscles,” Reardon said. “Your pelvic floor muscles sit at the base of your pelvis and help support your pelvic organs and growing baby during pregnancy. They also hold in pee and poop until an appropriate time to empty and play a role in sexual function and childbirth. Kegel exercises can improve incontinence, sexual function, and pelvic organ support if done properly and when indicated.”

Still, Kegels aren’t right for everyone. “It’s always best to check with your healthcare provider before performing Kegels,” said Reardon. “In some cases, the pelvic floor muscles can be too short or too tense, and adding more contractions on top of an already tight pelvic floor isn’t the best idea. Often, you may experience leakage and have tense pelvic floor muscles that need to be relaxed and lengthened before starting a strengthening program."

Read more: Combating Incontinence with Kegels

Other steps that Reardon recommends include:

• Topical estrogen to plump up the vulvar and vaginal tissues

• Using an all-natural balm to moisturize the vagina

• Working with a medical specialist like a urogynecologist

• Avoiding irritants like caffeine and alcohol

• Bladder training

• Scheduled toilet trips

You might also benefit from working with a pelvic floor physical therapist. According to Reardon, this can “proactively strengthen your pelvic floor muscles and educate you on optimal strategies for urination and bowel movements that prevent straining.”

Yes. Sometimes Kegels, healthy lifestyle changes, and activity modification aren’t enough to prevent unexpected voids. Even so, there are a variety of products that can keep you, your clothing, and your furniture clean and dry.

Here at Carewell, we carry a variety of products designed to manage urinary incontinence, including:

• Adult diapers and pull-ups

• Underpads (Chux)

• Top-liner booster pads

• Incontinence pads

• Catheters

• Bedpans

• And more!

If you have questions or need help making the right selection, reach out to our friendly Care Team at any time by calling (800) 696-CARE or sending a message to support@carewell.com.

Dealing with incontinence after menopause isn’t always easy, but it is manageable. “We often fail to discuss these very intimate changes we experience,” said Reardon. “Know you are not alone, and there is help and hope available!”