Bladder health

• I have trouble controlling my urination from time to time. What can I do?
• What is urge incontinence?
• What is stress incontinence?
• Are urinary tract infections more common during perimenopause and menopause?
• What are some of the treatments for urinary incontinence?
• I have recurring urinary tract infections (UTIs)? Is that related to my menopause?
• What other resources can I consult about problems I am having with urinary tract infections and/or incontinence?

Bladder control difficulties are common among menopausal women. Learn more about the causes—and solutions.

I have trouble controlling my urination from time to time. What can I do about it?

As they age, many women have trouble with urinary incontinence, the medical term for when your body accidentally leaks urine. There are a number of reasons why incontinence occurs and thankfully many treatments exist, including a wide range of non-surgical approaches. You can make lifestyle adjustments, find out about non-surgical support devices, do pelvic exercises, get help from a physiotherapist, and investigate operations that might provide a more permanent solution. Sometimes medications can be used to help with bladder control.

Physicians and other health professionals can help you work out what will work best for you. Take the first step and let them know you need help.

What is urge incontinence?

Women with “urge incontinence” usually have a sudden and urgent desire to urinate that sometimes comes on so fast that there isn’t enough time to get to a toilet. This leakage can be embarrassing and stressful. This type of incontinence usually indicates that the bladder’s storage system isn’t working properly.

A variety of treatments exist for urge incontinence and they include bladder training, electric stimulation of lower back nerves, eliminating certain fluids and foods from your diet which may irritate your bladder (such as caffeine), prescription medications, eliminating medications that cause urge incontinence, local estrogen therapy, and surgical interventions.

Sometimes this type of incontinence can be combined with stress incontinence.

What is stress incontinence?

Stress incontinence indicates a problem with the urethra or the “valve” that closes the bladder. Women will leak from the bladder when they cough, laugh or sneeze, or even change positions. This type of incontinence is usually related to the effects of childbirth or menopause that have weakened the pelvic support for the urethra.

Pelvic exercises (e.g. Kegel exercises, with or without the help of vaginal weighted-cones), support devices inserted in the vagina and some surgical procedures, can help this condition. Pelvic floor physiotherapy may also be helpful.

Sometimes this type of incontinence can be combined with urge incontinence. Current research has not proven that hormone therapy (HT) improves incontinence conditions in any significant way.

Are urinary tract infections more common during perimenopause and menopause?

As hormone levels decline at this time of life, there can often be a direct impact on the tissues, muscles, glands and functions of the vagina and urinary tract. There is an increase in urinary tract infections as women age. Some women may have multiple troublesome recurrent infections.

Chronic UTIs are cause for concern and a health professional should always be consulted since this type of infection can cause more serious problems.  Local estrogen therapy (e.g., cream, vaginal tablet) can be useful to avoid recurrent infections. This treatment works in part by changing the bacterial flora within the vagina, which helps protect the urinary tract against infection.

What are some of the treatments for urinary incontinence?

A variety of lifestyle, non-surgical support devices, and surgical options are available to address urinary tract issues. Sometimes it is as simple as pelvic exercises (e.g. the Kegel exercises—with or without the help of vaginal cones—that are often recommended before and after childbirth), that strengthen muscles in the pelvic floor, or even the use of a mechanical support device such as a pessary, disposable vaginal insert, or reusable silicone device. These devices are inserted into the vagina to support the urinary tract and its function. Local vaginal estrogen therapy (e.g., creams or tablets) may also help urge incontinence as well, but taking oral hormone therapy does not appear to be effective.

Lifestyle can play a role too. Smokers are more at risk for bladder problems, as are obese women. Excessive caffeine consumption can irritate a bladder condition. Losing weight and reducing the amount of fluids you drink each day can modify incontinence problems to some degree. Addressing a chronic cough (if you have one) can also be helpful, along with a few more planned trips to the washroom each day.

There are a number of medications that can be used to help the condition known as “over-active bladder”. In some cases surgery will be the best option, depending on the cause of the incontinence. It is important for women with bladder concerns to have a proper evaluation before any medical or surgical treatment is tried.

I have recurring urinary tract infections (UTIs)? Is that related to my menopause?

Some women have more urinary tract infections during perimenopause and when they have reached menopause. As hormone levels decline at this time of life, there can often be a direct impact on the tissues, muscles, glands and functions of the vagina and urinary tract. Urinary tract infections can lead to more serious infections (e.g. bladder infections) so it is wise to consult a health professional to get advice about available treatments.

What other resources can I consult about problems I am having with urinary tract infections and/or incontinence?

Information found at Women’s Bladder Health, and Laugh without Leaking can help women dealing with various types of incontinence. See also the Resources section of this website. The Canadian Continence Foundation also publishes several useful resources, including the Guide to Better Bladder Control.