Urinary Incontinence During Menopause: How to Reclaim Control

Bladder leakage during menopause is a common yet often overlooked issue, affecting 38%–55% of women over 60 years old.⁽¹⁾ Symptoms can range from minor leaks during activities, such as laughing or exercising, to sudden, uncontrollable leakage that can disrupt daily life.

Urinary incontinence is a significant symptom of the genitourinary syndrome of menopause (GSM), which is also associated with sexual dysfunctions, such as vaginal dryness and discomfort during intercourse.⁽²⁾ 

Despite its high prevalence, many women mistakenly accept urinary incontinence (UI) as a standard sign of aging or menopause and consequently don’t seek help. This misconception can prevent them from exploring effective treatment options that can significantly improve their quality of life.

Various medicinal and non-medicinal options, like vaginal support devices and hormone replacement therapy (HRT), are readily available to manage these kinds of menopause symptoms. By proactively addressing urinary incontinence, women can significantly enhance their comfort and quality of life, embracing this phase with the support and care they deserve.

What is urinary incontinence?

Urinary incontinence refers to the unintentional release of urine, with severity varying from occasional dribbles to a total loss of bladder control.⁽²⁾

Types of Urinary Incontinence

Several types of urinary incontinence can develop during the menopausal transition, each presenting unique challenges:⁽²⁾

Stress Incontinence

This is the most prevalent form of bladder control issues among women undergoing menopause. In this condition, weakened pelvic muscles fail to contain urine during physical activities like coughing, exercising, sneezing, laughing, or lifting heavy objects. The outcome may range from minor leaks to complete loss of bladder control. 

Urge Incontinence

This condition is also known as "overactive bladder," and it arises when bladder muscles contract involuntarily or cannot relax properly, leading to a frequent and urgent need to urinate. It may also lead to urine leakage or a complete inability to control urination.

Mixed Urinary Incontinence

This involves symptoms of both stress and urge incontinence, often presenting a complex challenge as it combines the characteristics of an overactive bladder with other forms of urinary incontinence.

Why does urinary incontinence happen during menopause?

During the menopausal transition, fluctuations in estrogen levels may cause UI in some women. A decrease in estrogen can lead to thinning of the urethra's lining, the short tube through which urine is expelled from the bladder. This reduction in thickness can impair the urethra's ability to form a tight seal and effectively control urine flow, thus increasing the likelihood of incontinence. Additionally, as women age, the pelvic floor muscles and surrounding tissues, which also rely on estrogen, may weaken, further exacerbating urinary incontinence issues.⁽³⁾

However, not all women will experience these changes to the same degree, and therefore, not all will develop UI.

Risk Factors for Urinary Incontinence

Some factors that might predispose women to UI or exacerbate symptoms during the menopausal transition include the following:⁽²⁾

• Lifestyle factors: Sedentary habits, such as prolonged sitting at work, frequent car use, or lack of physical activity, can weaken the body's overall performance. 

• Genetic predisposition: A higher incidence of UI is observed in women with a family history of urinary incontinence, suggesting a genetic factor in its development.

• Pregnancy and childbirth: The number of pregnancies and the nature of childbirth (particularly those induced with oxytocin) influence UI risk. Cesarean deliveries may lower the risk, whereas larger birth weights (more than eight pounds) and multiple natural births can increase it.

• Obesity: Abdominal obesity significantly raises the risk of UI. Studies indicate that obese women are 4–5 times more likely to suffer from incontinence compared to those of average weight.

• Health conditions: Several medical issues can increase UI risk, including urinary tract infections, chronic constipation, diabetic neuropathy, neurological disorders like Parkinson’s disease and multiple sclerosis, as well as chronic respiratory diseases like COPD, which increase abdominal pressure and potentially exacerbate UI.

• Medications: Certain drugs, including diuretics, antihypertensives, and anxiolytics (medicines to manage anxiety symptoms), may influence the occurrence of UI by affecting bladder control or muscle strength.

Diagnosing Urinary Incontinence

To diagnose UI, healthcare practitioners typically conduct a detailed medical history and physical examination, including a vaginal exam. They also measure the post-void residual volume to determine how much urine remains in the bladder after urination. To confirm the diagnosis, practitioners will rule out other conditions that mimic UI, such as urinary tract infections.

Treating Urinary Incontinence

Several treatment options are available to manage UI during menopause:

Pelvic Floor Muscle Exercises (Kegels)

Kegel exercises are highly effective for strengthening the pelvic floor muscles, which are crucial for controlling urination and preventing urinary incontinence. The correct muscles can be located by attempting to stop the flow of urine midstream. This helps to target the muscles needed for Kegel exercises. While this method is helpful for initially finding the correct muscles, it shouldn’t be performed regularly during urination, as it can lead to incomplete bladder emptying and increase the risk of bladder infections.⁽⁴⁾

Kegel exercises can be performed in various positions — standing, sitting, or lying down. The person tightens the pelvic floor muscles as if trying to halt urination, holds this contraction for three to five seconds, then relaxes the muscles for another three to five seconds. This sequence can be repeated ten times per session, with the goal of three sessions throughout the day.⁽⁴⁾

Lifestyle Changes

The following lifestyle changes may help manage urinary incontinence, enhancing comfort and quality of life:⁽²⁾ 

• Losing at least 5% of body weight can be beneficial for overweight individuals. This modest decrease in weight has been scientifically proven to help relieve symptoms of stress urinary incontinence.

• Reducing the intake of caffeine, alcohol, and carbonated beverages is advisable, as these can increase bladder pressure and irritate the bladder's lining. Additionally, managing the timing and volume of fluid intake can aid in better bladder control.

• Avoiding activities that exert excessive pressure on the pelvic floor muscles, such as exercises on trampolines, can prevent aggravating UI symptoms.

• Extending the intervals between restroom visits and practicing control over the urine stream during urination can strengthen the bladder’s capacity to hold urine and reduce urgency.

Vaginal Devices

Several devices are available to assist women in managing UI. A pessary, often used for stress incontinence, is one of the most common. This device is a stiff ring that is inserted into the vagina to help reposition the urethra and reduce leakage. Additionally, doctors may prescribe a urethral insert, a small disposable device designed to be inserted into the urethra to prevent leakage.⁽⁵⁾

Medications

Certain medications can help reduce symptoms and treat various types of UI. For an overactive bladder, doctors may prescribe anticholinergics, which can help calm the bladder. Another option is a beta-3 adrenergic receptor agonist, which increases the bladder's capacity to hold urine.⁽⁶⁾ Additionally, topical estrogen products may be recommended to strengthen the tone of the urethra and vaginal areas.⁽⁵⁾

Surgery

Surgery to reposition and support the bladder is often considered a last resort for treating UI. This option is typically reserved for individuals who have not responded to other forms of treatment. By lifting the bladder into a better position, the surgery aims to provide a more permanent solution to manage UI symptoms, enhancing the patient's quality of life when less invasive interventions have proven ineffective.⁽²⁾

Living With Urinary Incontinence

Women experiencing UI are encouraged to consult with a healthcare provider who can assess their symptoms and recommend a personalized treatment plan. This approach helps women regain control over their bladder function and improve their quality of life.

One effective treatment option involves the use of vaginal estrogen. This hormone therapy is administered topically in low doses directly to the vaginal area, enhancing the strength and tone of the muscles and tissues in the pelvic region.⁽⁷⁾ Additionally, hormone replacement therapy (HRT) may be delivered via skin patches, creams, or tablets, leading to significant improvements in urinary and pelvic floor health.

Supplementing with DHEA may also help, as it converts into both estrogen and testosterone, boosting hormone levels that may support the urinary system and pelvic muscles.⁽⁸⁾

Tips for Managing Urinary Incontinence

Several proactive measures can help maintain intimate hygiene and manage UI effectively:^(9,10)

• Avoid products that irritate the skin around the vulva and urethra, such as perfumes, powders, soaps, deodorants, spermicides, and certain lubricants, as they may contain harmful chemicals.

• Opt for loose clothing, and limit the prolonged use of sanitary or continence pads, which can irritate by rubbing against sensitive skin.

• Manage vaginal and vulvar dryness with vaginal estrogen pessaries, creams, and gels, which can aid continence and soothe irritated areas.

• Use over-the-counter vaginal moisturizers and lubricants to alleviate discomfort.

• Wear absorbent pads or liners to protect against leakage.

• Practice double voiding to ensure the bladder is completely empty after using the toilet.

• Plan regular bathroom breaks throughout the day to manage incontinence effectively.

• Discuss incontinence openly and honestly with a healthcare provider to explore the most effective treatments.

Experiencing urinary incontinence during menopause? Discover if HRT is right for you.

If you’ve entered the menopause transition and are struggling with urinary incontinence, you don’t have to suffer in silence. Take our brief menopause quiz to see if you’re an eligible candidate for HRT. Get started with Winona to take the first step toward feeling better.