Cough (pee). Sneeze (pee). Middle of the night (pee). Urinary incontinence in menopause is enough to drive most women a little nuts.
This unintentional loss of urine is a condition that occurs commonly in adult women, especially following pregnancy and delivery, but is often more common during or after menopause due to loss of elasticity in the vaginal tissue and weakening of the pelvic floor muscles that is associated with the loss of estrogen production.
Menopause incontinence can also be exacerbated by:
- Constipation – Straining to have a bowel movement can put excess pressure on muscles that control the bladder.
- Overweight – The excess weight puts added strain on the bladder muscles.
- Medications – Certain medications, particularly diuretics (“water pills”) can contribute to urinary incontinence.
- Nerve damage – People with diabetes, for example, may have nerve damage that sends the wrong signal to the bladder.
- Surgery – Having a hysterectomy in which the uterus is removed can affect the pelvic floor muscles that help control bladder function.
“Female urinary incontinence often gets worse with age, but women shouldn’t just accept it as a normal part of the aging process,” explains Marc R. Toglia, MD, system chief of female pelvic medicine and reconstructive surgery at Main Line Health. “The majority of women can be successfully treated, and effective treatment options don’t always involve surgery.”
Different types of urinary incontinence
There are several different types and causes of urinary incontinence. These include:
- Stress urinary incontinence (“the leaky valve”) – This is the most common type of urinary incontinence in menopause. Stress incontinence is when you leak small amounts of urine when you cough, sneeze, laugh, exercise or jump. The reason it happens is due to weakening of the urethra, the muscular valve holds urine tight at rest and relaxes to let urine flow when you need to go. The muscles of the urethra can weaken as the result of pregnancy and delivery, heavy lifting or straining, and during the process of menopause, which can weaken the supportive vaginal tissues. If the urethral muscle weakens significantly, you may have leakage with minimal activity, such as walking or changing positions, or you may experience increasingly larger amounts of urine leakage with activity.
- Urgency urinary incontinence (“the overactive bladder”) – Urgency incontinence is when you have a sudden need to empty your bladder (urgency) and lose urine before you get to the bathroom. The loss of urine is often so sudden and uncontrollable, and in such an amount, that you wet through your clothes. You may also experience urgency without leakage, but the sensation and frequency is enough to disrupt your daily life. Urgency incontinence may be brought on by drinking fluids, hearing the sound of running water, or changing positions. Many women with urgency incontinence feel the need to go to the bathroom very often (urinary frequency) or may wake up several times a night to go pee. You may also experience bed-wetting or leakage of urine during sex.
- Overflow incontinence – Overflow incontinence involves two seemingly opposite problems. On the one hand, the bladder does not empty sufficiently (either due to a weak bladder muscle or a non-relaxing urethra) while on the other hand you experience leakage because the bladder becomes so full that urine is forced to leak out. Women with overflow incontinence typically experience a diminished “need” to pee and have a slow or delayed urinary stream. Urinary tract infections are also a common factor in overflow incontinence.
Help for urinary incontinence in menopause
A lot of women suffer in silence when it comes to urinary incontinence in menopause. This may be because the problem starts off as a minor inconvenience (that you simply get used to) which later becomes a major nuisance or starts to impact your personal life. Some women are simply too embarrassed to speak up about the problem. According to the National Association for Incontinence, women wait an average of 6.5 years from the first symptoms of incontinence to getting diagnosed by a professional.
One of the most helpful things you can do to start to understand and treat your condition is to keep a diary of your urinary habits, including how often and when you urinate, and how frequently you experience leakage of urine or experience urgency. It is also helpful to record whether the leakage episode was associated with activity, or a sudden, strong urge to void (pee). Recording the type and amount of fluid intake is also important. Keep this diary for three or four days, and bring it to your next appointment to review with your doctor.
Seeing a doctor for urinary incontinence
Urinary incontinence can be treated by different types of physicians, including family doctors, gynecologists and urologists. Urogynecology, now known as female pelvic medicine and reconstructive surgery, is a board-certified subspecialty that focuses on the treatment of urinary incontinence and pelvic floor disorders in women. Physicians in this field are typically gynecologists or urologists that have undergone additional training and certification. Significant medical advances have led to a variety of new and improved treatment options in the past 10 years.
Female incontinence treatment
Urinary incontinence therapy varies based on whether you’re experiencing stress incontinence, urgency incontinence, overflow incontinence, or perhaps all three. Therapies for urinary incontinence include:
- Pelvic floor muscle therapy
- Medical therapy with drugs
- Third-line therapy, such as Botox for urinary incontinence or sacral neuromodulation for urgency leakage
- Behavioral modification with bladder retraining
“We’ve found that for mild cases, pelvic floor muscle therapy can be a helpful treatment for stress urinary incontinence, although surgery is generally the most effective,” says Dr. Toglia. “We typically treat urgency incontinence with a combination of medication, bladder retraining, and behavioral modification. Patients with a combination of conditions are somewhat more challenging to treat and will often require a combination of treatments.”
Another important aspect of treatment is fluid and dietary management. If you drink a lot of fluid, you’ll have to pee more frequently. Dr. Toglia reminds patients to drink smaller amounts of fluid spread out evenly throughout the day. “Remember, what goes in, must come out!”
Main Line Health serves patients at hospitals and health centers throughout the western suburbs of Philadelphia. To schedule an appointment with an incontinence specialist at Main Line Health, call 1.866.CALL.MLH (225.5654) or use our secure online appointment request form.
Editor's note: This post was originally published in October 2009 and has been completely revamped and updated for accuracy and comprehensiveness.