Menopause and urinary incontinence

Going through menopause can be challenging. The decrease in female hormones may present you with numerous potential problems and side effects, including female urinary incontinence (UI). But you are not alone. It is estimated that between 3 and 6 million people in the UK suffer from urinary incontinence. With more than half of postmenopausal women suffering from some degree of UI.

What is urinary incontinence?

Mr Osama Naji, our consultant gynaecologist at St Thomas’ Hospital, explains: “When you urinate involuntarily, you may suffer from urinary incontinence. This is usually because your urinary sphincter is weak, or because you have no control over it. Affecting your body in different ways, urinary incontinence can lead to several problems, including urinary tract infections (UTI), dermatitis and vaginal bleeding.

“Menopause is just one of the unique health conditions that affect women and could increase the risk of urinary incontinence”, adds Mr Naji.

Conditions like menopause, pregnancy and childbirth affect the urinary tract and its surrounding muscles. For this reason, women are more likely to have urinary incontinence than men. Generally, middle-aged to older women are more likely to suffer from the condition.

Types of urinary incontinence

There are several different types of urinary continence which could be linked to menopause. They include:

Urge incontinence

This is when you feel a sudden, overriding urge to urinate, and urine will leak either at this time or shortly afterwards.

Stress incontinence

The bladder leaks urine when it is under strain, such as when you laugh, cough or sneeze. Some people may suffer from a combination of stress and urge incontinence called mixed incontinence.

Overflow incontinence

Also known as chronic urinary retention; if you have this type of urinary incontinence, you are unable to fully empty your bladder and may leak urine frequently.

Total incontinence

This is when your bladder is unable to store urine and is frequently leaking or having to pass urine.

When does menopause start?

Menopause is a normal part of ageing. It occurs when the female sex hormone levels decrease naturally with age. When this happens, the ovaries will stop releasing eggs, meaning you won’t have periods or get pregnant. When you haven’t had a period for 12 consecutive months – and this is not due to pregnancy or sickness – you are likely going through menopause. It usually happens between the ages of 45 and 55 – the average age for menopause is 51.

There are several ways in which menopause affects the body. Menopause can cause physical symptoms such as:

• hot flushes
• palpitations (when the heartbeat becomes more noticeable)
• sleeping difficulty
• headache
• weight gain
• muscle aches
• joint pain
• skin conditions (including itchy or dry skin)
• a reduced sex drive
• discomfort during sex
• vaginal dryness
• vaginal pain
• urinary tract infections
• reduced bladder and bowel control.

Urinary incontinence in menopause

As explained above, menopause can cause urinary incontinence. This is due to:

• a result in a thinning of the lining of the urethra due to reduced oestrogen levels
• weakened pelvic floor muscles, which can lead to a more frequent need to urinate and decreased ability to hold in urine and faeces
• vaginal dryness, which can put you at more risk of a UTI
• a loss of bladder elasticity, which can cause you to pass urine more regularly
• weight gain, which can strain and weaken the pelvic floor muscles, resulting in less control for the bladder and bowels.

Women going through menopause are more likely to contract urinary problems in general, not just incontinence. These issues may include UTIs. If urinary incontinence is not treated, it can lead to health problems such as:

• a greater risk of UTIs
• skin conditions such as rashes and disorders
• a lack of interest in sex
• mental health issues such as depression.

Urinary incontinence treatment

If you suffer from urinary incontinence as a result of menopause, there are a range of treatment options and lifestyle changes you can make to try and combat the symptoms. The best options for you will depend on the type of incontinence and the severity. Treatment options include:

Kegel exercises

There are exercises you can do to strengthen your pelvic floor and prevent symptoms of urinary incontinence. Here are two examples of kegel exercises that you might like to try:

• while sitting, clench and then release your pelvic floor muscles. Repeat 10 times
• lying down with your knees bent, clench your pelvic floor muscles and hold for between 3 to 5 seconds. Then relax your muscles for 3 to 5 seconds. Repeat 10 times.

Tablets for urinary incontinence

A urologist or GP may offer medication if needed. Medications may include:

• duloxetine tablets – can help with stress incontinence
• antimuscarinics – for urge incontinence
• mirabegron – an alternative to antimuscarinics for urge incontinence
• desmopressin or loop diuretic – these two medications can help with the frequent need to urinate during the night (nocturia).

Maintain a healthy weight

If you are overweight, losing weight can help to prevent urinary incontinence symptoms. Exercising more regularly and sticking to a balanced diet can help you to lose weight effectively.

Surgery

A gynaecologist may suggest surgery when non-surgical treatments have been unsuccessful if needed. The form of surgery recommended will depend on the type and severity of your female urinary incontinence, and may include:

• colposuspension: which lifts the neck of the bladder, helping to prevent involuntary leaks
• sling surgery: which places a sling around the bladder’s neck to support it and prevent leaking
• vaginal mesh surgery: inserting a synthetic strip behind the urethra for support
• urethral bulking agents: injected into the urethra walls to strengthen them
• nerve stimulation: which can help to control the urge to urinate
• catheterisation for overflow incontinence: using a fitted or single-use catheter for urination.

Get in touch

Many classifications of urinary incontinence are short-term or easily treatable. But in some cases, your UI may be a life-long condition. However, there are steps you can take to better manage your symptoms, starting with a diagnosis.

If you’re experiencing menopause symptoms or struggling with urinary incontinence, our experienced consultant gynaecologists are here to help and offer a range of treatments. Find out more about our women’s services at Guy’s and St Thomas’ Private Healthcare or to book an appointment contact our customer service team on 020 7188 5197 or email privatepatientenquiries@gstt.nhs.uk.