Urinary Incontinence: Is There a Connection with Menopause?

If TV commercials are an accurate reflection of our lives, then you’d have to conclude that bladder problems are a big concern for women and men.  Since the ads I’ve seen show people who appear to be 50-ish in age, they suggest that incontinence isn’t just a problem of the elderly.  It’s one of the few health conditions still considered too private to discuss openly,  so I wondered just how prevalent it is for women in mid-life and if there’s a connection with Menopause.  For expert information and advice, I contacted Dr. L. Elaine Waetjen, an OB-GYN with a specialty in Urogynecology, as well as a researcher and associate professor at the University of California, Davis. I asked her at what age do women typically notice bladder problems?

Dr. Waetjen: Bladder problems can happen at any point in our lives, but for many women, they seem to begin occurring in mid-life and symptoms, including incontinence, may increase due to the direct effects of aging. For example, as women get older, the bladder capacity can decrease due to changes in the wall of the bladder, making it less elastic.  Older women are more likely to lose strength and/or coordination of their pelvic floor muscles, which can also affect how the bladder functions to store and empty urine. The rise in incontinence may also be related to other factors associated with aging. For example, women tend to gain weight as they get older and weight gain is associated with incontinence.

Wendy: Is there a connection with Menopause?

Dr. Waetjen: Though there is a peak in the prevalence of urinary incontinence between 45 and 55, it turns out that this rise is likely due to mild symptoms that then seem to resolve after about 55.  There is no data that can suggest Menopause, or changes in the hormones around Menopause, cause this rise in incontinence symptoms. What might be common is for women between 45 and 55 to notice some occasional leakage of urine. If this occurs only occasionally and does not impact lifestyle, it appears more likely to be transient or at least not likely to worsen.

Wendy:  Is there something that we can do to help prevent it?

Dr. Waetjen: We have no clear knowledge that confirms ways to prevent the development of incontinence. But because of specific associations, we can make educated guesses.  For example, as I mentioned, weight gain is associated with the development and worsening of incontinence and that incontinence decreases with weight loss. Therefore, maintaining a healthy weight and avoiding weight gain may prevent it. We also know that some women can gain control over incontinence when they regain the strength and coordination of their pelvic floor muscles, so it makes some sense that keeping these muscle strong and coordinated may prevent incontinence.

Wendy:  Does estrogen replacement resolve the problem?

Dr. Waetjen:  Many women have been told that taking estrogen after menopause can prevent or treat incontinence, but this has not been shown to be true. In fact, taking estrogen after menopause may actually increase the risk of developing or worsening incontinence though this effect is very small.

Wendy: Menopausal women often complain of urinary tract infections. Do they typically occur more frequently in later life?  

Dr. Waetjen: UTIs do occur more frequently later in life. This may be related to the changes that occur in the vagina related to aging and changes in estrogen levels. For example, after Menopause, the types of bacteria that colonize in a woman’s vagina may change. Some women lose the helpful bacteria that suppress the growth of bacteria that cause bladder infections. The loss of this bacteria is likely multifactorial, but is related to aging, change in vaginal acidity, and the effect of estrogen on the vaginal tissues. There may be other reasons for the increase in bladder infections, such as changes in the strength of the urinary stream that washes away the bacteria in the urethra, how well the bladder empties, and the effectiveness of the immune system.

Wendy:  What do you advise women who are beginning to experience incontinence?

Dr. Waetjen: There are a number of simple things women can do:

• Don’t drink too much. Our society encourages hydration but many interpret this to an excess. While there is no  clear evidence to say what amount women need, one general rule is 64 oz of total fluid per day for the average woman not working out or seating in heat.
• Avoid large amounts of caffeine as it is both a diuretic (causes more urine production) and a bladder irritant. Anything more than one soda or one cup of coffee/tea per day may create or exacerbate the problem of barely or not making it to the bathroom in time.
• I recommend doing “kegels” (pelvic floor muscle contractions) correctly and use those muscles when they feel that sudden urge to urinate or that they might leak. Many women think they are using the correct muscles. Rather than saying these exercises don’t work, which I hear frequently, ask their OB/GYN whether they are actually using the correct muscles and whether they have gained enough strength to be effective.

Wendy:  …and if bladder problems still persist?

Dr. Waetjen: If women have tried these simple steps and still have bothersome urinary symptoms, they should  ask their primary care doctor for a referral to a specialist. There are a number of treatment options for women depending on the type of incontinence they have. Medications like Detrol may work well for a subset of women with urinary urgency and incontinence associated with urinary urgency.   I usually prescribe it only after women have tried all of these steps since the drugs can be expensive and do have some side effects such as dry mouth.