Urinary incontinence — or the loss of bladder control — is a common experience in the years before and after menopause. While it may feel embarrassing to talk about, it’s a well-known issue in the medical world that you shouldn’t hesitate to bring up with your healthcare providers.
Types of incontinence
There are several different types of urinary incontinence, including:
- Stress incontinence. This generally occurs due to physical movement — such as coughing, sneezing, laughing, exercising, and lifting things—and results in the occasional leaking of urine.
- Urge incontinence. Ever had a sudden, urgent need to urinate and not make it to the toilet in time? This is often a sign of urge incontinence, which can be linked to several underlying issues.
- Mixed incontinence. Typically, this refers to people who are experiencing a combination of both stress incontinence and urge incontinence.
How sex plays a role
Women are more likely to develop stress incontinence, the most prevalent type, due to factors such as childbirth and menopause. For women who’ve given birth, there’s a roughly 1 in 3 chance of having stress incontinence, compared to a 1 in 10 chance for women who’ve never had a baby.
Female hormones, particularly estrogen, may also be involved. Estrogen helps keep the lining of the bladder and urethra healthy, so when estrogen levels begin to decline during perimenopause, these tissues can start to get thinner, making incontinence more serious and persistent.
Ways to manage and treat incontinence
Treatment will depend on the exact type of urinary incontinence you’re experiencing and whether there are any underlying issues, such as pelvic organ prolapse, constipation, or urinary tract infections. (Constipation, for example, can affect the nerves in the bladder.)
Some of the lifestyle changes that may be recommended include:
- Limiting diuretic beverages like alcohol, caffeine, carbonated drinks, and sparkling waters
- Avoiding foods that can irritate the bladder, such as chocolate, chili peppers, and citrus fruits
- Doing pelvic floor exercises to learn how to contract the muscles correctly
- Taking measures to reduce constipation, from consuming more fiber to using stool softeners
- Carrying a change of clothing to avoid the skin irritation that may come with wet garments
- Using personal care items specific to incontinence (not menstrual pads) as they keep skin drier and more protected
- Removing trip hazards and using a night light to make it safer to get to the bathroom quickly
Other treatments that may be appropriate, based on your situation, include:
- Behavioral techniques, including bladder training, scheduled toilet trips, and fluid management
- Medications, such as topical estrogen, anticholinergics, alpha-blockers, and mirabegron
- Electrical stimulation, which may involve multiple sessions over several months
- Medical devices, such as a urethral insert or pessary ,both of which prevent urine leakage
- Botox injections, which may be helpful for urge incontinence if other treatments have failed
- Bulking material injections, where a synthetic material is injected to keep the urethra closed
- Nerve stimulators, which act on the sacral nerves involved in bladder control
- Surgical interventions, such as sling procedures, prolapse surgery, and bladder neck suspension
Reviewed by the Ovia Health Clinical Team
“Urinary Incontinence in Women”. Australasian Menopause Society. Australasian Menopause Society. May 2020. https://www.menopause.org.au/health-info/fact-sheets/urinary-incontinence-in-women.