Menopause brings on many new health problems that can turn your life upside down. Bladder control is a common menopausal symptom, but one that no one really wants to talk about. But there is good news and you do not have to suffer in silence any longer. This article takes a brief look at why bladder control problems occur during menopause and the role estrogen plays.

Estrogen and the bladder
During menopause, your body produces less and less estrogen (the female hormone). By the time you have finished your last menstrual period and have been ‘period-free’ for 12 consecutive months, your body has quit estrogen production altogether. Estrogen plays a crucial role in bladder health.

Research studies indicate that estrogen helps to maintain a healthy bladder and urethra; the urethra is the tube-like structure in your body through which urine is passed and expelled from the body. Estrogen works to keep both the bladder and urethra firm, in the sense that the related muscles keep the urine in place until the body signals it is time to eliminate. Your pelvic muscles also play a part. These larger muscles are used to help with bladder control. They keep the urine where it should be until the bladder becomes full and must be emptied with a trip to the toilet.

Think of the times you have had the urge to go, but have held your urine until you were able to get to a washroom. Those strong healthy muscles prevent urine leakage for as long as possible. Contrary to our use of language, your bladder will not ‘burst’ or ‘explode’ due to holding in your urine. It will simply reach a point where these muscles can no longer hold back the fluid. As we get older, these muscles lose their ability to perform their job.

During menopause
As estrogen levels in the body decline, the muscles of the bladder and urethra weaken. In some women there is only a slight change but for others the muscles weaken to the point where holding back even small amounts of urine is very difficult. The result is urinary incontinence or quite simply, urine leaking from the body before it should.

Types of incontinence
There are two types of incontinence or bladder leakage that you may encounter during menopause. Depending on the severity, you can suffer some mild annoyance or inconvenience or your life might be greatly impacted.

Stress incontinence
Stress incontinence refers to those small leaks you might notice when coughing, laughing, sneezing, or lifting. These actions can cause a small amount of urine to pass through the bladder because the weakening muscles are unable to prevent the urine from getting out. This type of bladder control problem is the most common experienced by menopausal women.

You might find that ordinary sanitary pads or panty liners are unable to deal with absorption depending on the amount of urine you lose. There are many products on the market that look and act like today’s thin pads, providing security and comfort.

Urge incontinence
Urge incontinence refers to when the bladder muscles no longer respond to your body’s normal impulses to hold back and release urine. Instead, the bladder muscles contract or squeeze at the wrong times, or almost all the time. This ineffective squeezing interferes with nature’s process and the result is urine leakage on a larger scale.

By this point, most pads will no longer be enough and bladder incontinence products will be needed. Tagged with the miserable name ‘adult diapers’ for decades these products added to the embarrassment of dealing with bladder control. Fortunately better attitudes and awareness prevail and there is a wide variety of items to choose from designed to alleviate both discomfort and embarrassment.

If you are experiencing bladder control issues, you may also notice that you have to run to the bathroom more frequently than in the past. You might also have ‘nocturia’ or the frequent urges to go throughout the night. Sometimes you could suffer from painful urination, but make sure you consult with your doctor to rule out any other possible infections or health conditions.

Does estrogen replacement help?
According to the National Institute of Diabetes, Digestive, and Kidney Diseases (NIDDK) taking estrogen does little to counter the effects of weakened bladder muscles. There are also concerns about taking estrogen for too long and during your post-menopausal years. Estrogen will not repair the weak muscles or reverse the effects of declining hormonal levels. Your doctor can recommend one of several treatment options:

*Strengthening the pelvic muscles with specific exercises
*Medications such as Detrol may be prescribed
*Retraining the bladder via daily habits and sometimes biofeedback
*Electric stimulation of the bladder
*Inserting a pessary – a device that is used to hold the bladder up in its proper position

Dealing with menopause means putting up with many different conditions that can be stressful. Urinary incontinence and bladder leakage are not subjects you might find easy to discuss with your doctor. But by facing these conditions head on you can add dignity to coping with urine leakage and take back some control over your body and your life.

Menopause, Your Doctor, and You