How Menopause changes bladder control and more..

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As our ovaries start to decrease estrogen production our body begins the transition of menopause also called perimenopause. This transition period can be smooth and easy for some women but for others, menopause can be physically and emotionally debilitating. During this time women can experience a wide range of symptoms such as changes in monthly cycles, changes in metabolism, mood fluctuations, skin changes and the infamous hot flashes!! These gradual changes continue until you stop getting a period.

You are officially in menopause twelve months or one year after your last period 

Simply stated, menopause is when our body stops producing estrogen.However, it is more than simply cessation of menstrual cycles. It affects everything in our body. It changes how we digest food, how we use energy, mood, skin elasticity, bone density, bladder bowel control and sexual health. Genitourinary syndrome of menopause is a fancy name for a symptom- cluster that menopause causes in your ground floor!

Meet Joanne, she is a busy mom of two college aged kids and 1 golden retriever! Now that kids are out of the house, Joanne thought it was her time! She joined the gym and sketched out a routine for herself. Imagine how mortified she felt when she had to leave her gym class half way because she had peed in her pants! Those jumping jacks had no mercy on her bladder! Joanne was embarrassed and frustrated. Her doctor re-assured her that bladder leaks are very common for menopausal women and created a plan to get Joanne leak-free and back in the Gym working on her bone health!

Estrogen and Bladder

Estrogen is used by many parts of our body including bladder and urethra. It makes the urethral walls sticky and helps close it during high pressure situations. In other words, it helps us stay dry! It’s common for menopause to challenge bladder control and cause urinary leaks, getting up at night, frequent urination and difficulty with holding. Bladder issues can disrupt their daily life and cause dependency on depends ! Pun intended!!

What Are The Main Types Of Urinary Problems In Menopausal Women?

There are two main types of experience…

  • Stress Urinary Incontinence – where you may leak urine with cough, sneeze, laugh or exercise. Coital Incontinence is a type of stress incontinence that happens during sex.
  • Overactive Bladder – this is usually caused by some kind of irritation to the bladder and causes symptoms of urgency and/or frequent urination. It might feel similar to symptoms of bladder infection or UTI.

How Can I Help To Prevent Bladder Weakness?

In today’s day in age, there are several treatment options to fix urinary incontinence and it all depends on the type of bladder issues you have and what works best for your life!  I will share some most commonly used treatment strategies ( in no particular order )  that I see in my clinic but like most health concerns- you should talk to your doctor first.

Behavioral and lifestyle changes

Everything in our world and our body affects our bladder. Water intake, caffeine and alcohol intake can significantly influence bladder symptoms. Constipation and gut health in general is often linked to bladder leakage. General fitness level and chabits influence bladder health as well. Starting with a lifestyle inventory is a great first step to managing and improving bladder issues. If you want to learn more about this, talk to a Pelvic PT.

Bladder training

Pelvic PTs specialize in bladder training to help manage bladder issues including menopause related incontinence. Pelvic muscles are the muscles around the bladder, bowel and vagina. These muscles are intertwined with bladder muscle and closely control bladder health. Training your pelvic muscles is the most effective treatment strategy for leak-free life! Kegel exercises where you clench your vaginal muscles  have been getting the most press when it comes to strengthening muscles down there, it has become an increasingly catch-all solution to any and all pelvic issues. Many women are in fact dealing with tight muscles in the pelvis requiring the reverse of kegels to stop leakage ! To Kegel or Not To Kegel Is The Question and to find out your answer- talk to a pelvic PT.

Medical treatments

  • Vaginal estrogen cream is applied directly to the vaginal walls and urethral tissue. It helps decrease stress incontinence by bulking up the tissue in that area
  • Overactive bladder medications are commonly used for symptoms of urgency and frequent urination. Some people also use estrogen in the form of a pill or a patch to address urinary symptoms.
  • Medical devices can sometimes be used to address the root cause of bladder leakage. The best way to explain it is something similar to a pacemaker for your bladder that helps control bladder urgency. It is essentially a nerve stimulator to enhance bladder control.
  • Surgery- In some situations surgical interventions might be indicated to get rid of incontinence.

Products

Not all pads are made equally. Most pads are made for absorbing body fluids like menstrual and vaginal discharge. Urine inherently has different consistency than other vaginal fluids. If you are using panty liners to absorb pee, you are at higher risk for skin rashes and issues that arise from dampness. Products that are created for incontinence catch the urine and lock away the moisture protecting your skin.

Liners are generally known for front-to-back protection whereas pads are curved.They can “catch” upto 8 oz or urine and most of them are processed with some sort of odor-control system. If you have sensitive skin that might cause irritation.

Vaginal devices similar to pessary or vaginal sponges can sometimes be used inside the vagina to provide pressure against the urethra or bladder. This pressure “closes” the urethra and prevents leakage.

Over 12 million people are affected by bladder leaks. If you are experiencing urinary incontinence know that you are not alone and it is in fact a fixable problem. Let’s talk !

Namaste, 

Dr. Darshana (Vagina Warrior) Naik.

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