What causes menopausal stress incontinence – and what can help? Here’s our guide...

When Continence Nurse Specialist and author of The Pelvic Floor Bible, Jane Simpson, was interviewed on BBC Radio 4’s Woman’s Hour* recently, she mentioned that one woman in every three suffers from stress incontinence.

It’s not surprising, therefore, that the programme often covers the topic, and it crops up frequently on the Live Better With Menopause Community Forum and Facebook group. For some women, their first experience of stress incontinence may well be during menopause. We wanted to take a look at why this happens, what you can do to help reduce or prevent menopausal stress incontinence, and what are the best products to use if you are trying to cope with this condition.

What is menopause stress incontinence?

Stress incontinence is one of several types of urinary incontinence (the medical term for weeing unintentionally); it’s the type where some urine leaks out when your bladder is under pressure, for example when you laugh, cough, or run. So, it’s a little different from, say, urge incontinence, where you feel a sudden and often overwhelming to wee and some urine leaks out – that feeling when you wonder if you are going to make it to the nearest loo in time…

There are several possible causes for stress incontinence but the most common, at least for women – because, yes, men suffer from stress incontinence too - are vaginal (as opposed to Caesarian) childbirth, abdominal surgery such as a hysterectomy, obesity, ageing, and the menopause. But why and how does the menopause cause stress incontinence? The answer is that, as we move into perimenopause and then full menopause, our oestrogen levels continue to drop. This, in turn, causes the lining of the urethra (the tube that enables urine to flow out of the body from the bladder) to become thinner. At the same time, our pelvic muscles may start to become weaker and we can develop something called pelvic relaxation, which, sadly, isn’t the sort of relaxation that does us any good.

What can you do to reduce stress incontinence in menopause?

First, let’s clear up a common myth: not everyone going through menopause suffers from stress incontinence but, even if you do, there are some surprisingly simple steps you can take to prevent or reduce the symptoms.

If you are experiencing stress incontinence, it’s important to consult your GP for a correct diagnosis and to rule out any possible cause other than menopause, such as a urinary infection. But, assuming that your stress incontinence is menopause related, what can you do? Here are our top tips:

  • Watch the caffeine – tea and coffee are high in caffeine, which is a diuretic (something that makes you wee more frequently); so if you’re fond of frequent cups of either beverage, switch to a good decaffeinated variety. It’s worth shopping around to find a brand you like; cutting down on the caffeine doesn’t have to mean cutting down on flavour. Or why not try fruit or herb teas? They’re delicious and caffeine free.
  • Watch your fluid intake – it’s important to keep your fluid levels topped up throughout the day but it’s a question of balance. Try to drink at regular intervals, rather than going for hours without drinking and then drinking too much in one go.
  • Wee before having sex – it’s a sensible precaution, reduces pressure on your bladder, can help prevent cystitis, and it doesn’t have to be a passion killer!
  • Try to avoid getting constipated – constipation also puts unnecessary pressure on your bladder, as well as your bowels. If you just have an occasional bout of constipation, try adding some ground flaxseeds to breakfast cereals or smoothies. A magnesium citrate supplement could also help. If you suffer from frequent constipation, do consult your GP; it’s important to identify the cause and get suitable treatment or nutritional advice.

However, our number one recommendation is to pay attention to your pelvic floor muscles.  

Although weak pelvic floor muscles are a major cause of stress incontinence, it’s surprising how many people don’t do – or don’t know how to do – pelvic floor exercises (sometimes known as Kegel exercises).

The good news is that, once you’ve learned how to do them correctly, they only take a few minutes to do each day. But – and it’s a big but – it’s essential to do them every day, not just during menopause but for life.

There are some different approaches to pelvic floor exercises but the basic principles are the same, whichever version you choose to do: draw up and tighten the muscles on an out breath and relax them on an in breath. And remember, the sooner you start exercising these key muscles the better – ideally, once you are perimenopausal, if not sooner. This leaflet produced by the British Association of Urological Surgeons, gives a good, clear explanation.

If you attend Pilates classes, your instructor will probably include pelvic floor exercises as part of every session. If you need some help with learning to exercise your pelvic floor muscles correctly, see if there is a women’s health physiotherapist in your area or an NHS Incontinence Service (check with your GP or call your local hospital), staffed by specialist nurses, such as Jane Simpson (see above). The NHS also have also introduced the Squeezy app to help women to remember to do their pelvic floor muscle exercises and to do them in the right way.

A high-tech solution to pelvic floor weakness

Another way of checking that you are doing your pelvic floor exercises correctly and effectively is to use a special product, like the Elvie Pelvic Floor Trainer, which is linked to an app. The Elvie is ideal for helping with stress incontinence in menopause; it uses biofeedback from the internal trainer to tell you:

  • if you're squeezing the right muscles in the right way
  • to help you squeeze harder, and
  • to track your progress as you exercise more regularly. 

It’s comfortable to use, hygienic and totally safe - and you should start to see results within a couple of weeks.

How to choose the best incontinence underwear – for extra security

If you have to cope with heavier bladder weakness, the greater security provided by specially designed underwear, which ranges from discreet disposable pants disposable pants, to stylish washable briefs, will reassure you.

  • Tena Super Medium Incontinence Pants offer an all-in-one solution: they look and feel like everyday underwear, are easy to put on and take off, and Tena’s unique FeelDry technology rapidly absorbs urine, keeping it away from the skin.
  • Tena Fix Pants are designed for wearing with shaped incontinence pads; they hold the pad correctly for the best fit  - to avoid any urine leakage - and for comfort.
  • Confitex briefs could be the answer if you are looking for maximum comfort and a choice of colours and absorbency strength. These high-waisted washable briefs are made of bamboo, which is hypoallergenic and kind to the skin, and incorporate special three-layer technology to prevent leaks and odours.

What’s the best bedding for incontinence?

If you are trying to cope with any sort of incontinence at night, there are different types of bedding that can help you to stay dry and comfortable. You’ll feel more secure and relaxed and more likely to enjoy a good night’s sleep.

You can get special machine washable protectors for mattresses; these are treated with antibacterial and antifungal agents to keep everything clean.  Soft and comfortable 100% waterproof sheets and pillowcase and duvet sets are also available and come in different sizes and colours.

If nighttime incontinence means that you have to wash your duvet frequently, you might want to consider this waterproof and wipe clean duvet. It comes in single and double sizes, won’t crack or harden, and is a 10.5 tog weight, making it suitable for use throughout the year.

*You can hear the full BBC Radio 4 Woman’s Hour item on pelvic floor exercises, featuring Jane Simpson and Pilates instructor, Louise Kenyon, on BBC Sounds here. (Starts at 25 minutes into the programme.)

Find out more about all types of urinary incontinence, including symptoms, causes, diagnosis and treatment here.


Take a look at Live Better With’s full range of recommended products that can help you with bladder and incontinence issues.

Visit the Live Better With Menopause Community Forum for information, advice, and tips on stress incontinence, and to share your own questions and suggestions.