Why you can have trouble with incontinence during menopause - and practical tips for what to do about it...

“My husband said I could write a good toilet guide as everywhere we go, I need to wee.” At least this member of the Live Better With Menopause community could see the funny side of it. But for many women, loss of bladder control is no laughing matter and the emotional impact can be very upsetting.

Problems with our “waterworks” - incontinence - around the menopause are widely reported, but whether this is a direct result of the fall in oestrogen levels at this time of life is not clearly understood. Men have problems in this department, after all. 

Hormones clearly have  an impact however, and can aggravate other physical changes as we get older, like loss of muscle tone. If you have had surgery such as a  hysterectomy or caesarean, the muscles in your pelvic floor that support your bladder can be weakened, causing leaks. Childbirth can have the same effect.

Whatever the cause, managing incontinence when you are going out, at work or in bed can be challenging. The good news is that most bothersome bladders can improve, but you need to overcome any embarrassment and discuss the issues with an  appropriate healthcare professional to find the best treatment. This may take time, but it’s worth it, and the first step is to work out what type of incontinence problem you have. 

Urinary Tract Infections

If the need to pee is so urgent that you literally cannot hold it in, and it burns or stings while or after you have been on the toilet, you may have a urinary tract infection (UTI). These are very common around the menopause and are connected with the thinning of tissue and dryness, which make it easier for bugs to take hold. 

It’s really important that you see your doctor about this, and take a urine sample with you in a squeaky clean container. They will be able to tell in seconds and prescribe an antibiotic if necessary. Like any infection, a UTI can get out of control if not treated properly, and make you seriously ill. Watch out for feverishness, fatigue and headaches as these are the tell-tale signs. 


Urge incontinence

This is when you feel the need to pee far more often than you used to. This may be because when oestrogen levels fall, the lining of our waterworks can become thinner and drier and more prone to irritation. If you are having to get up several times a night to go to the bathroom (nocturia), broken sleep can make you feel even more emotional. 

Oestrogen cream

The answer could be to boost oestrogen levels (HRT) either in tablet form, or with a pessary or cream that you apply locally to help restore the lining of your waterworks. Your GP can prescribe this, and the amount is unlikely to increase some of the very low risks associated with HRT.

Have a drink

Not the alcoholic kind, or coffee or acidic fruit drinks - these are likely to irritate your bladder so you’ll be spending more time in the bathroom. Cut down on these, especially in the evenings.

It may seem counter-intuitive, but keeping your bladder well flushed out with water can help, because it will soothe any irritation and help it stay healthy. Aim for at least five glasses a day. A nice refillable water bottle to keep in your bag and your desk will help you stay hydrated - and you will be doing your bit for cutting plastic waste. 

Give up smoking

Nicotine can irritate the bladder and make you want to pee more, so cut down on the ciggies.

Mind over matter

Your bladder may not be the only part of you that’s stressed. Worrying that you may need to keep dashing to the toilet, especially at work or when you go out, will only increase your anxiety. Some experts suggest taking back control by scheduling your trips to the toilet and gradually increasing the amount of time between each visit until you feel more in charge of your bladder, rather than the other way round. (The exercises below can also help you feel more confident that you are in control.)

Stress incontinence

Whoops! Is there a wet patch in your pants every time you sneeze or cough?

This is because the pelvic floor muscles around your bladder are weak. We all lose muscle tone as we grow older, and lower oestrogen levels may exacerbate this (as will surgery in that area). Sometimes the muscles may become so weak that the don’t support the bladder properly and it drops - cystocele prolapse - which can cause discomfort and incontinence. 

Read more about menopause and stress incontinence here.

Get the right kind of help

There are also specialist nurses and physiotherapists who can help train your muscles - but whatever method, it can take several months to improve. 

Some women find their GPs are not very sympathetic and may not be fully informed about menopausal incontinence. 

“He then basically proceeded to blame me for not doing pelvic floor exercises and that I had to train my bladder by not going when I needed to (no examination). Ok that went well.” Live Better With Menopause Community member

Stick to your guns and ask to be referred to an expert health professional 

In extreme cases, surgery may be required but this should be a last resort and the diet and exercise recommendations below still need to be followed afterwards.

Lifestyle changes

Kegel exercises

Kegel exercises are designed to strengthen pelvic floor muscles, can be done anytime, anywhere - and practice makes perfect. Clench the muscles around your back passage, vagina and urethra (it can help to imagine that you’re stopping yourself from going to the toilet). Hold the muscles for 2 seconds, and then relax for 2 seconds. Do this 5-10 times in a row and repeat 3 times a day.  No one need ever know! A Kegel trainer can help here. 

Eat well

If you suffer from constipation and strain on the toilet, this can further weaken your pelvic floor muscles, so eating lots of fibre-rich fruit and veg, wholegrains and drinking plenty of water will help keep your stools soft. 

Live Better With offer a whole range of useful, recommended products for bladder issues in menopause, to reassure you that those leaks will be absorbed: pads to line your pants, washable pants with built in pads, and disposable pads for beds. You can also buy comfortable washable waterproof sheets, duvet and mattress covers. 

For information and advice on hair loss during menopause, and to share your tips or questions, why not visit the Live Better With Menopause community forum.