“Please help!!! I'm waking up to pee every 1 and a half to two hours at night …” said someone we spoke to recently. Another person said “I have been getting up throughout the night to pee for 10 years. I wake up hot and thirsty and pee every 1.5 to 2 hours. I got used to being ratty and coping on half empty.”
If “I just sneezed and peed a little” or any of the statements above resonate, you are reading the correct article. Here you will find all the answers about menopause urinary symptoms.
We have come a long way in recent years in understanding just how many changes in our body are related to menopause. Of these changes, perhaps the most personal, and unreported ones relate to the genital and urinary tract. In this article we will cover the urinary symptoms that occur during menopause, why they occur and how to manage them. We’ve seen that among other symptoms, women often find it difficult to talk about menopause urinary symptoms because they feel that the topic is taboo or has stigma associated with it. We've written another article about sex and menopause, called genitourinary syndrome of menopause.
How does the menopause affect the urinary system?
Symptoms of the genital and urinary tract are called urogenital symptoms and can encompass a range of symptoms. (1) It is estimated that 70% of perimenopausal women will experience vaginal discomfort of some kind, and around 60% of women experience changes in their bladder function. Of these women, it is thought that only 1 in 6 ever report this bladder dysfunction to a healthcare professional. This would suggest that the majority of all women have vaginal and/or bladder symptoms which remain unreported and potentially untreated.
The changes in bladder function we most commonly see around this time relate to the ability to hold urine. This includes: a sense of urgency to pass urine, an inability to hold urine during urgency, an inability to control urine during exertion (such as laughing or coughing) and increased frequency of urination. (2) Other bladder-related symptoms include; cystitis, urinary tract infection, pelvic organ prolapse.
Does menopause cause urinary symptoms?
Urinary incontinence is defined as the loss of bladder control. Urinary incontinence during menopause is more common than you might think, with around 60% of women in midlife experiencing some form of associated symptoms. (3) The severity can range from occasionally leaking urine when you cough or sneeze to having an urge to urinate that's so sudden and strong you don't get to a toilet in time. (2) This article should help you understand the different types of incontinence, so that if it’s something you are going through, you can better understand it and get treatment.
If you’ve read some of our other articles, you won’t be surprised to learn that this is related to the decline in oestrogen in a woman’s body after menopause. Oestrogen helps keep the lining of the bladder and urethra healthy, and when these organs have a lack of oestrogen, this can aggravate incontinence. Another thing that happens is that as you get older the muscles in your bladder and urethra can lose some of their strength, which is why pelvic floor exercises can help in many cases. (4)
These symptoms emerge around the time of the menopause because of the drop in oestrogen. The skin and tissues in our bladder and pelvic floor have oestrogen receptors, which means that when the oestrogen levels drop, their strength and function is affected. It is important to understand that, while some symptoms of the menopause will pass – for example hot flushes last an average of 7 years, vaginal symptoms will not improve unless treated! The good news is that there are many effective non-invasive treatments, which we will cover below.(6)
Types of incontinence:
- Urge incontinence: This is when you have an intense urge to urinate all of a sudden and can be followed by an involuntary loss of urine. Urge incontinence can also cause the need to urinate often, including making you get up in the middle of the night. It’s worth investigating why you are having this type of incontinence, since it can be caused by different conditions, including infections, or diabetes. Frequent peeing at night is known as nocturia, that is peeing more than twice during the night.
- Stress incontinence: This is when you pee a little when there is pressure in the bladder: usually by coughing, sneezing, laughing, exercising or lifting something heavy.
- Overflow incontinence: This is when you experience a frequent or constant dribbling of urine due to a bladder that doesn't empty completely.
- Mixed incontinence: This is a term for when you experience more than one type of urinary incontinence - a common occurrence. (5)
Is there treatment for urinary symptoms?
The good news is that the vast majority of menopause urinary symptoms are easily treatable with non-invasive treatment options. A range of treatment options, including pelvic floor training, behaviour modification and/or HRT may be suggested based on the symptoms experienced. For example, 70% of women experiencing leaking during exertion will resolve their urinary symptoms with pelvic floor retraining alone. We suggest downloading and using the Squeezy app, and it’s free!
Other useful tricks is to record when and how often you pee, including the volumes you pass each time. Our bladders are like all muscles in our body, if we don’t continue training it to hold urine, it will lose capacity to hold urine and may require ‘bladder retraining’. A physiotherapist is best placed to guide you through this, but keeping a diary and measurements is an important first step.
So, what can you do if you are experiencing menopause urinary symptoms?
We know it can be uncomfortable to talk about this, but now that you know how common it is, hopefully you won’t be embarrassed to talk to a healthcare provider, especially if you think this is affecting your quality of life. By talking to a healthcare professional about the symptoms you are experiencing, you can learn about the best treatment options for you. Specialist GPs, Specialist Nurses and Women’s Health Physiotherapists are all healthcare professionals trained in assessing and treating these symptoms.