Bladder problems, such as urine leakage and increased urgency, are commonly associated with menopause. Hormonal and age-related changes during this phase can make these issues more frequent. A 2019 review indicated that nearly 50% of postmenopausal women experience urinary incontinence (unintentional urine leakage).(1) Despite its prevalence, many women hesitate to address these concerns due to embarrassment or the belief that they’re an inevitable part of aging.
However, treatment options are available, and early intervention can help manage these symptoms effectively. Consulting a healthcare provider allows individuals to explore personalized treatment options to help them navigate this phase with greater comfort and confidence.
Most Common Bladder Problems During Menopause
Menopause-related changes can contribute to these bladder issues:
Urinary Incontinence
Urinary incontinence (UI) refers to the involuntary leakage of urine, ranging from small leaks to a total loss of bladder control. Below are common types of UI that can occur during menopause:(1)(3)
Stress Incontinence
Stress incontinence, the most common type among menopausal women, occurs when weak pelvic muscles cause urine leakage during activities like coughing, sneezing, or lifting.
Overactive Bladder (OAB)/Urge Incontinence
OAB refers to a collection of symptoms related to the frequent and urgent need to urinate.
Some indications of OAB include the following:(2)
A sudden urge to urinate that’s hard to delay, often leading to more frequent trips to the bathroom (more than eight times during the day or more than twice at night)
Waking up at night to urinate
Involuntary leakage of urine
Mixed Incontinence
This is a combination of stress and urge incontinence, involving both sudden urges to urinate and leakage in response to increased pressure on the bladder.
Recurrent Bladder Infections (Urinary Tract Infections)
Urinary tract infections (UTIs) occur when bacteria enter the urinary tract, leading to an infection.
UTIs are broadly categorized as upper or lower, depending on which part of the urinary tract is affected. Upper UTIs involve the kidneys and ureters and are typically more severe, often presenting with fever, chills, flank pain, nausea, and/or vomiting.(4)
Lower UTIs affect the bladder and urethra. The most common type of lower UTI is cystitis, which refers to the infection and inflammation of the urinary bladder. The bladder microbiome comprises healthy bacteria that act as a natural defense against harmful bacteria. Menopausal changes in the bladder and vagina can alter this microbiome, increasing the risk of cystitis.
Signs that could indicate a lower UTI or cystitis include the following:(5)
Pain or burning sensation during urination
Frequent and urgent need to urinate
Lower abdominal discomfort
Cloudy or foul-smelling urine
In some cases, blood in the urine, incomplete bladder emptying, and a feverish feeling may also be present.
Why does menopause affect bladder health?
Estrogen helps maintain the strength and flexibility of the muscles surrounding the bladder and pelvic organs. As estrogen levels drop significantly during menopause, the urethral and vaginal tissues may become thinner.(3)
These changes, along with the relaxation of the pelvic muscles as women age, can contribute to issues like OAB and UI. Hormonal changes may also increase the risk of UTIs.
Several factors, both physiological and lifestyle-related, can contribute to an increased risk of bladder issues before or during menopause:(6)
Childbirth: The process of childbirth can weaken pelvic structures, leading to bladder control issues.
Medications: Certain medications, such as anticholinergics (medicines that help manage involuntary muscle movements) and muscle relaxants, can affect bladder function.
Alcohol and Caffeine: These substances can act as diuretics and increase urine production and the frequency of urination.
Nerve Damage: Nerve interference can disrupt communication between the brain and bladder, causing bladder dysfunction.
Constipation: Chronic constipation can put pressure on the bladder and contribute to increased urination frequency.
Treatment Options for Menopausal Bladder Issues
Bladder issues during menopause can be managed using hormonal and non-hormonal approaches.
Non-Hormonal Treatments
The following non-medical treatments can help strengthen the pelvic muscles, improve bladder control, and reduce symptoms of overactive bladder and urinary incontinence during menopause.
Pelvic Floor Muscle Exercises
Kegel exercises are commonly used to strengthen the pelvic floor muscles, which are crucial in controlling urination.(7)
These exercises start by locating the right pelvic muscles. Once the correct muscles are identified, individuals can tighten them as if trying to halt urination for three to five seconds, then relax the muscles for another three to five seconds. This forms the basis of Kegel exercises. Repeating this exercise ten times per session and aiming for three sessions a day can help improve bladder control over time. Kegel exercises can be done in any position — standing, sitting, or lying down.
However, it’s common for individuals to see limited improvement in muscle strength when they solely attempt Kegel exercises on their own. Pelvic floor physical therapy is a growing field that involves guided exercises and manual techniques facilitated by a trained therapist to help strengthen and coordinate the pelvic muscles. This therapy can be very effective for those experiencing incontinence or pelvic organ prolapse.
Lifestyle Changes
Making the following lifestyle adjustments can help manage bladder symptoms effectively:(1)
Weight Management: Recent studies indicate that losing at least 5% of body weight can alleviate symptoms of stress urinary incontinence in individuals with a higher body mass index (BMI).
Dietary Adjustments: Reducing the intake of caffeine, alcohol, and carbonated beverages can help minimize bladder irritation.
Activity Modifications: Avoiding high-impact activities that put excessive strain on the pelvic floor muscles, such as trampoline exercises, can help prevent the worsening of symptoms.
Bladder Training: Gradually extending the intervals between restroom visits and practicing control over the urine stream during urination can help strengthen the bladder and reduce urgency.
Vaginal Devices
Several non-invasive devices can assist in managing bladder problems. One such device is a pessary, often used for stress incontinence. A pessary is a silicone device — available in different shapes and sizes — that can be inserted into the vagina to help reposition the urethra and minimize leakage. Another option is a urethral insert, a small disposable device inserted into the urethra to prevent leaks during activities like exercise.(8)
Vaginal Health
In addition to bladder control techniques, considering these tips for maintaining vaginal hygiene can help reduce irritation and discomfort:(9)(10)
Avoiding Irritants: Avoiding products with perfumes, powders, or chemicals around the vulva and urethra is crucial in reducing the risk of irritation. Wearing loose clothing and avoiding the prolonged use of sanitary or continence pads can also help minimize irritation.
Maintaining Vaginal Moisture: Using vaginal moisturizers, lubricants, or estrogen creams can help alleviate dryness and support bladder health.
Double Voiding: Emptying the bladder twice to ensure complete bladder emptying can help manage incontinence.
Hormonal Treatments
As hormonal imbalances contribute to bladder thinning and associated symptoms, hormone replacement therapy (HRT) can offer a valuable solution. HRT is available in different forms, allowing individuals to tailor it according to their specific needs:(11)(12)
Systemic HRT: This comprehensive form of therapy — administered via patches, tablets, gels, or creams — affects the entire body. By replenishing the body’s lost hormones, systemic HRT can reduce urinary symptoms such as urgency, frequency, nocturia (frequent urination at night), and painful urination. It can be a viable option for those experiencing other menopausal symptoms like hot flashes.
Localized HRT: For those experiencing bladder symptoms primarily related to urogenital atrophy, local estrogen treatments — such as vaginal creams or rings — offer targeted relief. These treatments deliver estrogen directly to the vaginal area, effectively alleviating symptoms of urgency, frequency, and stress incontinence. They can also prevent further atrophy and reduce the likelihood of recurrent urinary tract infections.
The 2019 American Urological Association (AUA) guideline recommends vaginal estrogen therapy to menopausal women with recurrent UTIs as a preventive measure. The guideline also supports the use of vaginal estrogen in women already using systemic HRT.(13)
Research indicates that about 25% of women using systemic HRT may still benefit from incorporating vaginal HRT to effectively manage bladder and vaginal symptoms.
While HRT can be effective in managing menopausal symptoms, discussing individual health considerations with a healthcare provider is essential. Not every woman may benefit from HRT, and in such cases, alternative treatment options may be explored to ensure comprehensive care.
Surgical Interventions
Surgical treatment for stress urinary incontinence focuses on providing better support to the urethra to prevent urine leakage during physical activities like coughing, laughing, or sneezing.
Common procedures include vaginal or abdominal surgeries and the use of support devices such as slings, artificial sphincters, or bulking agents. Slings are the most commonly used option and act like a small hammock to support the urethra.(6)
There’s no one-size-fits-all solution, and surgery is tailored to each individual’s needs. These procedures are usually performed by a urogynecologist or urologist with specialized training in pelvic floor conditions.
When to Seek Medical Help
Individuals experiencing bladder issues like urinary incontinence or recurrent infections should seek medical help. A physician, such as a urogynecologist or a urologist, can help identify the underlying cause of these symptoms and recommend the most effective treatment options. Knowing that effective treatments are available can empower individuals to take action, enhancing their quality of life and reducing discomfort. This proactive approach can lead to better health outcomes and foster a sense of confidence and well-being, enabling individuals to manage their bladder health without embarrassment.
