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Women don’t have to accept occasional bladder leakage as just another side effect of menopause or aging. In many cases, there are things you can do to stop and even prevent urinary incontinence.
Urinary incontinence (UI) is also known as “loss of bladder control” or “urinary leakage.” Millions of women experience UI, and the frequency of involuntary loss of urine becomes more common as you get older. The loss can be very minor—you might only leak a few drops when you laugh, exercise, cough, or pick up heavy objects. Or, you may experience a sudden urge to urinate and can’t keep it in, resulting in an accident.
Women can experience UI throughout their lives, but most episodes are the result of pressure or stress on the muscles and nerves that help you to hold or pass urine. Hormone changes could also affect muscle strength. Therefore, UI is more common in women who are pregnant, giving birth, or going through menopause.
Estrogen, a hormone that helps regulate monthly cycles, may protect against heart disease, and may slow bone loss, also helps keep the bladder and urethra healthy and functioning properly. As you near menopause, your estrogen levels begin dropping. This lack of estrogen may mean that your pelvic muscles are no longer able to control your bladder as they did before, and that urethral tissues may have weakened. As estrogen levels continue to drop throughout menopause and after, UI may become worse.
A few different types of urinary incontinence are associated with menopause. These include:
The most common kind of bladder control problem in older women is stress incontinence. Weakened muscles can’t hold back urine when you cough, exercise, sneeze, laugh, or lift something heavy. The result can be a small leakage of urine or a complete loss of control. This type of incontinence is most often caused by physical changes that result from pregnancy, childbirth, or menopause.
When your bladder muscles squeeze incorrectly or lose the ability to relax (so that you always feel the urge to urinate even when your bladder is empty), you may experience leaking or loss of control. This is sometimes called “overactive bladder.”
Menopause isn’t the only cause for bladder control problems, but combined with one of the following conditions, your risk for developing urinary incontinence increases.
Drinks with alcohol or caffeine fill the bladder quickly, which means you have to urinate more often.
Infections of the urinary tract or bladder may cause temporary UI. When the infection is cleared, UI will likely also be resolved.
Damage to nerves can interrupt signals from your bladder to your brain so that you won’t experience the telltale signs that you need to urinate. Therefore, you will not be able to control urination.
UI can be a side effect of some medicines, such as diuretics or steroids.
Chronic (long-term) constipation can affect bladder control. It can also weaken pelvic floor muscles, making it harder to hold in urine.
Carrying excess weight increases your risk for UI. The extra weight puts pressure on the bladder and can cause UI or make it worse.
How your urinary incontinence is treated depends on several factors, including the type of incontinence you’re experiencing. Many doctors will begin initial treatments by suggesting possible lifestyle changes. These include:
Your doctor may recommend more involved treatment options, especially if they don’t think lifestyle changes are helping. These options include:
Medications can reduce the symptoms of and treat some types of UI.
Electrical stimulation of pelvic muscles may help a person regain control of the bladder.
A pessary is the most commonly used device for the treatment of stress incontinence. This device is inserted into the vagina and helps reposition the urethra in order to reduce leakage.
You can work with a therapist to better understand how your body works and learn how it alerts you that you need to use the bathroom. A wire connected to an electrical patch over your bladder and urethral muscles sends signals to a TV screen that alerts you when your muscles are contracting. By learning when they contract, you may be able to gain better control over them.
Surgery to repair and lift the bladder into a better position is often the last resort for UI treatment. It’s reserved for people who couldn’t be helped by other forms of treatment.
Written by: Kimberly Holland
Medically reviewed by George Krucik, MD
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