What is urge incontinence?

Women with “urge incontinence” usually have a sudden and urgent desire to urinate that sometimes comes on so fast that there isn’t enough time to get to a toilet. This leakage can be embarrassing and stressful. This type of incontinence usually indicates that the bladder’s storage system isn’t working properly.

A variety of treatments exist for urge incontinence. The most effective include bladder training, eliminating certain fluids and foods from your diet which may irritate your bladder (such as caffeine), prescription medications, eliminating medications that cause urge incontinence, local estrogen therapy, and surgical interventions.

Sometimes this type of incontinence can be combined with stress incontinence.

What is stress incontinence?

Stress incontinence is when women will leak from the bladder when they cough, laugh or sneeze, or even change positions. This type of incontinence is more common after childbirth or menopause, but can be related to other issues such as strength, tissue health, intra-abdominal pressure or lifting/biomechanic issues.

Seeing a pelvic health physiotherapist who will conduct a pelvic floor assessment and provide exercise recommendations can help this condition. 

Sometimes this type of incontinence can be combined with urge incontinence. Current research has not proven that hormone therapy (HT) improves incontinence conditions in any significant way.

Are urinary tract infections more common during perimenopause and menopause?

As hormone levels decline at this time of life, there can often be a direct impact on the tissues, muscles, glands and functions of the vagina and urinary tract. There is an increase in urinary tract infections as women age. Some women may have multiple troublesome recurrent infections.

Chronic UTIs are cause for concern and a health professional should always be consulted since this type of infection can cause more serious problems.  Local estrogen therapy (e.g., cream, vaginal tablet) can be useful to avoid recurrent infections. This treatment works in part by changing the bacterial flora within the vagina, which helps protect the urinary tract against infection.

What are some of the treatments for urinary incontinence?

A variety of lifestyle, non-surgical support devices, and surgical options are available to address urinary tract issues. Sometimes it is as simple as pelvic exercises (e.g. the Kegel exercises—with or without the help of vaginal cones—that are often recommended before and after childbirth), that strengthen muscles in the pelvic floor, or even the use of a mechanical support device such as a pessary, disposable vaginal insert, or reusable silicone device. These devices are inserted into the vagina to support the urinary tract and its function. Local vaginal estrogen therapy (e.g., creams or tablets) may also help urge incontinence as well, but taking oral hormone therapy does not appear to be effective.

Lifestyle can play a role too. Smokers are more at risk for bladder problems, as are obese women. Excessive caffeine consumption can irritate a bladder condition. Losing weight and reducing the amount of fluids you drink each day can modify incontinence problems to some degree. Addressing a chronic cough (if you have one) can also be helpful, along with a few more planned trips to the washroom each day.

There are a number of medications that can be used to help the condition known as “over-active bladder”. In some cases surgery will be the best option, depending on the cause of the incontinence. It is important for women with bladder concerns to have a proper evaluation before any medical or surgical treatment is tried.

I have recurring urinary tract infections (UTIs)? Is that related to my menopause?

Some women have more urinary tract infections during perimenopause and when they have reached menopause. As hormone levels decline at this time of life, there can often be a direct impact on the tissues, muscles, glands and functions of the vagina and urinary tract. Urinary tract infections can lead to more serious infections (e.g. bladder infections) so it is wise to consult a health professional to get advice about available treatments.

Sexual Symptoms

Certain “urogenital” symptoms may develop progressively in the years or decades following menopause:

• Vaginal dryness, discomfort, irritation, itching, burning

• Pain during intercourse

• Vaginal discharge

• Vaginal bleeding

• Urinary infections that keep returning

• Loss of bladder control (urge and stress incontinence)

• A decrease or loss of sex drive (libido)

Studies suggest that only about one-third of those suffering from moderate to severe vaginal discomfort seek treatment. There are many treatment options available, so if you are struggling with these symptoms, be sure to see your doctor. Any vaginal bleeding that occurs 12 months after menopause should be investigated and not accepted as a menopausal symptom.

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