Urinary changes

This is one of several symptoms of the menopause. Hormonal changes at this time such as a fall in oestrogen levels mean that the bladder functions less effectively than before.

This results in urinary incontinence and urinary tract infections (UTIs).

Women who have suffered from urinary problems in the past such as cystitis find that they develop this more frequently than before and to a greater degree. This is likely to be more severe than before and worsens as a result of the menopause.

Then there are women who have never suffered from a urinary tract infection or any other similar condition who find that they started to develop this type of infection.

This manifests itself as an urgent desire to go to the toilet and to do this more often than before.

What are urinary changes?

These are likely to be urinary tract infections such as cystitis and urinary incontinence.

But these tend to occur in women who are overweight, obese or have had children. Childbirth puts a strain on the muscles of the bladder and weakens them which cause urine to leak out and hence incontinence.

Do all women experience urinary changes?

Not every woman will experience these but many women do find that they are prone to urine infections or have problems with bladder control.

It is difficult to say why some women get urinary tract infections such as cystitis more than others. It may be genetic, a result of childbirth or the fact that she is prone to these types of infections.

If you have suffered from repeated bouts of cystitis in your 20’s and 30’s then there is a high chance that you will do so during the menopause.

Causes of urinary changes

The main factor in all of this is oestrogen. This hormone is responsible for a range of functions within the body which includes protection for the vagina, bladder and urethra.

It maintains the strength and flexibility of the tissues within these organs which protects them against bacteria and infection. Plus it also stimulates blood supply to the pelvic region which enables the muscles to remain strong and healthy.

But falling levels of oestrogen mean that this protection is reduced which places your urinary system at increased risk of disease and infection.

Another factor and one which, unfortunately, you cannot do anything about is your anatomy. The female reproductive system consists of a urethra (tube which enables urine to be expelled from the body) which is shorter than the male urethra and this predisposes it towards infections.

A shorter urethra means that bacteria have less distance to travel down into the bladder where they cause a urine infection.

The ageing process means that the bladder along with many other organs of the body functions less efficiently than before.

Types of urinary changes

The two main changes are urinary tract infections and urinary incontinence.

Urinary tract infections

Bacteria especially the E coli bacterium, passes down the urethra and into the bladder where it multiplies to cause an infection. This infection then spreads throughout the urinary tract causing symptoms which include:

• Burning pain during urination
• Full feeling in the bladder
• Cramps

Your body is less able to fight infections such as these during the menopause.

Sexual intercourse also enables these bacteria to pass into the urinary tract and cause an infection.

Urinary incontinence

This is the medical name for bladder control problems. The muscles surrounding the bladder have become weakened over time, usually as a result of childbirth, which means that they are unable to keep the bladder closed.

When the bladder becomes full these pelvic muscles contract to keep the bladder closed until you are ready to pass urine. Nerves within the pelvis send signals to the brain which interprets these as a command to urinate.

To urinate means that that liquid (known as urine) is passed down the urethra and out of the body.

But if these muscles become weakened then they are less able to do this which means that urine can escape from the bladder when it is least expected.

Women who have urinary incontinence find that they need to visit the toilet more frequently and feel as if their bladder is full during this time.

There are several different types of incontinence but the most common one experienced by menopausal women is ‘urge incontinence’. This is where they experience a sudden urge to go to the toilet without any prior warning.

Other types of incontinence include:

• Stress incontinence: caused by pressure on the bladder. Laughing, coughing and sneezing can cause this pressure which results in a leakage of urine. This often develops in women who have had children as the pelvic muscles have slackened as a result.
• Mixed incontinence: a combination of stress and urge incontinence.
• Overflow incontinence: this is where the bladder is unable to fully empty which means that it fills too quickly the next time. This means increased visits to the toilet. Urine leakage is common.

It is easy to dismiss this as an inevitable part of the menopause and something which has to be endured but this needn’t be the case.

There are treatments available to deal with this which is discussed in the section below.

Treating urinary changes

This is a frustrating, embarrassing and distressing symptom but there are ways of dealing with this. These include hormone replacement therapy (HRT), antibiotics and self help.

Treatment for urinary infections

If you are suffering from repeated urinary infections then antibiotics such as trimethoprim can help as can over the counter medicines such as ibuprofen.

Some women find that cranberry juice helps although this is often consumed as a means of preventing an infection rather than a form of treatment.

Hormone replacement therapy (HRT) reduces many of the symptoms of the menopause which includes urine infections but it does have side effects.

HRT is discussed in more detail in our menopause treatment section.

Treatment for urinary incontinence

In regard to urinary incontinence: there are a range of treatment options which include medication, pessaries and botulinum toxin injections.

A pessary is a small object which resembles a small umbrella and is inserted into the pelvic cavity to relieve the pressure of this on the bladder. It ‘holds’the pelvic muscles up and away from the bladder. Botulinum toxin injections are injected into the bladder via a slim tube known as a ‘cytoscope’ which has the effect of firming and stiffening the bladder. These tend to last for 9 months or so.

(Source: BUPA Fact Sheets/ Urge Incontinence)

Another type of treatment involves electrical stimulation of the pelvic muscles. This involves stimulating the nerves within the pelvic area which strengthens them as well as allowing new nerves to grow.

If none of these options are effective then the final option is surgery. There are several procedures for doing so which involve strengthening the bladder and enabling better control.

One example of this is ‘augmentation cystoplasty’in which the surgeon implants tissue, harvested from the bowel, into the wall of the bladder to increase its size.

The aim of this is to reduce any pressure caused by urine and the constant feeling of wanting to go to the toilet.

Self help for urinary infections and incontinence

As well as the treatments discussed above there are a number of self-help options which you can use.

These include pelvic floor exercises –known as ‘Kegel exercises’- in which you contract these muscles to strengthen them and to improve bladder control.

You perform a series of contractions several times a day. Your GP will be able to advise you about these.

If you find this difficult then you can use ‘biofeedback’- a system in which you use sensors to inform you if you are performing the exercises correctly or not.

Bladder training is another option in which you learn to ignore the need to pass urine. You develop a routine in which you go to the toilet at set times each day and gradually increase the time between each visit.

This is done over a period of several weeks to see if you can control the urges to pass urine.

The idea is for you to experience fewer strong urges to go to the toilet which means that you can get into a regular routine.

Changing your diet may help. Limit the amount of caffeine you consume as that acts as a diuretic, eat fresh fruit and vegetables and change the amount of water you drink.

You may need to drink more or less water. Consult with your GP about this.

There are special types of clothing and aids such as incontinence pants and pads which can help. Whilst they might seem embarrassing they will give you a sense of confidence especially when you are out and about.

They are far more advanced than before and the newer versions are designed to be protective and comfortable. These can be purchased over the counter at your local pharmacist.