During menopause, women may feel discomfort and irritation which is caused by the Urinary bladder problems. Problems like urinary frequency, urgency, and incontinence are caused by the hormonal imbalance mainly by the decrease in level of estrogen. If we were able to understand and have awareness about the challenges women face, this will lead to seaking the appropriate medical aid and help.
Normal bladder function is represented by:
- A daytime frequency of 4-6 and night time frequency of 0-1.
- Approximately 1-2 cups of urine (250 – 500 ml of urine passed at a time).
- Able to control passing urine till a suitable time and place is available.
- The stream of urine is steady and the flow is continuous till the bladder is emptied.
- The bladder can be emptied completely.
- There is no leakage of urine in between toilet visits even at night.
Overactive bladder symptoms include frequency, urgency, nocturia and leaking
When estrogen drops through menopause many of these functions change. As we age, many factors can weaken the pelvic floor muscles responsible for bladder control resulting in urinary incontinence. This includes damage during pregnancy, childbirth, and weight gain.
The common urinary symptoms women complain about at menopause are:
Nocturia
This means getting out of bed several times to use the bathroom at night.
Painful urination or dysuria
A burning or stinging sensation when passing urine.
Stress urinary incontinence
Leakage of urine that occurs during sneezing, coughing, or heavy lifting.
Urge incontinence, overactive bladder, irritable bladder
Also known as overactive bladder or irritable bladder. Urge incontinence is the leakage that occurs when the bladder muscles squeeze seemingly at random or just all the time. This may or may not be associated with a sensation of urgency. For many women the bladder can just empty itself without warning and this is part of the symptom complex of overactive bladder and menopause.
Mixed incontinence
This is where there is some amount of urgency associated with leaking just before coughing or sneezing or just after. The picture is not clear cut with both urge incontinence and stress incontinence occurring at different times. Often a urodynamic study is required to get a diagnosis especially if surgery is being considered for stress incontinence.
Other symptoms that women complain of can be:
Urgency
Urgency is the sensation of wanting to go to the bathroom with anxiety that a leak might happen. Urgency may not always be associated with leaking. Many women manage their symptoms by increasing the number of times they visit the bathroom – this is called Frequency.
Frequency
Needing to go to the bathroom more often than usual. This can be in the daytime or night time. Many women cope with incontinence by keeping the bladder empty by going frequently. Urine infections can also cause frequency by creating a sensation of pain or urgency.
Incomplete emptying or incomplete voiding
This is when the bladder does not empty completely. It can be because of prolapse – where a part of the bladder balloons out of the vagina and straining to pass urine often worsens the bulge causing urine to be left behind. Typically, you feel like going back to the bathroom soon after you have been and are still able to pass some urine.
A bladder with residual urine (urine left behind after emptying the bladder) becomes a reservoir for bacteria to grow in. These are often bacteria from the bowel – E. Coli, Pseudomonas aeruginosa and Klebsiella pneumonia.
Recurrent urinary tract infections / recurrent UTI
Recurrent urinary tract infections need a thorough assessment
Recurrent urine infections are the bane of the menopausal bladder. The lack of estrogen causes even the bladder wall to lose its resistance to infection and become thinned out. The most common cause is incomplete emptying of the bladder.
Symptoms of a urine infection can be frequency, urgency, pain, fever, cloudy colored and smelly urine, pain in the lower abdomen and if the infection tracks up to the kidneys – pain in the flanks and loin area.
Recurrent urinary infections are diagnosed on urine microscopy and culture. More than three infections with the same organism in one year is classed as a recurrent infection. The treatment is with antibiotics and treating the cause which may include surgery to correct prolapse. Vaginal estrogen is very helpful in preventing recurrent urinary infections in menopausal women.
Straining to empty
When the bladder doesn’t empty completely it is natural to feel like straining. This often worsens the situation because of the structure of the female urethra. With menopause, the urethra also becomes thin and narrow and this can cause problems with emptying the bladder. Occasionally, prolapse can cause kinking of the urethra and straining can worsen the prolapse and make passing urine even harder.
Needing to replace the bladder to empty it
When the bladder balloons out into the vagina – called anterior vaginal wall prolapse it can collect urine and also kink the urethra. As the prolapse worsens, the woman may need to put her fingers into the vagina to replace the prolapse before she can empty her bladder.
Enuresis
This is wetting the bed when asleep. There can be a number of reasons for this including infections and the effect of sedative or diuretic medication used to treat other conditions.
Leaking urine continuously
This can happen due to a fistula which is an open connection between either the bladder, urethra or ureters to the outside – most commonly following surgery or radiotherapy. In younger women this would commonly be following a traumatic or complicated delivery. Urine most commonly leaks into the vagina but it can also leak through the cervix or out to the skin of the vulva or through the urethra. Rare neurological conditions can cause continuous leaking. This needs investigation and several additional tests to determine where it is coming from. Treatment is usually surgical.
We have seen how incontinence can adversely affect quality of life. Urinary incontinence affects over 50% of post-menopausal women. As the ageing population increases the sheer number of women suffering with incontinence is predicted to rise exponentially. The cost of managing incontinence is estimated to be over $13 billion worldwide.
Sleeplessness, nocturia, frequency and urgency increase distress in menopause
Conclusion
So, like, dealing with pee problems during menopause is kinda tricky. Hormones go nuts, and ladies face issues like waking up a lot at night to pee or leaking when they cough. Understanding these problems is super important for getting help. As more ladies get older, these issues will become a big deal. Fixing them is pricey, so knowing about them early on can make life better for lots of women.
Do write to me at masterthemenopause@gmail.com about what you liked in this article and whether it helped you address some of your concerns.