Bladder problems and urinary incontinence in menopause: what helps

Bladder problems and urinary incontinence are among the complaints many women notice in menopause, and the cause often lies in declining estrogen. As that hormone drops, the lining of the urethra and the bladder wall become thinner and less elastic, which can make you urinate more often, get bladder infections more easily or lose urine involuntarily. The good news is that in most cases these complaints respond well to treatment. What helps ranges from pelvic-floor exercises and lifestyle to local estrogen, depending on the type of complaint.

In short

• Declining estrogen makes the tissue around the bladder and urethra thinner and more sensitive. This falls under the genito-urinary syndrome of menopause (GSM).
• There are two main types: stress incontinence (urine loss when coughing, sneezing or lifting) and urge incontinence (a sudden, strong need to urinate).
• Pelvic-floor exercises, if needed with a pelvic physiotherapist, are often the first step, certainly for stress incontinence.
• Local (vaginal) estrogen can help with urgency, frequent urination and recurrent bladder infections. This is different from systemic hormone therapy.
• Blood in the urine, fever, flank pain or suddenly appearing symptoms always belong with your doctor first.

Why does menopause affect your bladder and urethra?

The bladder, the urethra and the vagina lie close together and all respond to estrogen. The tissue of the urethra and the bladder neck contains estrogen receptors, so when hormone levels fall in menopause, that tissue changes along with them. The lining becomes thinner, drier and less supple, and you notice this in your bladder.

According to Thuisarts.nl, the lining of the urethra becomes thinner after menopause, which can cause a burning feeling when you urinate and lets bacteria trigger a bladder infection more easily. These complaints are linked to the same hormonal change that causes vaginal dryness. We cover that side in more detail in our article on vaginal dryness and pain during intercourse. One thing worth knowing: bladder complaints in menopause are not a sign that you are doing something wrong, and you do not have to accept them as inevitable.

Which bladder complaints are common in menopause?

Broadly, there are two forms of involuntary urine loss, and they call for a different approach. It helps to recognise which one fits you, because that partly determines what can help.

• Stress incontinence: small amounts of urine loss when you cough, sneeze, laugh, lift or exercise. The pelvic floor and the sphincter do not hold back the pressure well enough.
• Urge incontinence: a sudden, strong need to urinate that is hard to postpone, sometimes with loss before you reach the toilet. This often goes together with urinating more often during the day and at night.

Alongside these, needing to urinate more often, waking at night to urinate, a burning feeling and recurrent bladder infections are part of the picture. A mixed form of stress and urge incontinence also occurs regularly. If you are unsure about the pattern, a bladder diary (noting how often and how much you urinate) often gives your doctor quick direction.

What can you do yourself about bladder complaints?

For mild complaints, you usually start with low-threshold steps. For many women this approach is the first choice and can already make a real difference, even without medication.

• Pelvic-floor exercises. Targeted training of the pelvic-floor muscles can reduce urine loss and, according to the NHG guideline, is an important first step, especially for stress incontinence. A pelvic physiotherapist can help you find and build up the right muscles.
• Bladder training. For urge complaints, gradually extending the time between toilet visits can help the bladder get used to a larger volume.
• Lifestyle. Excess weight puts extra pressure on the pelvic floor, so weight loss can ease complaints. Caffeine, alcohol and carbonated drinks can irritate the bladder in some women. Staying well hydrated matters, because drinking too little makes urine concentrated and can irritate the bladder more.
• Stopping smoking. Chronic coughing from smoking strains the pelvic floor and worsens stress incontinence.

Curious how bladder complaints fit into the bigger picture of menopause? Our free guide explains how hormonal changes connect to complaints like these, and which steps you can take yourself. Download the free guide →

Can local estrogen help with bladder complaints?

When the complaints are linked to thin, dry tissue around the bladder and urethra, local (vaginal) estrogen can help. It is applied as a cream or a vaginal tablet and restores the lining locally. There is reasonably convincing evidence that low-dose vaginal estrogen can reduce urge complaints and can lower the risk of recurrent bladder infections, although the effect is modest in size according to a systematic review in Annals of Internal Medicine. The international GSM guideline from the AUA, SUFU and AUGS therefore recommends local estrogen specifically for women with recurrent urinary tract infections.

It is important that local estrogen is different from systemic hormone therapy. With the vaginal form, only very little hormone reaches the rest of your body, and it does not work against hot flashes or night sweats. Systemic hormones, by contrast, are absorbed throughout the body, for example through an estradiol gel or patch. Local estrogen is mainly aimed at urgency, frequent urination and bladder infections. For pure stress incontinence, pelvic-floor exercises remain the most important treatment. Whether local estrogen is suitable and appropriate for you depends on your personal situation and history. At Menovia, our BIG-registered doctors review this within a structured programme, together with lifestyle as a complement.

When to see a doctor

Bladder complaints in menopause can often be treated well, but some signals should always be assessed medically first. Contact your doctor if you have:

• Blood in the urine, even if it happens only once.
• Fever, pain in your side or flank, or feeling generally unwell alongside urinary complaints, because this can point to a kidney infection.
• Pain or a burning feeling when urinating that persists or keeps coming back.
• Complaints that appear suddenly or worsen quickly.
• Urine loss that burdens your daily life, sleep or work.

Even when the complaints are not urgent but do persist, it is worth discussing them. Many women wait a long time, while good options are available.

Frequently asked questions

Are bladder problems in menopause normal? They are common and linked to declining estrogen, but common does not mean you simply have to accept them. In practice we see that most women notice improvement with the right approach.

Do bladder complaints go away by themselves after menopause? Usually not, because the lower estrogen level is lasting. The complaints can even increase after menopause. Treatment and lifestyle can bring them under control well, though.

Does drinking a lot less help against urine loss? No, that often backfires. Drinking too little makes urine concentrated, which irritates the bladder more. Spreading fluids sensibly across the day works better than restricting them.

Is vaginal estrogen the same as hormone therapy for hot flashes? No. Local estrogen works mainly at the site and does not help against hot flashes or night sweats. Systemic hormone therapy works throughout the body and has a different purpose.

Can a pelvic physiotherapist really help? Yes, targeted exercise under guidance can reduce urine loss, especially with stress incontinence. It does take patience and consistency over several weeks.

Sources

• Thuisarts.nl / NHG. I have complaints of my vagina due to menopause. thuisarts.nl
• NHG. NHG guideline Urinary incontinence in women. richtlijnen.nhg.org
• Danan ER, et al. Hormonal Treatments and Vaginal Moisturizers for Genitourinary Syndrome of Menopause: A Systematic Review. Annals of Internal Medicine. acpjournals.org
• American Urological Association, SUFU, AUGS. Genitourinary Syndrome of Menopause: AUA/SUFU/AUGS Guideline. auanet.org
• The Menopause Society (formerly NAMS). The 2020 genitourinary syndrome of menopause position statement. pubmed.ncbi.nlm.nih.gov

This information is intended as an educational resource and does not replace medical advice, diagnosis, or treatment. For complaints or questions about your personal situation, we recommend consulting a doctor.