Urinary incontinence: is menopause to blame?

Urinary incontinence is very common and affects many women in different ways. You may find that you leak urine if you jump or sneeze or you might notice that you can’t hold onto urine for as long as you used to be able to.

Woman with hands holding her crotch, she wants to pee - urinary incontinence concept

Urinary incontinence is often not really spoken about, which is a shame because there are some really effective treatments available for women. It is more common during and after the menopause.

There are two types of urinary incontinence: stress incontinence and urge incontinence. Some women have a combination of both.

Stress incontinence

Stress incontinence occurs when you can’t hold onto as much urine as before and this is usually due to the muscles and tissues which support your bladder becoming weaker with time. Many factors contribute to this and include having children, being constipated, if you are overweight or obese, and also having reduced muscle tone can be associated with low levels of oestrogen in the menopause. Having weak pelvic floor muscles can also contribute to this.

Urge incontinence

Urge incontinence is when you can’t hold onto as much urine as before so you need to rush to the toilet quicker than you used to. You may notice that you don’t get much warning before you need to go to the toilet either. In addition, you may find you have to get up more often at night to pass urine.

Urge incontinence can be caused by infection, destruction of the nerves controlling your bladder or thinning of the tissues of the tubing along which your urine flows.

This type of incontinence can be due to an overactive bladder. This means that your bladder does not fill up properly and tells your brain that you need to empty it even when it’s not full. You may find that you need to pass urine more frequently when you are stressed. It can also be caused by having a urine infection or from thinning of the tissues of your urethra – the tube that drains urine from your bladder – which occurs more commonly in the menopause.

How to tackle it… 

Vaginal ring pessaries are available to combat stress incontinence, which work to support your internal organs. They can work really well and are usually replaced every 6-12 months. You can still have sexual intercourse with them in place.

Using oestrogen locally such as vaginal pessaries, creams and rings can also help incontinence in the way that it helps all other kinds of muscles, as the oestrogen can help to improve your muscle tone.  This is different to taking HRT and is very safe, although HRT can help too.

It’s important to keep your pelvic floor muscles strong, as this can also help to combat incontinence. You can do this by squeezing your pelvic floor muscles for a few seconds 10-15 times a day. You’ll be able to tell which are the right muscles by stopping your flow of urine – this is great to show you you’re doing the right thing, but please don’t regularly try to stop urinating.

There are other different types of medication that can work really well. If one type of medication does not work, then you may be offered another which you may find effective.

If medication does not help then there are different operations which may be offered to you, depending on the cause and severity of your symptoms.

Louise Newson

About Louise Newson

I am a GP and medical writer with a particular interest in the management of the menopause. I have written numerous articles and presented at local and national meetings on topics related to the menopause and its management. To find out more, here's my website. BSc (Hons), MBChB (Hons), MRCP, FRCGP