Leaking the Truth – A Physiotherapist’s Guide to Bladder Control in Menopause

Navigating Bladder Health During Menopause – How a Pelvic Health Physiotherapist can Help

Myths around bladder control

Have you heard or been told the following?

• It’s normal to leak urine after childbirth.
• It’s normal to leak as you get older.
• There is nothing you can do to manage your bladder symptoms.

What if I told you that this is false? What if I told you there are a lot of treatment options available to help you regain bladder control? This topic is often considered taboo. Who wants to talk about bladder control really. But we should. And we will!

Why should we talk about bladder control and improving bladder health?

It’s so much more common than you think. According to the Canadian Urinary Bladder Survey, 33% of women over the age of 40 have symptoms of urinary incontinence. Over 26% of them do not even discuss this with their doctor.

Why? Most likely because we think bladder leakage is normal. “Of course, you leak! You had children, you are getting older, and you must learn to live with it.”

Absolutely not!

In total? Over 3.5 million Canadians have symptoms of urinary incontinence.

It affects 1 in 4 women.

This is not a small problem.

Why do we lose bladder control?

The most common type of incontinence is stress incontinence – bladder leakage with coughing, sneezing, laughing, and exercising. Do you cross your legs when you cough or sneeze? Do you leak when you do jumping jacks? Do you avoid a trampoline at all cost? These are symptoms of stress incontinence. Others may have symptoms of urge incontinence – leakage with a strong urge to void (pee) making it difficult to get to the bathroom on time. Do you find yourself planning your day around finding bathrooms because you are worried that when the urge strikes you will lose bladder control? This is a sign of urge incontinence. You can also have mixed incontinence, a combo of both stress and urge incontinence. 

What can lead to bladder leakage? This is not an exhaustive list! 

1. 

   Pelvic floor dysfunction. There are muscles, at the bottom of your pelvis, that contract and compress the urethra when you cough, sneeze, laugh or exercise. This helps reduce bladder leakage. These muscles, which you control, need to have good mobility, strength and endurance. They need exercise!

2. Constipation. This is a whole other blog post! I can talk about healthy bowel movements all day. Are you chronically straining when you have a BM? This can impact your pelvic floor muscle strength and may contribute to incontinence.

3. Loss of elasticity and collagen in the urethra and bladder. Elasticity is important because it allows your bladder to fill to its capacity and collagen helps close the urethra to ensure good compression which reduces leakage.

4. Other factors can also impact bladder leakage. Chronic coughing, excessive weight gain and lack of general physical fitness.

Why does bladder control get worse as we age or go into menopause?

As we age, we lose muscle mass and that includes the pelvic floor muscle. This is called sarcopenia. If the pelvic floor loses strength and mobility, there is not enough compression around the urethra and that leads to leakage with coughing/sneezing/laughing and exercising. If you lose pelvic floor endurance, then you will have a hard time getting to the bathroom on time.

But with menopause, or more specifically Genito Urinary Syndrome of Menopause (GSM), there are a few considerations. Remember how the bladder needs elasticity and the urethra is rich in collagen? Well, estrogen matters. There are estrogen receptors in the bladder and urethra. We lose estrogen receptors with menopause and that contributes to bladder symptoms like leakage and increases in urinary tract infections (UTI).

Estrogen plumps up our tissues, including the inside of the urethra. This helps the urethra close, preventing leakage and UTI’s. With menopause, the urethra can lose its seal, which is called a loss of “coaptation”. If the bladder is less elastic, then we can have symptoms like bladder urgency and feel like we need to void more often. There are also estrogen receptors in our pelvic floor muscles and a drop in estrogen does impact their strength and mobility.

So, hormones play a role in bladder health, especially with menopause.

What can you do to help regain bladder control.

1. Stay healthy! Women with chronic physical health conditions appear to be at higher risk of incontinence.

2. Stay fit and exercise to prevent sarcopenia. Find physical activities that you love to do. Go for a walk, play pickle ball, hike, swim, do yoga or lift weights. It does not matter! Do something fun that will motivate you to keep moving long-term. This will help prevent the loss of muscle mass encountered when aging.

3. Manage constipation. Gut health and healthy bowel movements are so important to reduce incontinence and improve our bladder health. Work with your medical team to help you manage constipation. Talk to your doctor or see a nutritionist or dietician to help sort out your diet and fiber needs.

4. Keep a healthy weight. This is such a sensitive topic, but many women do struggle with their weight when they transition into menopause. Hormones play a role in our struggles with weight gain. Again, find the right professional to help guide you in managing your weight in a healthy and safe way.

5. Find a pelvic health physiotherapist (if in the Ottawa area, you can find me at Killens Reid Physiotherapy)! We should be part of your health team 100%. Pelvic health physiotherapy is considered the first-line conservative treatment approach for incontinence. We are trained to assess and manage your pelvic health and help you regain pelvic floor strength. Yes, you need to exercise! Your pelvic floor is a muscle and like other muscles in the body you need to “use it or lose it”. It needs to be able to stretch and be flexible and yet strong! We provide strategies and treatment for all your bladder symptoms. We work closely with the rest of your health team (family doctor, gynecologist, urologist, nutritionist, nurse practitioner, naturopath) to help you navigate your bladder symptoms.

6. Find a healthcare provider that can educate you about hormone replacement therapy. Prosper Menopause Clinic would be happy to work with you to find the right type of estrogen therapy for you.

Why suffer from incontinence when there is so much you can do to manage your symptoms?

Be your healthiest self and thrive no matter your age and hormonal status.

Talk about this with your friends and family – bladder health should not be a taboo subject or something to be embarrassed about.

Marie-Josée F. Forget PT

Pelvic Health Physiotherapist

Instagram: mj.forget

Website: www.mjforgetpt.ca

References:

1. Hannestad, Rortveit, Sandvik, Hunskaar. A community-based epidemiological survey of female urinary incontnence: The Norwegian EPINCONT Study. November 2000, Volume 53, Issue 11, Pages 1150-1157
2. https://www.canadiancontinence.ca
3. Minassian VA, Stewart WF, Wood GC (2008) Urinary incontinence in women: variation in prevalence estimates and risk factors. Obstet Gynecol 111:324–31
4. Markland AD, Vaughan C, Okosun I, et al. (2018) Cluster analysis of multiple chronic conditions associated with urinary incontinence among women in the USA. BJU Int 122:1041–8.
5. Daugirdas SP, Markossian T, Mueller ER, et al. (2020) Urinary incontinence and chronic conditions in the US population age 50 years and older. Int Urogynecol J 31:1013–20.
6. Association between chronic conditions and urinary incontinence in females: a cross-sectional study using national survey data, Natalie V. Scime, Erin Hetherington, Amy Metcalfe, Kathleen H. Chaput, Sandra M. Dumanski, Cynthia H. Seow, Erin A. Brennand, Apr 2022, 10 (2) E296-E303
7. Angelou K, Grigoriadis T, Diakosavvas M, Zacharakis D, Athanasiou S. The Genitourinary Syndrome of Menopause: An Overview of the Recent Data. Cureus. 2020;12(4):e7586. Published 2020 Apr 8. doi:10.7759/cureus.7586
8. Joanie Mercier, Mélanie Morin, Dina Zaki, Barbara Reichetzer, Marie-Claude Lemieux, Samir Khalifé, Chantale Dumoulin, Pelvic floor muscle training as a treatment for genitourinary syndrome of menopause: A single-arm feasibility study, Maturitas, Volume 125, 2019, Pages 57-62, ISSN 0378-5122, https://doi.org/10.1016/j.maturitas.2019.03.002.
9. Dumoulin, L. Pazzoto Cacciari & J. Mercier (2019): Keeping the pelvic floor healthy, Climacteric, DOI: 10.1080/13697137.2018.1552934
10. Herschorn, S., Gajewski, J., Schulz, J., & Corcos, J. (2008). A population-based study of urinary symptoms and incontinence: the Canadian Urinary Bladder Survey. BJU international, 101(1), 52–58. https://doi.org/10.1111/j.1464-410X.2007.07198.x
11. Featured Photo by Robert Lukeman on Unsplash