Menopause and Bladder Control

Some women begin to have problems with their bladder and experience overactive bladder (gotta go, gotta go right now) and urinary incontinence or loss of urine at inopportune times at the time or shortly after menopause.

Does Menopause Affect Bladder Control?

Yes. Some women have bladder control problems after they stop having periods (menopause or change of life). If you are going through menopause, talk to your health care team.

After your periods end, your body stops making the female hormone estrogen. Estrogen may help keep the lining of the bladder and urethra healthy. A lack of estrogen could contribute to weakness of the bladder control muscles.

Pressure from coughing, sneezing or lifting can push urine through the weakened muscle. This kind of leakage is called stress incontinence.

Although there is no evidence that taking estrogen improves bladder control in women who have gone through menopause, small does may help thicken the bladder lining and decrease the incontinence.  Your doctor can suggest many other possible treatments to improve bladder control.

What Else Causes Bladder Control Problems in Older Women?

Sometimes bladder control problems are caused by other medical conditions. These problems include:

Infections

Nerve damage from diabetes or stroke

Heart problems

Medicines

Feeling depressed

Difficulty walking or moving

A very common kind of bladder control problem for older women is urge incontinence. This means the bladder muscles squeeze at the wrong time and cause leaks.

If you have this problem, your doctor can prescribe medication that can certainly alleviate that problem.

What Treatments Can Help You Regain Bladder Control?

Your doctor may recommend limiting foods or fluids, such as caffeine, which are bladder irritants and increase the desire to go the rest room.

There are also pelvic exercises that can strengthen the muscles in the urethra and the vagina.   Life’s events like childbirth and being overweight, can weaken the pelvic muscles.

Pelvic floor muscles are just like other muscles. Exercise can make them stronger. Women with bladder control problems can regain control through pelvic muscle exercises, also called Kegel exercises.

Exercising your pelvic floor muscles for just five minutes, three times a day can make a big difference to your bladder control. Exercise strengthens muscles that hold the bladder and many other organs in place.

Two pelvic muscles do most of the work. The biggest one stretches like a hammock. The other is shaped like a triangle. Both muscles prevent leaking of urine and stool.

Pelvic exercises begin with contracting the two major muscles that stretch across your pelvic floor. There are three methods to check for the correct muscles.

1.     Try to stop the flow of urine when you are sitting on the toilet. If you can do it, you are using the right muscles

2.     Imagine that you are trying to stop passing gas. Squeeze those same muscles you would use.

3.     Lie down and put your index finger inside your vagina. Squeeze as if you were trying to stop urine from coming out. If you feel tightness on your finger, you are squeezing the right pelvic muscle.

Do your pelvic exercises at least three times a day. You can exercise while lying on the floor, sitting at a desk or standing in the kitchen.

Be patient. Don’t give up. It’s just five minutes, three times a day. You may not feel your bladder control improve until after three to six weeks. Still, most women do notice an improvement after a few weeks.

Other treatments include inserting a device, a pessary, directly into the vagina to lift the urethra and the base of the bladder to its proper position behind the pubic bone.  And finally, if the conservative methods of medication, exercises, and dietary modification don’t work, then you should talk to your doctor about one of the surgical procedures that can lift the bladder into the proper position to prevent leakage

Bottom Line: No one needs to suffer the embarrassment of urinary incontinence.  Help is available for all those women who have bladder control problems

A Kegel A Day Keeps the Doctor Away

Mary Ann is a 45-year old woman who loses urine (incontinence) when she coughs and sneezes.  She is provided with exercises to strengthen the pelvic floor muscles of her bladder. She does the exercises every day for 12 weeks and has significant improvement in her urinary symptoms.

There are many conditions that put stress on your pelvic floor muscles such as childbirth through vaginal deliveries, obesity, chronic coughing, and after menopause when there is a deficiency of estrogen or the female hormone produced in the ovaries.

When your pelvic floor muscles weaken, your pelvic organs descend and bulge into your vagina, a condition known as pelvic organ prolapse. The effects of pelvic organ prolapse range from uncomfortable pelvic pressure to leakage of urine or feces. Fortunately, Kegel exercises can strengthen pelvic muscles and delay or maybe even prevent pelvic organ prolapse.

How to perform Kegel exercises

It takes diligence to identify your pelvic floor muscles and learn how to contract and relax them. You can learn to identify the proper pelvic muscles by trying to stop the flow of urine while you’re going to the bathroom.

If you’re having trouble finding the right muscles, don’t be embarrassed to ask for help. Your doctor can give you important feedback so that you learn to isolate and exercise the correct muscles.

After you’ve identified your pelvic floor muscles contract your pelvic floor muscles and hold the contraction for three seconds then relax for three seconds.  Repeat this exercise 10 times.  After you have learned how to contract the pelvic muscles for 3 seconds, work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions.  Perform a set of 10 Kegel exercises three times a day. The exercises will get easier the more often you do them. You might make a practice of fitting in a set every time you do a routine task, such as sitting at a red light.

For those women who have trouble doing Kegel exercises, biofeedback training or electrical stimulation may help. In a biofeedback session, a nurse, therapist or technician will either insert a small monitoring probe into your vagina or place adhesive electrodes on the skin outside your vagina or rectal area. When you contract your pelvic floor muscles, you’ll see a measurement on a monitor that lets you know whether you’ve successfully contracted the right muscles. You’ll also be able to see how long you hold the contraction.

Results are not immediate or the first time you do the exercises.  You can expect to see some results, such as less frequent urine leakage, within about eight to 12 weeks. Your improvement may be dramatic — or, at the very least, you may keep your problems from worsening. As with other forms of physical activity, you need to make Kegel exercises a lifelong practice to reap lifelong rewards.

An added bonus: Kegel exercises may be helpful for women who have persistent problems reaching orgasm.

Bottom Line:  Many women have a problem of loss of urine with coughing and sneezing.  Kegel exercises are effective for very mild urinary incontinence.  It’s inexpensive, does not require use of medication, and if you are patient, it does, indeed, work.

Self Care for Women With Urinary Incontinence

Incontinence is a condition that results in the involuntary loss of urine without the owners’ permission. It is a condition that affects millions of American men and women. There are many changes that occur in the human body as we get older. Like many other bodily system, the urinary tract undergoes changes with age. These changes make middle age and older men and women more likely to become incontinent of urine as they grow older. It is important to remember that incontinence is not a necessary part of the aging process but it is more common in older men and women. There are a number of actions that women can take to decrease or even limit this embarrassing situation.

The skin around the outside of the vagina in women is called the “vulva”. This area includes the skin around the urethra and the vaginal “lips” or labia. Frequently, in incontinent women this area is red, raw, and sore from urine irritating the skin. If this is a problem for women, these tips may help make women more comfortable and avoid irritation of the bladder, urethra, and surrounding skin.

• Women who are incontinent should wear cotton underwear instead of underwear made of synthetic material such as nylon. I also suggest that women do not wear synthetic pantyhose, especially not under pants or jeans. Women will also find that the underwear will be less irritating to the vulva if the underwear is washed in pure soap or soap flakes and not in harsh detergents or with the addition of fabric softeners. I suggest that women wash the vulvar area no more than twice a day, using only plan water or mild soap such as Ivory or Dove.
• Women who are incontinent should avoid bath oils, bubble baths or bath salts. All of these can be very irritating to the already sensitive skin of the vulva. Vaginal deodorants or douches should also be avoided. Tampons should not be used as they may irritate the bladder and the urethra.
• After bathing, the vulvar area should be gently dried with a towel, and then use a hair dryer on cool or low setting to dry the vulva completely.
• If you need a powder to help keep the vulvar area dry, I suggest using ordinary cornstarch and not talcum powder.
• Finally, try drinking pure water as much as possible and avoid caffeinated beverages such as coffee, tea, and cola beverages. Avoid alcohol especially in excess as alcohol may irritate the bladder and the urethra.

Nearly every woman with incontinence can be helped and most can be cured. If this is a problem that is affecting your quality of life, I suggest you contact your physician.

You Don’t Have to Be Wet When You Exercise

Stress urinary incontinence refers to the leakage of urine that occurs during physical activities, such as coughing, sneezing, walking and lifting.  It is not surprising that many women lose urine during exercise given the impact exercise may have on the bladder, the urethra or the tube that allows urine to exit the body, and the pelvis.  If women have urinary incontinence during exercise, it is not uncommon for many women to give up exercising entirely because of the social embarrassment associated with this condition.  One-fifth of women who exercised recreationally stopped exercising because of the incontinence.

Nearly one-third of recreational athletes have some urinary incontinence during exercise.  Exercises that involved repetitive bouncing, such as aerobics or running, are most likely to provoke urinary incontinence.

Loss of urine during exercise is not only limited to middle-aged women who have had children.  Over 25% of young college varsity athletes or physical education majors who had not had any children reported some leakage while participating in their sport.  Nearly 2\3 of gymnasts reported some leakage, but only 10% of the swimmers had loss of urine.  This is not surprising since swimming is a much lower impact activity.  Another study compared incontinence in physical education majors which was nearly three times more common than in students studying nutrition.  Both of these groups of women were just as likely to have occasional incontinence in other activities of daily life, regardless of whether they were athletes or not.  This suggests that exercise alone does not cause incontinence but that the high intensity of exercise raises the pressure in the bladder and exceeds the woman’s continence threshold.  The continence threshold is the amount of pressure that the urethra is able to withstand before loss of urine occurs.  This threshold may be decreased from such factors as childbirth which stretches the tissues in the vagina and weakens the muscles and connective tissue in the pelvis.  Other conditions decreasing the continence threshold include certain medications such as alpha blockers, estrogen deficiency as seen in post-menopausal women, obesity, chronic coughing, and nerve disorders as occasionally seen in women with diabetes.

High impact exercising also predispose women to leak.  With jumping or running, the bladder has to accept over 25 pounds of force from the abdominal organs slamming down against the bladder and the urethra which can exceed the continence threshold and result in incontinence.

There is also evidence that loss of collagen in the connective tissues may be responsible for the loss of urine in women who lose urine during exercise.  As women get older there is a loss of collagen and this may be responsible for some of the incontinence that occurs in women during exercise.

Are women who exercise at risk for clinically significant incontinence later in life?  Probably not.  A study that questioned female Olympians who competed 20-30 years ago, found that those who participated in high impact sports (gymnastics and track and field) were not more likely to have more severe incontinence today than women who competed in lower impact exercises such as swimming.

Solutions to exercise incontinence

Most importantly, women should not stop exercising.  This is especially important as a women reaches middle age and can easily become overweight.  Being overweight is definitely associated with urinary incontinence so women can get into a vicious cycle if they stop exercising as they can become more overweight and have even more incontinence.   Some women may cope with the use of pads used during exercise, others can change from high-impact to lower impact exercises such as swimming.  There are also pelvic muscle strengthening drills that can stop or cut down leakage during exercises.  Now there are inserts containing a small, single use liquid covered with silicone that can be inserted into the urethra and conforms to the urethra creating a seal and preventing the loss of urine during exercise.  The insert is removed during regular bathroom visits where it is discarded and replaced with a fresh insert.  Finally, for women whose quality of life is impaired by the incontinence, surgery can alleviate incontinence in most women.

Bottom line:  Help is available for those who suffer from incontinence during exercise.  If you want to explore the various treatment options you should discuss them with your doctor