Menopause and Bladder Control
National Kidney and Urologic Diseases Information Clearinghouse
Who is likely to have bladder control problems?
You may think bladder control problems are something that happen when you get older. The truth is that women of all ages have urine leakage. The problem is also called incontinence. Men leak urine too, but the problem is more common in women.
Many women leak urine when they exercise, laugh hard, cough, or sneeze.
Often women leak urine when they are pregnant or after they have given birth.
Women who have stopped having their periods-menopause-often report bladder control problems.
Female athletes of all ages sometimes have urine leakage during strenuous sports activities.
Urine leakage may be a small bother or a large problem. About half of adult women say they have had urine leakage at one time or another. Many women say it's a daily problem.
Urine leakage is more common in older women, but that doesn't mean it's a natural part of aging. You don't have to "just live with it." You can do something about it and regain your bladder control.
Incontinence is not a disease. But it may be a sign that something is wrong. It's a medical problem, and a doctor or nurse can help.
What else causes bladder control problems in older women?
Urine leakage has many possible causes.
What treatments can help you regain bladder control?
Weak muscles. Most bladder control problems are caused by weak pelvic muscles. These muscles may become stretched and weak during pregnancy and childbirth. Weak muscles let the bladder sag out of position, which may stretch the opening to the urethra.
Infection. A urinary tract infection can irritate bladder nerves and cause the bladder to squeeze without warning. This type of incontinence goes away once the infection has been cured.
Nerve damage. Damaged nerves may send signals to the bladder at the wrong time. As a result, a bladder spasm may push out urine without warning. Sometimes damaged nerves send no signals at all, and the brain can't tell when the bladder is full. Nerves can be damaged by diseases (such as diabetes or multiple sclerosis) or trauma (due to pelvic or back surgery, radiation).
Medicines, alcohol, and caffeine. Leaking can happen when medicines affect any of the muscles or nerves. You may take medicine to calm your nerves so that you can sleep or relax. This medicine may dull the nerves in the bladder and keep them from signaling the brain when the bladder is full. Without the message and urge, the bladder overflows. Drinking alcohol can also cause these nerves to fail. Water pills — diuretics — take fluid from swollen areas of your body and send it to the bladder. This rapid filling may cause the bladder to leak. Caffeine drinks such as coffee and cola also cause the bladder to fill quickly. Make sure your drinks are decaf.
Excess weight.Being overweight can put pressure on the bladder and contribute to stress incontinence.
Talking about bladder control problems is not easy for some people. You may feel embarrassed to tell your doctor. But talking about the problem is the first step in finding an answer. Also, you can be sure your doctor has heard it all before. You will not shock or embarrass your doctor or nurse.
Your doctor will likely offer several treatment choices. Some treatments are as simple as changing some daily habits. Other treatments require taking medicine or using a device. If nothing else seems to work, surgery may help a woman with stress incontinence regain her bladder control.
Talk with your doctor about which treatments might work best for you.
What professionals can help you with bladder control?
Pelvic muscle strengthening.
Many women prefer to try the simplest treatment choices first. Kegel exercises strengthen the pelvic muscles and don't require any equipment. Once you learn how to "Kegel," you can Kegel anywhere. The trick is finding the right muscles to squeeze. Your doctor or nurse can help make sure you are squeezing the right muscles. Your doctor may refer you to a specially trained physical therapist who will teach you to find and strengthen the sphincter muscles. Learning when to squeeze these muscles can also help stop the bladder spasms that cause urge incontinence. After about 6 to 8 weeks, you should notice that you have fewer leaks and more bladder control.
Timed voiding. By keeping track of the times you leak urine, you may notice certain times of day when you are most likely to have an accident. You can use that information to make planned trips to the bathroom ahead of time to avoid the accident. Once you have established a safe pattern, you can build your bladder control by stretching out the time between trips to the bathroom. By forcing your pelvic muscles to hold on longer, you make those muscles stronger.
Diet changes. You may notice that certain foods and drinks cause you to urinate more often. You may find that avoiding caffeinated drinks like coffee, tea, or cola helps your bladder control. You can choose the decaf version of your favorite drink. Make sure you are not drinking too much fluid because that will cause you to make a large amount of urine. If you are bothered by nighttime urination, drink most of your fluids during the day and limit your drinking after dinner. You should not, however, avoid drinking fluids for fear of having an accident. Some foods may irritate your bladder and cause urgency. Talk with your doctor about diet changes that might affect your bladder.
Weight loss. Extra body weight puts extra pressure on your bladder. By losing weight, you may be able to relieve some of that pressure and regain your bladder control.
Medication. No medications are approved to treat stress urinary incontinence. But if you have an overactive bladder, your doctor may prescribe a medicine that can calm muscles and nerves. Medicines for overactive bladder come as pills, liquid, or a patch. Medicines to treat overactive bladder can cause your eyes to become dry. These medicines can also cause dry mouth and constipation. If you take medicine to treat an overactive bladder, you may need to take steps to deal with the side effects.
Medicines for other conditions also can affect the nerves and muscles of the urinary tract in different ways. Pills to treat swelling — edema — or high blood pressure may increase urine output and contribute to bladder control problems.
Talk with your doctor; you may find that taking a different medicine solves the problem without adding another prescription.
Pessaries. A pessary is a plastic ring, similar to a contraceptive diaphragm, that is worn in the vagina. It will help support the walls of the vagina, lifting the bladder and nearby urethra, leading to less stress leakage. A doctor or nurse can fit you with the best shape and size pessary for you and teach you how to care for it. Many women use a pessary only during exercise while others wear their pessary all day to reduce stress leakage. If you use a pessary, you should see your doctor regularly to check for small scrapes in the vagina that can result from using the device.
Nerve stimulation. Electrical stimulation of the nerves that control the bladder can improve symptoms of urgency, frequency, and urge incontinence, as well as bladder emptying problems, in some people. This treatment is usually offered to patients who cannot tolerate or do not benefit from medications. At first, your doctor will use a device outside your body to deliver stimulation through a wire implanted under your skin to see if the treatment relieves your symptoms. If the temporary treatment works well for you, you may be able to have a permanent device implanted that delivers stimulation to the nerves in your back, much like a pacemaker. The electrodes in the permanent device are placed in your lower back through a minor surgical procedure. You may need to return to the doctor for adjustments to find the right setting that controls your bladder symptoms.
Surgery. Doctors may suggest surgery to improve bladder control if other treatments have failed. Surgery helps only stress incontinence. It won't work for urge incontinence. Many surgical options have high rates of success. Most stress incontinence problems are caused by the bladder neck dropping toward the vagina. To correct this problem, the surgeon raises the bladder neck or urethra and supports it with a ribbon-like sling or web of strings attached to a muscle or bone. The sling holds up the bottom of the bladder and the top of the urethra to stop leakage.
Catheterization. If your bladder does not empty well as a result of nerve damage, you might leak urine. This condition is called overflow incontinence. You might use a catheter to empty your bladder. A catheter is a thin tube you can learn to insert through the urethra into the bladder to drain urine. You may use a catheter once in a while, a few times a day, or all of the time. If you use the catheter all the time, it will drain urine from your bladder into a bag you can hang from your leg. If you use a catheter all the time, you should watch for possible infections.
Professionals who can help you with bladder control include:
- Your primary care doctor
- A gynecologist (guy-nuh-CALL-uh-jist): a women's doctor
- A urogynecologist (YOOR-oh-guy-nuh-CALL-uh-jist): an expert in women's bladder problems
- A urologist (yoor-ALL-uh-jist): an expert in bladder problems
- A nurse or nurse practitioner
- a physical therapist