Menopause & Urinary Symptoms

Menopause & urinary symptoms at a glance:

• Changes in a woman’s urinary function often accompany menopause. A primary cause is urogenital atrophy, which is the deterioration of the urinary tract and vagina.
• These urinary changes occur for two reasons: Menopause reduces the amount of the female hormone estrogen, and a lack of estrogen reduces the urinary tract’s ability to control urination. Advanced age, which usually coincides with menopause, also has various debilitating effects on the pelvic area organs and tissues.
• Symptoms include the need to urinate more frequently, the inability to control urination (incontinence), dryness and itching in the vagina, and increased urinary tract infections.
• Treatments vary and include dietary changes, strengthening exercises, topical estrogen for the vagina, and surgery.

Causes of menopausal urinary symptoms

When menopause occurs, estrogen production is reduced, which is the major cause of urogenital atrophy. Atrophy means a wasting away of muscle mass, and urogenital atrophy involves atrophy of the vagina as well as atrophy of the urinary tract.

The lack of estrogen weakens the bladder (which holds urine) and the urethra, the tube that carries urine out of the body, compromising their ability to control urinary functions. Reduced estrogen also alters the acidity of the vulva and the vagina, which can make the area more prone to infection by bacteria or yeast overgrowth.

Menopausal urinary symptoms can also be caused by pelvic organ prolapse, in which one or more organs of the pelvic area drops down into the vagina. This can be due to stress from vaginal childbirth that becomes evident after menopause. Such stress may also cause damage to pelvic floor muscles, also resulting in urinary problems. Whether specific urinary symptoms are related to menopause, aging or a combination of the two is the subject of continuing study.

Menopause urinary symptoms

Symptoms associated with urogenital atrophy can range from minor inconveniences to emotional distress. Unlike other symptoms of menopause, such as hot flashes, urogenital atrophy symptoms can become worse as the woman ages.

Symptoms related to urinary atrophy are:

• Stress incontinence: the leaking of urine due to the stress of laughing, coughing or sudden movement
• Urge incontinence (irritable/overactive bladder): the sudden, strong urge to urinate, which can result in a loss of bladder control before one can reach a bathroom
• An increased frequency in the need to urinate
• Waking up several times during the night to urinate (nocturia).

Symptoms related to vaginal atrophy are:

• A reduction in the fullness of the vulva and the vagina
• Dryness, itching and burning in the vagina or on the vulva
• Pain during sexual intercourse
• Vaginal bleeding
• An increase in urinary tract infections due to a change in the acidity of the vagina.

Urinary symptoms of pelvic organ prolapse are urge incontinence and painful urination.

Treatments for menopausal urinary symptoms

As lack of estrogen is the primary cause of urogenital atrophy, the treatments for it in postmenopausal women involve hormone therapy (HT). These can help restore the vagina to premenopausal condition and relieve many symptoms of urogenital atrophy.

Systemic HT (taken orally and affecting the whole system) may reduce the urinary symptoms of urgency, frequency, nocturia and painful urination, but there is continuing debate about the effectiveness of systemic HT in treating urogenital atrophy.

Local estrogen, applied externally, is helpful in relieving the symptoms of urinary urgency, frequency and stress incontinence, and can also help prevent urogenital atrophy and the recurrence of urinary tract infections.

The most common treatment for vaginal atrophy symptoms is low-dose vaginal estrogen replacement, utilizing creams, tablets or vaginal rings.

However, some women are not able to have HT for any menopausal urinary symptoms such as women with breast cancer. For symptoms of vaginal atrophy, they can use vaginal moisturizers for normal relief and vaginal lubricants to relieve dryness prior to intercourse.

Non-hormonal treatments for bladder control symptoms, including those related to pelvic organ prolapse and weakening of the pelvic floor muscles, can involve lifestyle changes and medical procedures. These include:

• Reducing caffeine
• Bladder-training techniques that increase the capacity to hold urine, control the timing of urination, and control body functions with the help of a machine (called biofeedback)
• Maintaining a healthy weight
• Avoiding stress to the pelvic area and doing Kegel exercises
• Electrical stimulation of the bladder muscles
• A pessary device inserted in the vagina to help hold up a prolapsed bladder
• A device placed in the urethra that blocks leakage
• Various surgical techniques to restructure support for the prolapsed organ.