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Do you find yourself leaking urine after the menopause? As taboo as this topic may feel, you're certainly not alone — and there are things you can do, as well as medications your doctor can prescribe, that will help you.

The declining estrogen levels characteristic of the perimenopause have far-reaching effects on just about every part of the body — and all the bits involved in urination aren't an exception. The urethra's lining can thin, and the pelvic floor muscles weaken, during this time. With this comes the unfortunate possibility that you'll, ehm, leak a bit, a risk that only goes up if you've ever given birth vaginally.

 

Some women experience stress incontinence — the kind where you'll lose some urine when you sneeze, cough, laugh, or run. The result of weakened pelvic floor muscles, this kind of incontinence strikes many menopausal women but doesn't usually get worse with menopause. Urge incontinence, meanwhile, happens when the muscles that control your bladder are overactive or irritated, and besides causing you to feel like you need to pee much more often, it can also lead to some urine leaks. 

In addition to these common problems, some menopausal women will face nocturia, or waking up needing to go to the bathroom at night, and others will experience pain while peeing. This is often caused by urinary tract infections, which you're unfortunately at an increased risk of after entering the menopause. 

Why are urinary tract infections more frequent in postmenopausal women?

Urinary tract infections become a more common problem as you approach the menopause and after because of the thinning of tissues that occurs due to declining estrogen levels. This, in turn, leaves your urinary tract more vulnerable to infections that cause UTIs like cystitis. 

Since urinary tract infections are so common, you've probably dealt with them already and know the signs. You may feel like you need to pee only to find that nothing comes out when you go to the bathroom. As soon as you notice this sign, drink more water and cut down on sugar.

You can also try to boost your immune system — make sure you eat a healthy and varied diet that contains plenty of natural vitamin C, and drink kefir or take a probiotic supplement. This can help prevent urinary tract infections, but also help you out if you feel one coming on already.

Women who experience:

  • pain
  • burning sensations
  • blood in their urine
  • or the urge to pee very often

should see a doctor, though, rather than relying on home remedies to try to get better. If untreated, cystitis can progress to a kidney infection. 

How does urinary incontinence impact your sex life?

Many post-menopausal women leak a bit when they laugh or sneeze but yes, urinary incontinence can impact your sex life as well — around 25 percent of women who struggle with incontinence are thought to leak during sexual intercourse. That kind of thing can take all the fun out, of course, so you may find this really affects your libido. 

Fortunately, suffering urine leaks now doesn't mean you're doomed to be stuck with them forever — besides peeing before sex, you can also do pelvic floor exercises and even consider medications and surgery. 

How is menopause-related incontinence treated?

The first step is to let your doctor know what you're dealing with — they can't help you if they don't know what's going on, and they'll have seen this problem countless times in their practice. Once you have been evaluated, your doctor may suggest:

  • Antispasmodics like oxybutynin, darifenacin, and tolterodine are often offered to people with stress incontinence. They prevent your bladder muscles from contracting in ways that make you leak.
  • Duloxetine (Cymbalta) is an antidepressant that also helps fight incontinence. 
  • Mirabegron can be prescribed to people with an overactive bladder.
  • Low doses of desmopressin are good for nocturia.
  • Vaginal estrogen cream sometimes alleviates stress incontinence.
Non-pharmacological treatments are also available. A pessary puts pressure on your urethra to prevent spills, and is, along with menstrual pads, a non-invasive solution. Some women will benefit from a urinary catheter to drain their urine (don't worry, this doesn't mean you have to wear it all the time). Electrical stimulation can help you train your bladder as well, and if other treatments have been exhausted and you're still left with incontinence, surgery can be considered. An operation to lift your bladder is very effective at treating stress incontinence, while it isn't as helpful for people with urge incontinence.

Urinary incontinence: What can you do yourself?

These steps will help you prevent urinary incontinence as well as alleviate it if you're already leaking. 

Drink lots of fluids — but the right kind

Aim for eight glasses of water a day, but don't drink too much right before you go to bed as this comes with the risk of waking you up later. Alcohol and caffeine contribute to incontinence, so cut back there. 

A healthy weight

If you're overweight or obese, fat presses down on your bladder and your pelvic floor muscles suffer, making leaking more likely. Women who have found themselves adding (more than) a few extra pounds during the perimenopause can benefit from weight loss. 

Kegel exercises

Kegel exercises may just be more talked-about than they are performed, but they really do help strengthen your pelvic floor. You probably know the drill — tense the muscles you hold in when you need to pee, relax, and go again. Do this as often as you can (stand to). A series of eight repetitions three times a day is a good starting point. 

Going to the gym? Ask about your pelvic floor

If you already have a gym instructor, don't waste the opportunity to ask about exercises that will help you build up core strength and give that pelvic floor a boost. Working with an instruction ensures that you don't accidentally do the kind of workout that actually makes your incontinence worse, like lifting heavy weights in the wrong way.

Yoga?

Yoga is great for flexibility, relaxation, and... the pelvic floor. Mula bandha is a kind of posture that helps you strengthen the muscles that you're having trouble with. 

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