Menopause and its preceding phase, perimenopause, bring about changes in the bladder and bowel functions due to alterations in the lining of the urinary tract, weakening of the pelvic floor, and increased susceptibility of the bowel to dysfunction. In fact, it is estimated that 9.6 million women in North America 50 and younger experience urinary incontinence or stress leakage. These changes are primarily attributed to declining estrogen levels, resulting in various challenges such as stress incontinence, overactive bladder, pelvic organ prolapse, constipation, urinary tract infections, and vaginal dryness. These are categorized as Genitourinary Symptoms of Menopause (GSM) which impacts 70 to 80% of women in menopause. Unlike other challenges such as hot flashes, GSM does not necessarily resolve over time and can progress, increasing your health risks for things such as urinary tract infections (UTI).
Challenges During Menopause:
Stress Incontinence: Unintentional urine leakage during activities like coughing, laughing, or running.
Overactive Bladder and Urge Incontinence: Frequent or constant urges to pass urine, sometimes with little warning.
Pelvic Organ Prolapse: Weakening of pelvic floor muscles leading to sensations like something falling out of the vagina.
Constipation: Importance of maintaining regular bowel movements through hydration and a fiber-rich diet.
Urinary Tract Infections: Weakened defense against bacteria due to reduced estrogen levels.
Vaginal Dryness: Thinning of vaginal walls and decreased lubrication, leading to discomfort and potential pain.
Causes of Symptoms: Pelvic floor dysfunction arises during perimenopause and menopause due to a significant drop in estrogen levels. Estrogen plays a crucial role in maintaining the health of the urinary and reproductive systems, and its decline results in thinning of the bladder and urethra lining and weakening of pelvic floor muscles.
The impacts extent well beyond our avoidance of trampolines and public jumping jacks. It can seriously impact your quality of life including intimate relationships and your sexual health and wellness. A lack of awareness and preventative measures means you have to be aware of your pelvic health to keep it strong and healthy before any challenges arise. Thinking you will never be that person who needs bladder leakage pads is not healthy avoidance. Let’s get on this!
Meet Janet, she is a 43 year old, who has always had an active bladder. As a child, she remembers having to be the last one to leave the house on a road trip so she could pee right before getting into the car. While she sporadically practiced her Kegel exercises (she thought she was doing them right!), her urgency to pee began to increase as she aged. In fact, one day, on her 40 minute commute to work, she found herself having to urinate urgently. She tried to relax her bladder, undid the top of her pants, and even released her seatbelt. Finally, she found herself exiting from the highway and urgently finding a side street where she pulled over, opened her car door and urinated. However, this was not before peeing slightly in her pants. She drove the rest of the drive home in urine soaked pants and ran upstairs when she arrived home to shower and change before anyone would notice. While initially she thought this was a ‘one off’ situation, this continued to occur more regularly and in different situations. Janet thought she was just getting old, however, after speaking to her older sister, she found help. Through this, she learned menopause (GSM) was contributing to her bladder issues. She started to do her Kegels routinely, take vaginal estrogen and visit her pelvic physiotherapist routinely.
Pelvic Floor Exercises: Regular exercises to strengthen pelvic floor muscles and help improve bladder control. Called Kegels, these specific exercise techniques are a series of contracting and relaxing pelvic muscles. The simplest thing to do is first become aware of these muscles by focusing on contracting them while peeing and stopping your flow of pee, hold for a few seconds before releasing. Another trick is to pretend you are tightening our vagina around a tampon. You can also try to contract as though picking up a blueberry with your vagina, relax as though setting it back down. Completely relax before the next rep. Aim to do this 10 to 12 times. If there is no improvement in symptoms, or if there is worsening of symptoms, see a health care practitioner who can assess PFM strength/status. It is common for muscles to be too tense (like having tense neck muscles), and strength work may aggravate this or be ineffective. There are numerous free sources for Kegel exercises on line. If you are struggling, a pelvic floor physiotherapist can assist you. Check out our podcast with Angelique Bresolin from Proactive Pelvic Health to learn more!
Technology: Utilizing technologies like biofeedback, electrical stimulation machines, and vaginal weights under the guidance of a specialist can be helpful for motivation, tracking and improving your pelvic floor contraction IF you are weak. If symptoms are occurring because your muscles are too tense, this may be unhelpful and bothersome. There are companies creating at home machines. Elvie Trainer for example provides an at home stimulator with an app that includes short workouts at a cost of $199.
Bladder Retraining: Gradually increasing the time between bathroom visits to improve bladder capacity and creating a schedule to create a mind and body connection. You can then begin to train to delay the time between restroom breaks.
Journal & Record: If you are getting up in the night several times to pee, stop drinking fluids at least four hours before going to bed. Jot down triggers as some foods and drinks act as diuretics or irritants which increase your need to urinate. Some common items include: dairy products, acidic or spicy foods, caffeine products like coffee, chocolate, energy drinks and soda, as well as alcohol and citrus drinks.
Medical Treatments: Antibiotics can be used for infections, however, recurring and prolonged antibiotic use can lead to antibiotic resistance and major health risks related to this. Vaginal estrogen (or DHEA) has the strongest evidence for GSM.
Bowel Maintenance: Hydration, fiber-rich diet, and recognizing normal bowel habits using the Bristol Stool Chart. Consider adding flax seed such as Bob’s Red Mill flax products as well as examining your magnesium intake.
Vaginal Dryness Treatment: Vaginal estrogen application in various forms, prescribed by a healthcare professional. There are also additional products that can promote moisture and ease discomfort. Vella Bioscience for example has an excellent Intimate Elixir. Other companies such as KINDRA, FemmeSense, Pleasure Pod, and Honey Pot have created vaginal moisturizer products that help. Check out our blog on lubricants and moisturizers to learn more.
Think About Your Shoes: If you think about your shoes, it creates urgency suppression. This technique of thinking of things unrelated to your bladder and need to pee reduces the urge to pee. You can focus your mind on anything (it does not have to be your shoes) and also try taking deep calm breaths.
Breathwork & mobility: Symptoms like frequency and urgency are common symptoms associated with too much tension in the pelvic floor. Diaphragmatic breathing, meditation, and gentle yoga stretches can be a helpful place to start.
Pelvic Floor Physiotherapist: A physiotherapist specializing in the pelvic floor can be invaluable for those having issues or even proactively to confirm the health of your pelvic area.
Pelvic Health Tips:
Maintain a Healthy Weight: A healthy weight can minimize bladder, bowel, and pelvic floor issues.
Quit Smoking: Smoking cessation can contribute to overall pelvic health.
Balanced Diet: Consume a diet rich in vegetables and fiber.
Self-Care: Allocate time for personal well-being to manage overactive bladder symptoms.
Choose Appropriate Exercises: Opt for pelvic-friendly exercises like yoga or Pilates, avoiding activities that strain pelvic floor muscles.
Remember, your pelvic floor health significantly influences your quality of life. Proactive action can reduce health risk factors later down the road. If you are having issues, it is not ‘just aging’ there are things that can be done! With appropriate management, many symptoms can be improved or effectively addressed during menopause.
Book an appointment with a pelvic health physiotherapist or nurse practitioner at PAUZ today!
Register for our newsletter and information at Join PAUZ.