Menopause Matters: Kate Wells
Urinary urgency and incontinence can be a real problem for women in midlife and beyond.
Once upon a time, standing in a visitor center in the Olympic National Park I was startled when a 60ish woman burst through the door and asked desperately for the bathroom. In my mid 40’s at the time I had no concept of urinary urgency. Fifteen years later however, it’s another story.
Urinary Urgency:
Urinary incontinence (UI) is an important social problem that affects more than 50% of postmenopausal women [1] and its effects are far reaching. Urinary incontinence negatively affects many aspects of life, significantly reducing the daily functioning associated with work, physical activity, or intimacy, and can contribute to placement in long term care.
” Urinary incontinence negatively affects many aspects of life…“
Irritation And Discomfort:
The loss of hormones, particularly estrogen contributes to an increase in urinary urgency and incontinence incidents. From surprise sneeze or activity incontinence, to increased frequency and increased urgency, and trip planning around bathroom locations. For a woman used to having complete control of her bladder, these changes are a shock. There can also be an increase in urinary tract infections (UTI’s) and or intractable interstitial cystitis – irritation and discomfort that just doesn’t go away.
There are receptors for estrogen in the skin that lines the urethra – the tube from the bladder to the outside world. It’s a little hard to imagine the inside of your urethra – but it’s there, and without estrogen it doesn’t hold together well. As this skin gets thinner and develops microtears irritation infection can occur more frequently. The loss of estrogen definitely contributes to increased UTI’s, and to general irritation often known as interstitial cystitis.
Physical Changes:
There are physical changes too. Collagen is necessary for muscle and ligament strength. As time passes, we make less collagen. The pelvic area has a basket of muscles and ligaments which hold the pelvic organs in place. The uterus, ovaries, bladder, vagina, lower intestines, all rely on this basket.
For some women, the base of the bladder can fall below the muscles at the bladder neck, allowing urine to pool even after emptying. This can result in two situations – first, any bacteria which may inhabit the bladder will be concentrated in the small pool and replicate – a pathway to another UTI. Second, any movement can swirl that small pool of urine over the neck of the bladder and down the urethra – and there is the source of the leak!
” As time passes, we make less collagen.”
The pelvic floor muscles can be affected by the number and duration of baby deliveries. Damage from pregnancy and then pushing can go un-noticed. Even though many women are advised to exercise after a delivery – so many of us struggled to shower once a week let alone remember to do pelvic exercises.
So What Is To Be Done?
There are several things you can do to keep yourself out of the incontinence products aisle.
1. Pelvic Floor Exercise:
First and foremost is pelvic floor exercise, and not just Kegels. The whole basket of muscles and ligaments that holds your organs in place needs to be in good shape. Pelvic floor muscle exercise has been found to be effective in all types of urinary incontinence. [2] There are now apps and plenty of online resources to learn what exercises to do. Forgive the pun but this really is a situation of use it or lose it!
2. Physical Steps:
There are other physical steps you can take, particularly phased emptying. When the muscles are strong – that toilet trip takes 30-45 seconds and then you are done. This changes as the muscles weaken, so take your time while sitting on the pot. Allow your body to release the first wave of urine, but then wait, give your body another minute or two to release a second wave. Then finally, while still sitting, tip your upper body forward so you are physically lifting the base of the bladder up over the bladder outlet – making sure you empty completely.
3. Estriol Cream:
Consider using some estriol cream. Estriol is the weakest of the estrogens but acts very effectively on the estrogen receptors along the urethra and in the muscles as the bladder neck. A small, continual supply of estriol will help with skin and muscle strength which reduces stress incontinence. [3] Estriol use can also reduce the chances of developing a UTI or generalized irritation. Your body naturally wants to heal and repair itself – estriol is a tool which empowers that healing process.
“Sugar is an inflammatory agent plus anyone with diabetes is at risk for nerve damage..“
4. Cut Down On Carbohydrates:
Cutting down on carbohydrates of all sorts. Sugar is an inflammatory agent plus anyone with diabetes is at risk for nerve damage – including the nerves involved in bladder control. This will help mitigate urinary urgency and incontinence.
Stress Urinary Urgency And Incontinence:
Incontinence is far from a sexy health topic – but because it affects so many women, it’s important that we talk about it. Hopefully this article helps you – and more important, other women you know – feel hope that they can find a solution to the oops!
- Barnaś E, Barańska E, Gawlik B, Zych B. Factors most significantly affecting quality of life in women with urinary incontinence. HYGEIA Public Health. 2015;50:643–648.
- Sung Tae Cho, Khae Hawn Kim. Pelvic floor muscle exercise and training for coping with urinary incontinence. J Exerc Rehabil. 2021 Dec; 17(6): 379–387.
- Nevine I. D. te West, Katie Harris, Steven Jeffrey, Iris de Nie, Katrina Parkin, Jan-Paul Roovers, Kate H. Moore. The effect of 12 weeks of estriol cream on stress urinary incontinence post-menopause: A prospective multinational observational study. Neurourology and Urodynamics Volume 42, 4 Apr 2023, 699-889
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About the Author:
Kate Wells is a hormone expert and true biochem nerd who has been educating practitioners about hormones for many years. Starting out as a High School science teacher, and then pivoting to the business world, Kate new she wanted to combine her passions for science and business and found the perfect match in leadership roles at labs specializing in hormone testing and hormone formulation.
She currently runs her own bioidentical hormone product companies where she writes educational articles and continues to educate practitioners on the role of hormones in optimal longevity. Beyond nerding-out on the latest research, Kate is an avid hiker, regularly putting in 20-mile hikes in the beautiful wilds of Colorado, loves to build stuff, swing dance, and work with fabric to make colorful quilts. Kate is the author of A Forecast for Health and is the CEO and co-founder of Parlor Games LLC. Kate holds a BS, MBA, and has completed a Fellowship in Herbal Medicine.
