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Why Has Menopause Made My Incontinence Worse?

Kim Vopni January 2023

Pelvic Floor: Kim Vopni

Incontinence is the involuntary loss of urine and it can interfere with so many aspects of our life. 

As we approach and move beyond menopause, symptoms often get worse and what was a once just a gentle bother is now a much bigger issue.

“It is common but not normal and incontinence is treatable.”

What Is Incontinence?

When urine comes out of your body when you don’t want it to that is considered incontinence. Stress urinary incontinence occurs when urine leaks our after exertion like a laugh or cough or jump. Urge incontinence is when we have a sudden urge to pee. Then can’t make it to the bathroom in time. Some people may experience both types which is called Mixed Incontinence.

Isn’t Incontinence Normal As We Age?

It is common but not normal and incontinence is treatable. The pad companies don’t want us to know that. And instead tell us messages that ‘light bladder leakage (which is incontinence by the way) is just part of being a woman’.

There are many factors that contribute to incontinence developing. Pregnancy and childbirth are known risk factors as is chronic heavy lifting, obesity, constipation, and chronic coughing. There are also hormonal influences which correlate with the drop in estrogen that we see during the days before our period, while breastfeeding, and as we approach menopause. Muscle loss and collagen loss also play a role in the onset or worsening of incontinence.

Why Does Menopause Make Incontinence Worse?

As we lose estrogen the tissues in and around our bladder and pelvis become thinner and drier. Along with muscle loss and collagen loss, the tissues become less resilient and robust. Worsening symptoms can be a combination of age, stress, habits, health, and hormone status.  

Can Incontinence Be Fixed?

Yes! Incontinence is very treatable and it is never too late to address it. It is important to determine what the root causes are. Seeing a pelvic floor physical therapist is a great first step. They will do a thorough evaluation of your pelvic floor muscles and help you understand what may be causing your urine leaks.

“Constipation is a risk factor for pelvic floor dysfunction..”

Scar tissue from childbirth is one aspect they will look for. Adhesions from tears or episiotomies can interfere with muscle function and once it is mobilized it can make a world of difference. Your pelvic floor physical therapist will also look at your posture and your breathing which are key factors in allowing for optimal pelvic floor function.

Pelvic Floor Muscles:

We need the pelvic floor muscles to react at the right time with the right amount of force for the activity at hand. Things like scar tissue, poor pelvic position, overactive muscles, and laxity can all interfere with the timing and the force potential. It is also important to look at diet and remove any bladder irritants.

Drinking adequate water (2-3 liters/day) is essential for bladder health as well as bowel health. Constipation is a risk factor for pelvic floor dysfunction and can also irritate the bladder and create sense of urgency.

Should I Do Kegels?

People with incontinence are often told to do kegels and find that they don’t work so they give up. We have loads of evidence about the effectiveness of kegels but the challenge is we don’t have loads of people being taught how to do them correctly.

Kegels are a voluntary activation and relaxation of the pelvic floor. Most people think of them as just a ‘squeeze’ and end up using their inner thighs or glutes instead of their pelvic floor. A pelvic floor physical therapist can help you learn how to do kegels correctly.

No Pelvic Floor Therapist?

If you don’t have one near you, you can search for videos called The Core Breath which will provide imagery and visualization cues that will help. Research suggests that we need to do three sets of 10, ten second holds, thre times a day. While this is evidence based, most people have trouble committing to this program.

Instead, I recommend adding kegels (the core breath) to movements such as bridges, squats, lunges, and push ups to train the pelvic floor dynamically. Adding kegels to movement helps retrain the reaction time of the pelvic floor as well as builds strength and endurance. Once you have become comfortable with adding the core breath to movement, you can then start to add resistance which is good not only for the pelvic floor but also helps stave off muscle loss and keeps our bones strong too!

“Consistency is key not only in fixing the problem but also in keeping it away.”

How Long Does It Take To Fix It?

When kegels are done correctly and consistently (and especially when they are added to movement) change can happen in as little as two to four weeks.

Consistency is key not only in fixing the problem but also in keeping it away. Kegels are not a quick fix but rather a lifestyle. But once you are adding them into movement, they become just part of your daily workout routine.  

Are Kegels Enough?

A dynamic kegel practice is essential as well as tissue support in the way of vaginal moisturizer and vaginal estrogen. As we approach and move beyond menopause, we no longer have circulating estrogen. Our pelvic floor loves estrogen and really misses it when it is gone.

Local vaginal estrogen can be inserted into the vagina and works locally to keep the tissues resilient. Some notice improvements with vaginal estrogen alone but I still recommend a kegel practice to keep the muscles working optimally. Vaginal moisturizer is also a great way to support the health of our vaginal tissues.

Risk Of UTI:

Look for one that has hyaluronic acid as the main ingredient. Vaginal moisturizer and estrogen will help keep the vaginal ph balanced and reduce the risk of UTI’s as well.  

Incontinence is not a normal part of aging and you do not need to accept pads as your destiny. See a pelvic floor physical therapist, do your pelvic floor exercises, and keep your tissues supported for life!

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Kim Vopni

About the Author:

Kim Vopni is a self professed pelvic health evangelist and is known as The Vagina Coach. She has a BA in Psychology and a postgraduate certificate in Health and Fitness. She is a certified fitness professional who became passionate about spreading information on pelvic health when she was pregnant with her first child. 

Kim is the founder of Pelvienne Wellness Inc – a company offering pelvic health programs products and coaching for women in pregnancy, motherhood and menopause. She is also the creator of the Ab System – a revolutionary birth prep and recovery system for pregnant women.  Kim certifies other fitness and movement professionals to work with women with core and pelvic floor challenges through her Core Confidence Specialist Certification and Pre/Postnatal Fitness Specialist Certification. You can find her on-line at www.vaginacoach.com and on social media @vaginacoach