Menopause & Urinary Dysfunction

Menopause is an inevitable part of a woman’s life.  It occurs between the ages of 45 and 55, and marks the end of the reproductive phase. The progressive decline in ovarian activity causes an array of unpleasant symptoms such as hot flushes, mood swings and irritability.  At this time in a woman’s life she may also notice increased difficulty with bladder control.  What most people do not realize is that menopause has a direct influence on the genitourinary system, thus being responsible for symptoms of urinary incontinence, urgency and dyspareunia (pain with sex).  So, we cannot completely blame obstetric injury during childbirth for the cause of such symptoms!!

The following genitourinary symptoms are often experienced by women who are in menopause or are post-menopausal:

–       Inability to hold urine and having to ‘rush’ to the toilet.

–       Leaking of urine on the way to the toilet (urge urinary incontinence).

–       Leaking of urine with a cough, sneeze, laugh or with exercise (stress urinary incontinence).

–       Getting up frequently at night to urinate.

–       A weak or intermittent urinary stream, or hesitation with voiding.

–       Feeling as though you cannot fully empty your bladder.

–       Vaginal dryness and itchiness.

–       Pain with sexual intercourse.

–       Increased urinary tract infections.

But why?

These urinary and vaginal symptoms arise for the following reasons:

1)    Reduced Oestrogen: Menopause causes an imbalance in hormones, and more specifically the reduction in oestrogen. This characteristically results in urogenital atrophy, more commonly known as the loss of muscle mass and deterioration of the vagina and urinary tract. The lack of oestrogen affects the bladder’s ability to hold urine, and compromises the urethra’s (the tube that carries urine out of the body) ability to remain shut until it is time to wee.  As such urinary incontinence occurs.  Furthermore decreased oestrogen also causes; thinning of the lining of the vagina, altered acidity of the vulva and vagina thus increasing likelihood of vaginal dryness, discomfort with sexual intercourse and vaginal infection by bacteria or yeast overgrowth.

2)    General Aging: Of course there is also the impact of general age-related changes that influence the genitourinary system.  These include reduced blood circulation, insufficient stimulation of nerve receptors, and general tissue deterioration, among other person-specific chronic conditions that may predispose someone to worse symptoms. However, more specific to the bladder is a decrease in collagen fibres within the body. This causes a less elastic bladder which has difficulty stretching as it fills with urine, resulting in an irritated bladder muscle that makes you have more urgency and need to wee more frequently.  And so starts a cycle of overactive bladder, and less-than ideal habits of excessive urination.

3)    Pelvic Organ Prolapse: The bladder, vagina/uterus & bowel make up the pelvic organs.  If one or more of these organs drops down into the vagina cavity, due to deterioration in connective tissue or pelvic floor muscles, this can trigger urinary symptoms in menopausal women.  A pelvic organ prolapse may only be symptomatic once reaching menopause, and may have been caused by a traumatic vaginal child birth many years prior.

4)    Weak pelvic floor muscles: The pelvic floor muscle complex does not walk away completely unscathed during the menopausal stage of life.  As mentioned earlier, the onset of menopause (and general aging) tends to weaken most muscles of the body; the pelvic floor included.  As the pelvic floor muscles help control the bladder, bowels and support the vagina/uterus, any weakness in these muscles can ensue: more frequent urge to urinate, urinary incontinence and pelvic organ prolapse.

As described here, these symptoms related to menopause are very distressing and can have a negative impact on a woman’s work, social life, sexual and personal relationships.  The good news is, these symptoms can be treated and managed often conservatively.

A good place to start is to see our Physiotherapist, Chloe, who has specific training in women’s health, pelvic floor and urinary incontinence physiotherapy.  She will be able to assess your condition and give you the appropriate management to help retrain your bladder, pelvic floor muscles, manage prolapse and restore your quality of life!  Call and arrange an appointment with Chloe for further assistance.

About the Author:

Chloe Medwin is a Physiotherapist at Physiotas on the North West Coast.

Chloe completed a Bachelor of Health Science and a Masters of Physiotherapy Practice at La Trobe University’s Melbourne Campus in 2016 and started working at Physiotas in early 2017. Chloe enjoys the diversity of ages and conditions that private practice physiotherapy offers. She has a specific interest in women’s health, especially pregnancy and post-natal physiotherapy.

A self-confessed ‘foodie’, Chloe likes to visit local cafes and bake desserts in her spare time. She also likes to keep active by regularly participating in Clinical Pilates.