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In addition to hot flashes and mood swings, menopause can also bring changes in the body, including those related to your bladder. Urinary incontinence, or leaking urine that you can’t control, is not the “sexiest” of topics, but it’s one that needs just as much attention since it can bring up some uncomfortable and sometimes embarrassing challenges.

While urinary incontinence is a common problem before menopause, it can get worse as you age. In fact, half of women over the age of 70 have some form of incontinence. And while there are many factors that can contribute to bladder leakage, the hormone changes that happen during menopause can be one of the most significant factors as we age. It's not the most common menopause symptoms, but 12% of females ages 40-65 say they have urinary incontinence.*

What are the different types of urinary incontinence?

There are two types of urinary incontinence that are most often related to menopause:

• Stress incontinence is the involuntary loss of urine during times when there’s increased stress placed on the bladder. This often happens when you do something as simple as laugh, cough, or sneeze. It can also happen when you’re exercising. Stress incontinence happens when the muscles and tissues which help to support the bladder and urethra (your pelvic floor muscles), become weak or undergo excessive pressure, making it more difficult to support your bladder function as well as before. You can think of stress incontinence as a structural issue.
• Urge incontinence is characterized by urinary leakage that occurs as a result of a sudden and strong urge to pee. It’s typically the result of changes in nerve signaling and involuntary over reactivity of the muscles that surround and support the bladder muscles. It’s that urge that you (or a friend) have probably experienced where you’re arriving home, keys in the door, and don’t quite make it to the bathroom on time. You can think of urge incontinence as a functional issue — everything is built correctly but isn’t working the way it should.
• Mixed incontinence. You may have symptoms of both stress and urge incontinence, and this is known as mixed urinary incontinence.

Why does menopause cause incontinence?

Estrogen has many important effects on the urinary system. Estrogen supports the health of the bladder, urethra, pelvic floor muscles, and the tissues in the vaginal wall. It also contributes to the normal function of the muscle surrounding the bladder (detrusor), and the urethra. Estrogen is also very important in facilitating healthy blood flow to the tissues of the urinary system. As estrogen levels drop during the later stages of menopause (after your final period), these muscles and tissues that are important in bladder function can become thinner, less flexible, and as a result weaker, all of which can lead to bladder control issues.

What can I do to improve my menopause bladder issues?

There are things you can do to strengthen your pelvic muscles and control your bladder.

• Pelvic floor exercises. For muscles that are underused or weak, regular pelvic floor exercises, often called Kegels, can help strengthen the pelvic floor muscles that support the bladder and urethra. A Kegel exercise involves relaxing and tightening the pelvic floor muscles. The pelvic floor muscles, which are located between the tailbone and the pubic bone inside of the pelvis, help to control the flow of urine. To help identify them, the next time you pee you can try stopping the flow of urine. However, it is not a good idea to regularly practice Kegels by starting and stopping your urinary flow. Performed regularly, these exercises can be particularly beneficial for stress urinary incontinence. A good place to start is 3 sets of 10 Kegels every day.
• Bladder training. The overall goal of bladder training is to help you regain control by increasing the amount your bladder can hold and the time between visits to the toilet. To train your bladder, you’ll need to repeatedly contract pelvic floor muscles (Kegel) at the time of the urge to pee and hold the contraction for as long as the urge goes away. Practice makes perfect. This change won’t happen overnight, so be patient. And remember, practice makes perfect. These techniques can especially help with urge incontinence.
• Hydrate. While it may seem counterintuitive, staying well hydrated can help reduce bladder irritation. Sip water throughout the day when you feel thirsty. There’s no need to drink excessive amounts.
• Modify your lifestyle. Losing weight or maintaining a healthy weight with a healthy diet and regular exercise can reduce the strain on the pelvic floor muscles and bladder.
• Maintain a healthy diet. Focus on avoiding caffeine, alcohol, spicy foods, and acidic foods as they can irritate your bladder.
• Manage stress. High stress levels can worsen bladder issues. Use relaxation techniques like deep breathing, yoga, and/or meditation to reduce stress.
• Medical interventions. In some cases, medical interventions may be necessary. These can include medications that help with bladder function, local hormone therapy, and surgical procedures to fortify support for the bladder and urethra.
• Seeking professional help. People who are experiencing incontinence should never hesitate to seek medical advice. A healthcare provider can work with you to understand the type and severity of your bladder issue and recommend treatment options. Your gynecologist is a good place to start the discussion. They may refer you to a specialist called a urogynecologist or urologist, if you need more invasive testing or procedures.

Education is a key component of managing urinary incontinence. Talking with healthcare providers, friends, and family members can help break down the stigma you may feel and promote a safe environment for you to navigate this phase of life and feel more in control…of your bladder.

*Data from Attitudes & Usage study conducted in August 2021 with 4,578 female participants ages 40-65. Funded by Kenvue.