Getting to bladder confidence

Managing your menopause symptoms might feel more manageable when you’re comfortable speaking up about them — but we understand if you’re feeling nervous or even embarrassed sharing experiences like having frequent bathroom trips or incontinence. We’re here to help support you on this journey toward confidently managing your symptoms.  

Staying social and having community can help you manage stress and feel more supported during menopause — but it’s understandable if you occasionally worry about needing the toilet, especially outdoors. We hope we could help reassure you that your experiences are treatable, manageable, and needn’t disrupt your day-to-day routine or habits. With our content, we’re aiming to provide a safe space for women who are navigating their hormonal health and want to learn more. 

Curious about women’s hormonal health in general? You could consider exploring other deep dives into the different symptoms of menopause — including how it affects your skin and how a simple skincare routine can be an empowering act of self-care.

Menopause & Bladder Issues: What Is Happening Inside My Body?

When you’re in menopause, here are some common bladder-related difficulties you might experience:  

• Involuntary urine leakage when you’re laughing, coughing, or lifting something heavy (called stress incontinence)  
• More frequent urinary tract infections
• An overactive bladder (or needing to go more urgently and frequently to the bathroom), with or without leakage (also called urge incontinence)
• Not being able to fully empty your bladder, which may be from bladder prolapse
• Symptoms of mixed incontinence, or a combination of stress and urge incontinence
• Increased nighttime urination.  

Women often relate bladder changes as a normal part of ageing. While bladder changes may be typical, they are not inevitable and can be tackled, leading to better urinary tract health and quality of life. A few of the variables that may affect urinary changes in menopause include:  

1. Changing hormone levels: including oestrogen, which gradually decreases after menopause and affects the tissues of the vagina, vulva, and urethra.  As these tissues thin and have less lubrication, urinary tract infections become more common, along with vaginal dryness.  This might also cause you to experience sexual difficulties during your menopause years. Decreasing oestrogen levels may also cause night time hot flushes, frequent awakenings, and nighttime bathroom trips. 
2. Changing pelvic floor muscles: as your body matures, you might experience your pelvic muscles ‘relaxing’ over time or growing weaker. This may be accentuated by a history of childbirth (even by caesarean delivery), chronic constipation, high-impact exercise, and being overweight. As the connective tissue loosens and the muscles lose tone, the support of the pelvic floor decreases which can cause herniations of the bladder and rectum into the vagina, and prolapse of the pelvic organs. Clinical symptoms of this may include stress incontinence, mixed incontinence, feeling pelvic pressure, feeling a ‘bulge’, and having to place a finger in the vagina to successfully defecate.   
3. Being above the healthy weight range for your height, especially if you carry a bit more of your weight around your abdomen, since it might place more pressure on your bladder.  
4. The side effects of certain medications: like diuretics, which increase urination. 

Here’s the good news: genital and urinary symptoms during menopause are both common and treatable — so let’s explore how women in this phase of life are dealing with them and how it can affect your day-to-day and long-term health.   

What does it mean for me?

Urinary difficulties affect around 50% of women in menopause; some studies have even found that:  

Urinary incontinence affects women twice as often as men 

30-40% of women between 40-65 experience urinary incontinence 

Stress incontinence may be correlated with a weak pelvic floor and/or bladder support, as well as anatomic changes, weight, and high-impact exercise. Strengthening and coordinating the pelvic floor musculature with a menopause-friendly exercise routine is a great way to support normal function. If symptoms persist, you may consider pelvic floor physical therapy and an evaluation with a gynaecologist or urogynaecologist. 

On a day-to-day basis, experiencing frequent trips to the loo can understandably make you feel nervous or anxious before, say, leaving home or taking part in social activities — which in turn might negatively impact your overall life quality and satisfaction. We cover more on how you can manage the stress from these experiences through self-care methods in a later section of article. 

Urinary difficulties might also combine with other menopause symptoms. For example:  

• Frequent nighttime toilet trips can result in you not getting enough sleep, which can lead to fatigue and excessive daytime tiredness.  
• This lack of sleep can negatively impact your mental health and make you more likely to experience depression, stress, and/or anxiety. 
• Decreased vaginal moisture with time might lead to pain during sex 
• Thinning of the genital tissues may lead to increased frequency of urinary tract infections 
• But like other (peri)menopause symptoms, taking a few practical steps can go a long way. Let’s explore what might work best for you.