Menopause and incontinence

Menopause is a natural stage of life that brings many changes. For some women*, this includes changes in bladder and bowel control, which can lead to incontinence. Incontinence is common and manageable, and support is available.

With early support from a continence health professional, many women find solutions that improve symptoms, restore confidence and support their quality of life.

* References to ‘women’ or ‘men’ include anyone with similar health needs, regardless of sex at birth or gender identity. Read our Gender inclusivity statement.

How menopause affects continence

It can be helpful to understand what is happening in the body during menopause.

Weaker pelvic floor muscles

The pelvic floor muscles help prevent the loss of urine (wee) from the bladder and faeces (poo) from the bowel. During menopause these muscles may weaken. This can lead to:

• a strong need to go to the toilet
• finding it hard to hold on and reach the toilet in time
• finding it hard to control passing wind or gas
• more chance of pelvic organ prolapse.

For many women, pelvic floor exercises can help make these muscles stronger and improve control.

Please check with a nurse continence specialist or pelvic health physiotherapist to make sure these exercises are right for you. If your pelvic floor muscles are too tight, these specialists can provide advice to help manage symptoms.

Less bladder elasticity

Bladder elasticity is how well the bladder muscle can stretch to hold urine (wee) and then tighten to let it out.

As people grow older, the bladder may become less elastic. This can cause it to feel full sooner and trigger the need to pass urine more often. We call this an ‘overactive bladder’. Together with weaker pelvic floor muscles, it may be harder to delay going to the toilet.

Bladder training and pelvic floor exercises can help. For some women, vaginal oestrogen cream or vaginal ‘tablets’ may also help – your doctor can tell you more about these.

Vaginal dryness

Lower oestrogen levels can cause a dry vagina, which may make sex uncomfortable. Lower oestrogen is also linked with symptoms such as:

• burning when passing urine (wee)
• needing to pass urine (wee) frequently.

The risk of urinary tract infection may be increased. Support options include vaginal oestrogen (cream or tablets), but it is also important to check for a bladder or urinary tract infection. Your GP (doctor) can help with this.

Other factors that may affect continence

• Putting on weight: Extra weight around the tummy can place more pressure on pelvic floor muscles. Losing weight and doing pelvic floor exercises to make the pelvic muscles stronger can help reduce leakage.
• Other health conditions: Health conditions such as diabetes may affect the way the nerves send and receive messages to the bladder to manage bladder control (to prevent leaking urine, or wee). Managing health conditions can help prevent symptoms.
• Birth injuries: Some women may experience incontinence later in life due to injuries from childbirth. Exercises or surgery may help. It is important to seek early advice from a nurse continence specialist or pelvic health physiotherapist to support recovery and long-term pelvic floor health.

Common continence symptoms during menopause

Common symptoms include:

• needing to pass urine (wee) often or urgently
• leaking urine (wee) on the way to the toilet
• leaking urine (wee) when you cough, sneeze, laugh, lift or exercise
• getting up more than once at night to pass urine (wee). This is called nocturia
• frequent urinary tract infections
• pelvic pain
• finding it hard to control passing faeces (poo) or flatus (wind)
• constipation.

These symptoms are common and can be treated to improve health and wellbeing.

Support before and during menopause

Support is available to help you manage the changes of menopause.

• Seek early help for incontinence through a nurse continence specialist, pelvic health physiotherapist or GP (doctor).
• Strengthen pelvic floor muscles before menopause to reduce the risk of incontinence or prolapse
• Maintain a healthy weight to reduce pressure on the pelvic organs
• Eat a high fibre diet to help prevent constipation.

If you’re not satisfied with the advice from your health professional, you have the option to seek a second opinion from another qualified health professional.

What you can do next

• Learn about pelvic floor exercises
• Read the 5 healthy habits to help prevent incontinence

This content has been reviewed by sub­ject mat­ter experts in line with Continence Health Australia’s established process. Read about our clinical content review protocol.