Hmm menopause…. hot flushes, mood swings, low libido, insomnia, night sweats, but wait there’s more! A lesser-known fact is that overactive bladder (OAB) syndrome is also more likely in postmenopausal women aged 45 to 54 years. This can result in a sudden urgency to sprint to the loo and often!
Like many health conditions, the topic of menopause is often surrounded by a wall of silence. Numerous women experience embarrassment and discomfort around talking about their menopause symptoms and unfortunately don’t seek help for something that is manageable. However, “when women do speak out, they soon discover that other women are going through similar experiences and are often greatly relieved to know they are not alone,” says Janie Thompson, Clinical Services Manager for the Continence Foundation of Australia’s National Continence Helpline (1800 33 66 88).
Common barriers to women seeking help include stigma and shame, a belief that symptoms are a normal part of ageing, cultural and language difficulties, lack of access to trained healthcare providers and lack of knowledge of available treatment options.
Incontinence is experienced by over 55 per cent of postmenopausal women, with rates increasing significantly after 60 years of age. However, it is important to emphasise that incontinence is not a normal consequence of ageing.
Lower urinary tract symptoms (LUTS) are experienced by nearly one in three women and are associated with a significant negative impact on quality of life. LUTS is a broad term which includes urinary urgency, frequency, and lower urinary tract pain, as well as voiding dysfunction. Despite the high prevalence and negative impact of LUTS less than 25 per cent of women seek help.
Janie says that whilst stress urinary incontinence (SUI) is the most common type of incontinence experienced by women, OAB can be more obvious after menopause, and can cause more anxiety because of having the sudden urge to go to the toilet.
“OAB is characterised by urinary urgency or rushing and is usually accompanied by increased daytime frequency or going to the toilet more often and/or nocturia or waking to go to the toilet at night, and you may have urinary incontinence on the way to the toilet. Your bladder wants to empty suddenly without a lot of warning,” says Janie.
By contrast, SUI is the unintentional loss of urine due to effort or physical exertion, including exercising, sneezing, and coughing and your pelvic floor or urethra (bladder tube) are unable to prevent this leakage due to weakness or changes. It is often due to the combination of pregnancy, childbirth, being overweight, straining to use your bowels and having weakened pelvic floor muscles. You can have both these types of incontinence at the same time.
HOW DOES MENOPAUSE IMPACT BLADDER AND BOWEL HEALTH?
During the menopausal transition, oestrogen levels decline dramatically, which may lead to a thinning and weakness in the tissues of the pelvic floor and bladder, which normally depend on a regular and healthy supply. Vaginal dryness, due to reduced oestrogen, can also affect the tissues of the urethra. As such, many women notice changes to their bladder and bowel health, including:
REDUCED BLADDER CAPACITY
As women age, the bladder can start to hold less and not empty as well. As the bladder fills with urine, this loss of bladder flexibility and volume may cause you to go to the toilet more often. Combined with weaker pelvic floor muscles, this makes it much more difficult to hold on or put off going to the toilet.
A WEAKER PELVIC FLOOR
An inevitable consequence of the aging process is loss of muscle mass due to oestrogen and collagen deficiency, and the pelvic floor muscles may become thinner and weaker. This can lead to urinary or faecal incontinence as we use our pelvic floor muscles to help control our bladder and bowel, urine leakage with coughing and sneezing, or urgency and frequency.
Given the abundance of oestrogen receptors in the urogenital tract, it is not surprising this natural reduction of endogenous estrogen can cause or potentiate pelvic floor muscle issues and recurrent urinary tract infections (UTIs).
Oestrogen helps maintain the surface moisture of the vagina and urethra. With less oestrogen in the body, the vagina and urethra (bladder tube) can become drier. This can be painful and irritating, especially with sexual intercourse, increasing the risk of urinary tract infections (UTIs) and incontinence.
Some factors, particularly childbirth and a weaker pelvic floor, mean pelvic organ prolapse (POP) is more likely to occur after menopause. POP occurs when one of the pelvic organs sags and may bulge or protrude into the vagina. There are different types of POP, and it is important to have any prolapse properly assessed. The most common symptoms of POP are the feeling of a lump in the vagina, vaginal heaviness or pressure, difficulty emptying the bladder or bowel and lower back pain. Not surprisingly this can cause embarrassment, anxiety, fear of going out and avoidance of exercise and social situations.
SYMPTOMS FROM CHILDBIRTH
Some women may experience damage to their anal sphincter during birth, but the symptoms might not be obvious until later in life. Faecal incontinence due to this damage most commonly starts in perimenopause, when hormonal changes may lead to the development of symptoms.
RECURRENT URINARY TRACT INFECTIONS AND DYSPAREUNIA
Microbial changes in the vagina associated with menopause include increased vaginal pH as a result of reduced oestrogen levels, which leads to a decrease in the usual lactobacillus dominant vaginal flora seen in premenopausal women. This increases the potential for pathogenic microbes like E. coli and Enterococcus, most commonly associated with UTIs, to populate in the vagina.
SO, WHAT CAN BE DONE?
According to Janie Thompson, improvement can start with making the workplace more conducive to menopausal women’s comfort. “Employers can make sure simple things like good ventilation, regular breaks to help with fatigue and providing toilets that are easily accessible is all in place,” she says.
There are also many treatment options available for menopause and incontinence, and women don’t have to just put up with the symptoms and inconvenience. For incontinence, these may include pelvic floor muscle training, bladder training, vaginal oestrogen cream or an oestrogen pessary, lifestyle changes and surgery. For more information and to speak confidentially to a Nurse Continence Specialist, call the National Continence Helpline on 1800 33 00 66.
The Foundation also has a lifesaving toilet help card available for those who often find themselves caught out and in need of urgent access to a toilet.
Download toilet help business card
Download Menopause Fact Sheet
For more tips on managing menopause in the workplace go to Jean Hailes.
Early menopause means going through menopause before the age of 45. Early menopause can happen after medical treatment such as removal of the ovaries and chemotherapy for cancer.
Perimenopause refers to the years leading up to menopause where there is a drop in female sex hormones, namely oestrogen, which may fluctuate.
Menopause marks the last period or menstrual cycle a woman has.
Usually refers to the time after a woman has gone through menopause; 12 months after her last menstrual period.