Why does your bladder weaken during menopause?

No woman escapes menopause. After the age of 45, the production of the female hormones estrogen and progesterone decreases and that usually causes complaints. What many women don’t know is that this drop in estrogen also causes changes in your urinary tract. Take the bladder.

Your bladder is a highly elastic hollow organ, like a balloon. It consists mainly of muscle tissue and has to temporarily store the urine until it is full. During urination, the muscles in the wall of your bladder contract and the urine is forced out. The urethra begins at the bottom of the bladder. It is closed by the sphincter and the pelvic floor muscles. As long as you want to hold the urine, the sphincter and pelvic floor muscles must ensure that the exit of the bladder is closed. During urination, the sphincter and pelvic floor muscles must relax so that the urine can flow out easily.

Shrinking mucous membranes

The inside of your bladder is normally very pleated, which helps the pelvic floor muscles and sphincter to hold back urine. Due to the drop in estrogen during the menopause, the mucous membranes shrink and the folds decrease. This can make holding your pee more difficult. In addition, the decrease in estrogen causes a thinner mucous membrane in the bladder, an altered bacterial composition in the bladder barrier and altered bladder contractions. All of these can lead to bladder infections, incontinence and frequent urges to urinate even when the bladder is not full (overactive bladder).

But that’s not all. Your pelvic floor also undergoes changes due to the menopause. As mentioned, your pelvic floor supports your bladder and therefore plays an important role in holding urine. The pelvic floor consists of collagen and muscles, but due to the decrease in estrogen in your body, the amount of collagen in your body decreases. This makes your skin weaker and less elastic, but also your pelvic floor less flexible and your muscles stiffer. This makes it more difficult to tighten your pelvic floor muscles, so that you lose urine more easily.

uterine prolapse

Moreover, the pelvic floor not only supports your bladder, but also your uterus and rectum. If the ligaments and muscles of the pelvic floor are not strong enough, the uterus can sink down, something that happens relatively often during menopause. The cervix then drops into the vagina or even out. The symptoms of a uterine prolapse are a nagging feeling in your lower abdomen and back, a pressure in your vagina (the feeling that something is coming out), problems with defecation and bladder complaints such as loss of urine or recurring bladder infections. Such a uterine prolapse can also cause complaints when sitting, cycling and cause pain during sex.

Such a prolapse also affects the other organs in your pelvis. For example, your bladder can also sag slightly due to the pressure of the shifted uterus and the slack pelvic floor muscles and supporting tissues. This also makes it more difficult to hold your urine and ensures that you can lose small amounts of urine when coughing, sneezing or exercising. This is also known as stress incontinence. Stress incontinence is therefore something that occurs in many women during and after the menopause, but an overactive bladder is also common. In this case, the bladder is out of balance and hypersensitive and as a result you have to urinate often, you often have the feeling that you have to urinate (and almost nothing comes) or you cannot hold your urine. In addition, some women complain that they have to get out very often at night because they have to urinate, something called nocturia.

You lose muscle strength

The menopause cannot be blamed solely for the bladder complaints, because the fact that you simply get older also has an effect on your muscles. You lose muscle strength and mass (sarcopenia in medical terms). This is due to a combination of two factors: older people exercise less and do not get enough protein. Proteins are crucial for maintaining muscle mass. But people who get older often eat less and also absorb proteins less well. Lean, protein-rich products such as cottage cheese, yogurt, chicken meat and fish help your muscles stay in shape. So make sure you eat enough of it. But the best remedy for muscle loss is strength training. And you’re never too old to start doing that. That doesn’t mean you have to hang on to the machines at the gym; Sports such as Pilates are also great for strengthening your muscles.

Any illnesses can also affect the functioning of your bladder. Diseases such as diabetes or multiple sclerosis (MS) can cause nerve damage, resulting in bladder complaints. In addition, there are drugs, such as certain antidepressants and pain medications, that can negatively impact your bladder. If you think this is the case with you, you can discuss with your doctor whether a different dose or other medication can eliminate the symptoms.

What can you do yourself?

You cannot always prevent bladder problems, but there are things you can do yourself to prevent urine loss.

Kegel exercises

Pelvic floor exercises, also known as Kegel exercises, are exercises that train your pelvic floor muscle, invented by gynecologist Arnold Kegel. You can use special balls, so-called pelvic floor trainers†

Watch what you eat and drink

It is tempting to drink less, to limit accidents. But enough fluids are needed to keep the bladder healthy and drinking less can actually make the problem worse. Drink one and a half to two liters of water every day and certainly no less than one liter. Coffee, tea, soft drinks and alcoholic drinks stimulate urine production. This means that your kidneys will produce more fluid to process these drinks and your bladder will be full again faster. Carbon dioxide, alcohol and caffeine also stimulate your bladder, so limit their intake. And energy drinks are not good at all, because they contain many more caffeinated substances that have a stimulating effect on your bladder. Also watch what you eat; some foods are better avoided if you lose urine.

Be careful when you drink

Drink small amounts during the day to prevent your bladder from suddenly having to process a large amount of fluid, which increases the chance of urine loss. Do not drink anything for at least two hours before going to bed. During your sleep you lose fluids. Your urine is therefore more concentrated and that can irritate your bladder. That is why it is smart to drink a glass of water as soon as possible after waking up.

watch your weight

Every extra pound puts extra pressure on your bladder.

What can the doctor do?

If you really suffer from bladder complaints, it is wise to go to the doctor and possibly ask for a referral to the urologist. This person – sometimes together with a dietician, gynaecologist or pelvic physiotherapist – looks at what is a good solution for you for your bladder complaints. In order to determine the form of incontinence and possible cause, they can do several tests:

• Urinalysis
  For this you hand in urine to detect a possible (chronic) bladder infection.
• micturition list
  To gain insight into your drinking and urination behaviour, you must keep a urination diary (micturition list).
• flowmetry
  This is a urological examination that tests the function of the bladder. During the examination you will urinate in a special toilet, the flow meter. This measures the strength of the urine stream and the amount of urine you pass. It is important to know if you are completely emptying your bladder. After urinating, an external ultrasound is made to see how much urine is left in the bladder after urination. This is called an echo residue determination.
• Internal examination
  To examine whether your bladder or uterus has prolapsed, the vagina will be looked at. The function and strength of the pelvic floor and the mobility of the urethra are also examined. This is done by making you cough, blowing on your hand and tensing your pelvic floor.
• Ultrasound
  This involves an ultrasound examination of the uterus and ovaries via the vagina. Enlargement of either can put pressure on the bladder and cause incontinence symptoms.
• Urodynamic research
  The bladder filling and urination are measured simultaneously via a pressure gauge. This examination is performed by the incontinence nurse.
• Cystoscopy
  This involves checking the bladder for abnormalities in the bladder or the bladder mucosa.

Depending on the outcome of these investigations, the next steps are determined. These can be pelvic floor exercises under the supervision of a pelvic floor physiotherapist, but also medication or surgery.