Living with Stress Urinary Incontinence During Menopause

by Jennifer Upton

Life during the perimenopause and menopause years shouldn’t mean a person has to slow down.

One only has to look at the mosh pit at a Foo Fighters concert to know that women over 40 rock the house.

But for women who suffer from stress incontinence, dancing in the front row for hours is a difficult prospect.

What is Stress Urinary Incontinence (SUI)

Although it is thought to occur mainly in women who have given birth, Stress Urinary Incontinence (SUI) can happen to anyone, making it the most common but less severe of several types of urinary incontinence.

With SUI, urine leakage occurs when pressure is placed upon the abdomen causing stress to the bladder when someone

  • Coughs
  • Sneezes
  • Lifts or carries heavy objects
  • Dances
  • Laughs

It can also happen during certain forms of exercise such as jogging or aerobics.

How Menopause Contributes

Menopause may impact many urinary symptoms which fall under a broader category of symptoms collectively known as Genitourinary Syndrome of Menopause or GSM.

Genitourinary Syndrome of Menopause can include

  • Stress Urinary Incontinence,
  • urgency and urge urinary incontinence,
  • increased infections and
  • voiding issues.

Reduced levels of estrogen and other hormonal changes that impact the muscle strength in our pelvic area can cause weak bladder control.

But hormones are not the only factors at play.

Others include:

  • Being overweight
  • Interstitial Cystitis - a chronic condition where the lining of the bladder is thinner and weaker than usual leading to regular urinary infections
  • Nicotine consumption
  • Some medications
  • Drinking alcoholic and/or caffeinated beverages, which fill the bladder causing the need to urinate more often.

What’s it like to live with Stress Urinary Incontinence (SUI)?

The stories of living with SUI are many and varied including a 45-year-old punk singer with SUI who reported a chain of events that highlights the sometimes-humorous nature of SUI.

“I was at one of our gigs watching the opening band. Someone broke wind in the crowd. It was so stinky it made me cough and then pee onto my boot 10 minutes before I had to get on stage. Fortunately, I didn’t get any urine on my blue chiffon dress.”

Not all stories are humorous.

Many women with Stress Urinary Incontinence have other health conditions such allergies or asthma. Conditions that come with sneezing, wheezing and coughing.

Keeping these symptoms under control is paramount to staying ahead in the constant race to the restroom.

Many don’t make it on time, leaving embarrassing wet spots on their clothes.

Meticulous planning around the location of a toilet becomes an everyday part of life as does the scheduling of beverage consumption.

It’s a delicate balancing act between proper hydration and leakage.

Dealing with Stress Urinary Incontinence (SUI)

The first step to dealing with SUI is to get a proper diagnosis.

Many women suffer for years in silence.

It’s important to find the right doctor and get an accurate diagnosis.

There are many options for Stress Urinary Incontinence (SUI) sufferers.

The first step on the path to an improved life with SUI is to use incontinence products to deal with leaks.

The prices start from $1.99 and up and include absorbent pads and absorbent, washable or disposable pants which all come in a variety of shapes, sizes and thicknesses.

Some opt to carry a portable female urinal while others choose to insert a tampon-like device called a urethral insert or urine plug prior to activities likely to cause leakage.

Each individual should consider which product is most likely to be suitable for them and choose the one most suitable for their lifestyle.

Having some time to practice using the chosen product before it is required (SUI sometimes comes and goes) will boost confidence even further.

Some producers provide a beginning pack so that customers can try the product.

Other non-surgical options require lifestyle changes.

  • Engage in daily pelvic floor strengthening exercises such as kegels or yoga
  • Yoga–there are several poses in different disciplines that will strengthen the pelvic floor muscles
  • Quit smoking
  • Quit or cut back on caffeine and/or alcoholic beverages (sigh)
  • Lose weight
  • Avoid lifting, carrying or pushing heavy objects
  • Replace activities like jogging and aerobics with swimming or Pilates
  • Keep your bowels regular – eat plenty of fiber and drink plenty of water
  • Treat episodes of constipation immediately

If you have Interstitial Cystitis, observe an acid-free diet.

No citrus fruits, spicy food, etc.

Find information on what foods may trigger an episode of IC and increase episodes of Stress Urinary Incontinence (SUI) on https://www.ichelp.org/understanding-ic/diet/what-to-eat/

Medications

There are currently no medications available that treat Stress Urinary Incontinence (SUI) either in North America or the UK, but there are several that might treat an overactive bladder.

According to The National Institute of Health Excellence in the UK, Stress Urinary Incontinence accounts for 24% of all cases of urinary incontinence (1.)

In the U.S., one in three women will experience SUI at some point in their life (2.)

With numbers as high as this, it’s clear more funding for research into this area of medicine is desperately needed.

There is ongoing research that shows a variety of results whether HRT will improve, or exacerbate symptoms of SUI.

One paper concludes that “the use of HT regimens may predispose to the de novo development or worsening of pre-existing SUI.”

Another concludes “The majority of studies reported that vaginal estrogen treatment when compared with placebo has more beneficial effects on symptoms and signs of vaginal atrophy including sensation of burning, dyspareunia and UI symptoms.”

Pelvic Floor Physical Therapy

This treatment comprises first receiving an evaluation by a physical therapist with specialized training in pelvic floor physical therapy.

The PT will check the endurance, strength, and motor control of the muscles that support your core.

The PT will then develop a customized treatment plan to assist you in improving your pelvic floor function based on the results of the exam.

Working with you on behavioral strategies like bladder retraining techniques may be part of the therapy plan.

The PT may employ a range of methods including internal massage.

According to Voices for PFD improvements in fecal and/or urine continence may result from specific therapies.

Surgical options

If previous incontinence therapies have failed, doctors may advise surgery to enhance bladder control.

Voices for PFD says experts advise you only think about having surgery for urine incontinence if:

  • The signs of incontinence are annoying.
  • Your medical professional determined you have SUI.
  • The symptoms of incontinence were not alleviated by non-surgical therapy.
  • Surgery is anticipated to have more positive effects than negative ones.

The surgeries available vary from country to country and include:

  • Colposuspension – where the neck of the bladder is lifted and stitched either via keyhole surgery or a cut in the abdomen
  • Sling Surgery–where a sling made of tissue (either donated or harvested from the patient) is placed around the neck of the bladder to help support it

Other options include: Injection of agents which may increase the size of the urethra walls and, sometimes, it may be suggested that you have an artificial urinary sphincter fitted to relieve your incontinence. https://www.nhs.uk/conditions/urinary-incontinence/surgery/

Important Note

In 2018, The UK banned the use of certain types of transvaginal mesh previously used in surgeries to treat SUI.

In October 2022 the FDA followed suit citing poor outcomes. https://utswmed.org/medblog/fda-ban-transvaginal-mesh-what-does-it-mean-women-facing-pelvic-organ-prolapse/

Why Getting Help Matters

When someone’s entire daily schedule revolves around the need to be near a bathroom, it removes a person’s agency and choices for activities.

It’s important to ask for help.

Incontinence is not a normal part of aging.

Part of improving the quality of life depends on asking for help.

Don’t give up on that dream to dance like no one’s watching down front.

Cited Sources

  1. https://cks.nice.org.uk/topics/incontinence-urinary-in-women/background-information/prevalence/

  2. https://www.urologyhealth.org/urology-a-z/s/stress-urinary-incontinence-(sui)
 The information and other content provided in this blog, website or in any linked materials are not intended and should not be considered, or used as a substitute for, medical advice, diagnosis or treatment.

mySysters is an app for women in perimenopause and menopause. Good Housekeeping and Woman’s Day named mySysters the Best App for Women in Perimenopause and a Must Have App for Women

Jennifer Upton is an American (non-werewolf) writer/editor in London. She currently works as a freelance ghostwriter of personal memoirs and writes for several blogs on topics as diverse as film history, punk rock, women’s issues, and international politics. For links to her work, please visit https://www.jennuptonwriter.com or send her a Tweet @Jennxldn