How to manage my overactive bladder during perimenopause?

Question

Hello doctor,

I am a 47-year-old woman struggling with an overactive bladder. I am constantly rushing to the bathroom, even at night, which leaves me tired and frustrated. I also have perimenopausal symptoms like irregular periods, mood swings, and vaginal dryness, and I wonder if these hormonal changes are making my bladder problems worse.

Sometimes I even leak a little when I laugh or embarrassingly cough. I am not sure if this is just part of getting older or if I might have something like pelvic floor dysfunction. I have tried cutting back on caffeine and doing pelvic floor exercises, but they have not helped much.

Could my hormones be affecting my bladder control?
What treatments can help with both bladder issues and menopause symptoms?
Are there safe medications or therapies that would not interfere with hormone therapy if I need it?
Should I see a urologist, a gynecologist, or both?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Excessive fluid intake can worsen urinary incontinence (UI). On the other hand, restricting fluids too much may lead to concentrated urine, which can irritate the bladder lining and increase urgency, frequency, and the risk of urinary tract infections (UTIs). Ideally, fluid intake should be about 1500 ml (milliliters) per day or 30 ml per kilogram of body weight in 24 hours.

Research has shown a strong link between smoking and both UI and urinary urgency in women. This connection may be due to the increased intra-abdominal pressure caused by chronic coughing in smokers or due to increased bladder (detrusor) muscle activity triggered by nicotine.

Women who smoke should be educated on the relationship between smoking and UI and should be offered support and strategies to help them quit. A body mass index (BMI) greater than 30 kg/m² (kilograms per square meter) is an independent risk factor for UI in women. Obesity may increase intra-abdominal pressure, placing chronic stress on the pelvic floor and leading to structural damage that causes UI. Weight loss through surgery has been shown to improve UI in women who are morbidly obese. Even moderate weight loss can improve symptoms in overweight women.

Besides the physical strain, neuroendocrine mechanisms may also play a role. Fat tissue (adipose tissue) produces leptin, which can increase activity in the autonomic nervous system, particularly the sympathetic (noradrenergic) nerves. Sympathetic overactivity, seen in some animal models like spontaneously hypertensive rats and in some humans, may contribute to UI.

Pelvic floor muscle training (PFMT) helps maintain urethral closure by strengthening the support provided by the endopelvic fascia and the constant contraction (tone) of the levator ani muscles. When done correctly, PFMT improves the coordination and strength of these muscles, helping restore or maintain continence.

A systematic review of 12 clinical trials involving 672 women found that PFMT significantly improved continence-specific quality of life, reduced the number of incontinence episodes, and decreased leakage measured by pad tests compared to women who did not practice PFMT.

For best results, a specialist physiotherapist and a motivated patient are essential. PFMT can be taught individually or in group sessions. According to a Cochrane review, regular supervision (once a week) for three months, combined with group training, improves success rates, with up to 90% of women reporting improvement.

The National Institute for Health and Care Excellence (NICE) recommends performing eight pelvic floor contractions, three times a day, for at least three months. For women unable to contract their pelvic floor muscles effectively, electrical stimulation and/or biofeedback can be helpful to support motivation and therapy adherence.

In postmenopausal women, low oestrogen levels may contribute to UI. A 2021 Cochrane review that included 34 studies with over 19,000 women (more than 9,000 of whom received local oestrogen) found that local vaginal oestrogen therapy significantly improved symptoms of stress urinary incontinence (SUI) compared to placebo.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.