Preventing menopausal incontinence; or, how not to wet our pants

I remember the exact moment I peed my pants for the first time as an adult. I was actually walking towards the bathroom, when I sneezed and felt a distinct release of liquid ‘down there’. I stopped in shock and wondered why I was starting my period so early. Imagine my horror discovering it wasn’t my period, but a release of urine.

I had officially experienced incontinence associated with perimenopause.

What is incontinence?

Incontinence is an involuntary loss of urine in the form of some drips, leak or full out gush. It can also be the need to continually go to the bathroom, or the feeling of always having a full bladder.

How is the body supposed to function?

The bladder collects urine produced by the body, and the pelvic muscles and sphincter keep it all in until the bladder is full. The bladder then sends a signal to the brain that it is time to pee. The pelvic muscles remain contracted until you sit down and relax the muscles.

What goes wrong in menopause?

During peri-menopause and menopause our estrogen levels drop. Estrogen is responsible for keeping the urinary tract and bladder lining healthy. It also helps the pelvic muscles stay strong by increasing blood flow to the pelvic region.

When estrogen drops, the pelvic muscles weaken and the opening to the bladder doesn’t stay closed. And out comes the urine.

Are there types of incontinence?

There are four types of incontinence:

• stress – sudden pressure from the abdomen on the bladder due to a sneeze, cough, laugh, or high impact exercise;
• urge – the sudden and unexpected need to go to the bathroom;
• mixed – experiencing both stress and urge types;
• overflow – leakage because the bladder doesn’t empty properly.

Are you doomed to adult diapers?

No, incontinence can be significantly reduced or eliminated by doing the following:

• limit caffeine – it is a diuretic and causes more frequent urination;
• drink lots of water – to flush out any bacteria build up in the bladder;
• eat lots of fruits, veggies and whole grains – to keep your hormones balanced;
• Kegel exercises – to strengthen the pelvic muscles;
• bladder retraining – delaying going to the bathroom so that the bladder holds more urine;
• maintaining a healthy weight – to reduce pressure on bladder and muscles.

You can also consider the following:

• pessary – a device used to hold the pelvis up off of the bladder;
• cones & balls – to train the pelvic muscles to contract properly;
• bladder swings – surgically implanted to support the bladder;
• electrical stimulation – to train the pelvic muscles to contract.

Are there other factors contributing to incontinence?

While wetting our pants certainly seems rather embarrassing at our age, we shouldn’t be afraid to discuss the problem with our doctor. Forty percent of menopausal women experience incontinence, so we certainly aren’t alone. We need to rule out other causes, such as:

• bladder infections;
• constipation;
• medications;
• abnormalities with the urinary tract;
• neurological disorders.

I am trying to incorporate Kegel exercises into my daily routine. Just like any other exercise, it’s hard to make a habit of it. But the impact of not doing these particular exercises is rather obvious, and being able to laugh in public without peeing my pants is a great motivator.

Silver & Grace Approved Books

Looking for resources on menopause? The following books have the Silver & Grace Seal of Approval as excellent resources for women. They are available through Amazon.

Menopause for Dummies
Shmirshky: the pursuit of hormone happiness
The Hormone Survival Guide

For other Silver & Grace approved books check out Eliza’s Recommendations.