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Understanding Menopause and Urinary Tract Infections

How Does Menopause Affect a Woman’s Urinary Tract? 

As women grow older, we may start to notice changes in our vaginas, our ability to enjoy sex, and the way our urinary tract and bladder works. Not only can these changes cause embarrassing leaks, but they can also affect our intimate lives. Menopause and urinary tract infections often go hand-in-hand and are very common as we age – but they don’t need to be.

The good news is that there are safe and simple solutions to help reduce the impact of the changes on our urinary tract and vagina. Winona is here to help you find the answers to these types of questions and many more. 

Menopause and Your Urinary Tract

The hormone imbalances that occur during menopause, particularly the drop in the hormones estrogen and progesterone, can lead to many physical and emotional symptoms. It’s important to understand that all hormones are tiny chemical messengers that interact with each other. If one hormone is too high, another may become too low, and those changes can create a wide variety of symptoms.

There are estrogen and progesterone hormone receptors throughout our bodies. So, when levels of these hormones start to decline sharply during perimenopause, our whole body will be impacted, including the vagina, urinary tract, and bladder. When your body’s estrogen concentrations get back to youthful levels by taking hormone replacement therapy (HRT) you can begin to feel yourself again

As we age, estrogen levels drop and the bladder begins to lose both its volume and elasticity, making frequent bathroom stops your new normal. The vaginal walls are also very sensitive to estrogen levels. As estrogen levels drop, so does the thickness of our vaginal walls and urethra, which is the small tube that carries urine from the bladder out of the body. Thinner urethra walls make it easier for bacteria to access the bladder and urinary tract infections (UTIs) increase. 

So, as we age, the vaginal walls are weaker, the urethra is thinner and the bladder also begins to shrink leaving women more susceptible to incontinence (loss of bladder control) and infections. We know it all too well… peeing a little when we cough, sneeze, exercise, or laugh. Laughing or sneezing puts extra pressure on your bladder, which can cause what’s called “stress incontinence.” It can be partially due to weakened muscles from aging, but decreasing hormones play an important role. Most of the time, leakage is a few drops of urine, but it can become a full loss of control. 

Losing the muscle strength that controls your bladder is not only embarrassing, but it is a medical problem that can be treated. Rather than use adult diapers, there are effective ways to find relief starting with hormone replacement therapy (HRT) and bladder training. Lack of regular physical exercise may also contribute to this condition (1,2).

Managing Bladder Leaks

You may remember having bladder problems when you were pregnant. Women who are pregnant are likely to have urinary incontinence because the muscles are more relaxed and of course, the fetus pressing on the bladder. It usually resolves itself once the baby is born, but with menopause, incontinence only gets worse if not dealt with (1, 2).  To best treat incontinence, it is important to know what type of incontinence you are dealing with. Types of urinary incontinence:

● Stress Incontinence: loss of urine due to physical pressure on the bladder. The most common symptoms are leakage of urine with coughing, laughing, sneezing, or lifting objects. Stress incontinence is common during perimenopause. This type of incontinence is related to a weakening of the pelvic floor muscles. Treatment may include pelvic floor muscle exercises (Kegel exercises), and HRT medication.
● Urgency Incontinence: loss of urine due to an urgent need to urinate, which is caused by overly active or irritated bladder muscles. It is most often caused by damage to the nervous system. If you notice that you have to urinate quickly when you hear water running, you may be experiencing this type of incontinence. Treatment may include medications designed to reduce involuntary contractions in your bladder.
● Transient Incontinence: temporary loss of urine due to medication or a UTI. 
● Overflow incontinence: continuous dribbling related to an obstruction in the urethra.
● Overactive bladder: frequently urinating. While it’s “normal” to urinate 6-8 times daily,  if you are urinating more frequently you should consider getting help.

Why Incontinence with Menopause?

Your bladder sits above your pelvic bones and is supported by your “pelvic floor.” The pelvic floor is less of a floor and more of a ‘sling’ of tendons and muscles that support your internal organs. Think of a hammock of muscles that run between the pubic bone in the front, and stretch back to the tailbone at the back. 

A woman’s pelvic floor muscles support her uterus, bladder, and colon. The bladder relaxes and fills with urine throughout the day. If it is working properly, the small opening that opens and closes (your sphincter) to release urine will keep the bladder closed until you can use the bathroom. During pregnancy and then menopause, your pelvic floor muscles will be less able to hold the urine in and the sphincter can open unexpectedly. 

With age, hormone levels drop steadily. Hormones work to keep your bladder and urethra healthy.  Lower levels of estrogen and testosterone can cause pelvic floor muscles to become weak. As these hormone levels continue to drop during menopause, Stress Incontinence and Urge Incontinence symptoms can become worse.

Hormones, Your Bladder, and Urethra

Women and men both have urethras. Of course, a man’s urethra is much longer since it has to travel to the end of the penis to release urine. But for both, the urethra is a tube that passes urine from the bladder out of the body. Reduced levels of estrogen starting around menopause can cause a thinning of the lining of the urethra (1-5).

The surrounding pelvic muscles may weaken with aging, a process known as “pelvic relaxation.” As a result of the decreased hormones and the weakening muscles, women at midlife are at increased risk for urinary incontinence, or the involuntary leakage of urine. The main risk factors for developing urinary incontinence are vaginal childbirth and increased age (4).

Menopause, Sex, and Your Vaginal Health

Sex is one area where urinary incontinence can be a real problem. Some 25% of women with incontinence experience urinary leakage during intercourse, but it’s likely a much higher number as very few want to discuss it (3). Obviously, this can be embarrassing and can lead them to avoid sex, or maybe they worry so much about leakage that they can’t relax and enjoy sex.

You need not endure problems with urinary incontinence. HRT can be a first step in improving the tone of your pelvic muscles and improving the lining of the urethra. There are also Kegel exercises that can train and strengthen the pelvic floor muscles.  Urinating right before intercourse can also be helpful.  Incontinence is also a symptom of UTIs.

Managing Vaginal Dryness

Vaginal dryness is a symptom of menopause that is rarely discussed, but it can damage your quality of life and affect your sexual relationships. It’s embarrassing for most women to discuss, even with their physicians. That’s unfortunate, as there are many ways that this can be managed.

HRT is a great first step for getting your vagina back to its youthful lubrication and moistness. Water-soluble lubricants can help too. Drinking plenty of water and fluids reduces vaginal dryness as you age.

Other Factors Beyond Menopause

Menopause and the drop in hormones is not the only consideration when looking for a cause of urinary incontinence. Sometimes it is a symptom of something else. The following suggestions can help to decrease your risk of Urinary Incontinence (UI) (3,4):

1. Avoid alcohol, carbonated or caffeinated drinks like coffee, or tea. These beverages fill your bladder quickly and may make you feel like you need to use the bathroom more often. Try drinking more water or decaffeinated drinks.
2. Avoid drinking in the evenings & limit your beverages at night to avoid frequent trips to the bathroom and leaking.
3. Eat a high-fiber diet to avoid constipation, which puts added stress on your pelvic floor.
4. Maintain a healthy weight. We know that extra weight, especially around your abdomen, increases pressure over your bladder.
5. Infections in the urinary tract can cause UI, but after treatment, it should improve.
6. Medications like steroids and diuretics can cause UI.
7. Nerve damage can interfere with signals from your bladder to your brain and you don’t feel any urge to urinate leading to UI.

Urinary Tract Infections (UTIs)

Although some women sail through menopause with few or no discomforts, the ever-decreasing levels of hormones can cause some pretty difficult symptoms including chronic urinary tract infections (UTIs).  Some menopausal women have occasional UTIs, but others experience chronic UTIs that occur month after month after month.

A UTI can occur in any part of your urinary system, including your bladder, kidneys, ureters (tubes between kidneys and bladder), and urethra (the tube that urine exits your bladder and leaves your body). As estrogen production falls in menopausal women, UTIs can occur more frequently. 

There are several reasons for this:

1. As you age, the vaginal tissue thins, making it more prone to infection. 
2. You may have trouble fully emptying your bladder each time you urinate, which can increase the chance of an infection in your bladder. 
3. With less estrogen in your body, bacterial levels can change, allowing infection to set in.

Tips for Preventing UTIs

1. Drink a lot of water, up to eight glasses per day
2. Urinate before and after having sex
3. Wipe from front to back after urination
4. Wear cotton fabrics and loose-fitting clothes when possible
5. Change your underwear every day
6. Be sure your bladder is not full for long periods.

Solutions for Chronic UTIs

Antibiotics are an excellent treatment that will clear UTIs, but it’s best not to take antibiotics long-term, or frequently. We should try to avoid getting a UTI in the first place. Here are a couple of things that you can do to reduce the incidence of menopause-related UTIs:

1. Lifestyle changes: You can lower your risk of developing a UTI by making important lifestyle changes each day. For example, drinking plenty of water helps flush some harmful bacteria out. Going to the bathroom whenever you get the urge and allowing your bladder to empty as fully. Drinking cranberry juice or taking daily cranberry supplements helps ward off UTIs.
2. Vaginal estrogen cream can restore hormone levels in your vagina. This helps prevent UTIs because vaginal estrogen supports the “good” bacteria that help keep “bad” infection-causing bacteria in check. Vaginal estrogen is available as twice-weekly creams.

Summary

Menopause and urinary tract infections often go hand-in-hand. The reduction in estrogen with menopause may result in the symptoms of vaginal dryness, incontinence, and urinary tract infections. There are a number of ways to reduce these symptoms. Too many women simply “tolerate” these symptoms, but if aging and menopause are causing you discomfort, go to Winona today to see what options are available.

At Winona, we understand how hard it can be to cope with menopause-related symptoms. That’s why we offer a full range of symptom treatment options on our online platform, available 24/7, with licensed physicians providing prescription FDA-approved medications.

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About The Author

Short Bio of Dr.Nancy L. Belcher, PhD., MPA

Dr.Nancy L. Belcher, PhD.,MPA is a veteran of the scientific and nonprofit business world. Nancy effectively partners with healthcare providers, scientists and industry stakeholders to improve healthcare for all. She is an active member of the North American Menopause Society and an advocate dedicated to improving the lives of so many women. A woman of substance who dedicated her life to Science. If she’s not working, Nancy enjoys spending her free time with her husband, Dr. Chris Belcher, their five sons, and one daughter-in-law.