With the onset of menopause the pelvic floor muscles (like most muscles in the body) tend to weaken. As these muscles prevent the loss of urine (wee) and faeces (poo), any weakness may result in a more frequent urge to visit the toilet and decreased ability to hold on and reach the toilet in time. Weak pelvic floor muscles can make it harder to control wind or gas, and may also play a part in the onset of prolapse.
Learn more about urge incontinence.
As women age, the bladder becomes less elastic and has more difficulty stretching. As the bladder fills with urine (wee), this loss of stretch may irritate the bladder muscle causing it to be ‘overactive'. An ‘overactive' bladder will cause you to pass urine more frequently. Combined with weaker pelvic floor muscles, this makes it much more difficult to hold on or put off going to the toilet.
A program of bladder training and pelvic floor muscle exercises may help you regain control. Vaginal oestrogen cream or an oestrogen pessary is sometimes prescribed to help with these symptoms.
Learn more about stress incontinence.
The loss of the hormone oestrogen results in vaginal dryness as the lining of the vagina produces less mucus. The urethra (outlet tube for the bladder) also develops similar changes. This dryness can put you at higher risk of developing a urinary tract infection as a result of normal bowel bacteria moving into the urethra. Oestrogen cream or an oestrogen pessary may be prescribed to reduce vaginal dryness. Personal hygiene is particularly important and all women should wipe from front to back.
Many women find they gain weight with the onset of menopause. The pelvic floor muscles support most of your body weight and any excess weight further strains these muscles causing them to weaken. Weak pelvic floor muscles do not support the bladder and bowel as they should and if this happens you may notice leakage when coughing and sneezing (stress incontinence) or the need to frequently or urgently visit the toilet (urge incontinence).
Other chronic health problems may start to play a part in your health and these may cause or worsen incontinence. Diabetes has specifically been identified as putting women at higher risk of developing incontinence.
Nerve damage (neuropathy) is a common complication of diabetes. Nerves to the bladder and bowel can be damaged causing loss of sensation, poor emptying and constipation. Keeping your diabetes well controlled is the best way to prevent or stop this nerve damage.
A hysterectomy is an operation to remove the uterus (womb). Some women who have a hysterectomy or prolapse repair find they have a problem with bladder control. Pelvic floor exercises before and following surgery should be part of the treatment you are offered.
Some women who have had babies may find bowel control problems occurring with the onset of menopause. During birth, the anal sphincter (muscle around the anus) can be damaged but this may not become a problem until later in life. An exercise program for pelvic floor muscles may fix the problem however, some women will need to have surgery to repair this damage.