Happy sunny Sunday everyone! I Iove it when the clocks spring forwards and we are blessed with that extra evening light. So, this week on the A-Z weekly Menopause symptom blog we have arrived at U and I am going to be talking about URINARY INCONTINENCE.
I am still amazed at just how much can be affected as our reproductive hormones decrease.
So, urinary incontinence is basically the unintentional loss of urine that is caused by a loss of elasticity of the vaginal tissues and a weakening of pelvic floor muscles that is caused by the reduction or loss of reproductive hormones, specifically estrogen.
Often we find that this can happen when we laugh or cough or exercise. I don’t think there are many midlife women (especially those that have had children) that would feel confident to be bouncing on a trampoline. If they are then they are lucky and few!!
Now the frustrating thing is that because it is associated with this reduction of estrogen, and the supply of this hormone gets lower and lower through perimenopause, the problem can get worse and worse as we age.
So, there are different types of urinary incontinence and the example I gave about not being able to jump on a trampoline would definitely come under the first I am going to talk about – Stress urinary incontinence.
This can sometimes be referred to as the “the leaky valve” and this is the most common type of urinary incontinence in menopause. As I mentioned earlier this can happen when you cough, sneeze, laugh, exercise or jump. The reason it happens is due to weakening, in particular, in the urethra, which is the the duct by which urine is conveyed out of the body from the bladder. This muscular valve holds urine tight at rest and relaxes to let urine flow when you need to go. The muscles of the urethra can weaken as the result of pregnancy and delivery, heavy lifting or straining, and during the process of menopause, which can weaken the supportive vaginal tissues.
Unfortunately, the weakening can often be quite extensive and as a result there may be leakage with minimal activity, such as walking or changing positions. In addition, you may experience increasingly larger amounts of urine leakage with activity.
Another type of incontinence that may be experienced is what is referred to as the “overactive bladder” and this refers to urgency urinary incontinence. Urgency incontinence is as it sounds, and you have a sudden need to empty your bladder and lose urine before you get to the bathroom. The loss of urine can be so sudden and uncontrollable, and in such a large amount, that you wet through your clothes.
It is possible that you can also experience urgency without leakage, but the sensation and frequency is enough to disrupt your daily life. The sudden need to pass urine and that feeling of urgency can be brought on by drinking fluids, hearing the sound of running water, or changing positions. Many women with urge incontinence end up with what is known as urinary frequency, because the feel the need to go to the bathroom very often or may wake up several times a night to go pee. They have basically developed a routine to try and avoid an unwanted total void in an inappropriate place, so go to the bathroom often to avoid this happening. The trouble is the bladder almost becomes trained to behave in this way very quickly and sadly bed-wetting or leakage of urine during sex can also then occur.
Now, finally the last type (as though two other types aren’t enough….) we have what is known as overflow incontinence. Now this is basically the opposite of the other problems. On the one hand, the bladder does not empty sufficiently (either due to a weak bladder muscle or a non-relaxing urethra) while on the other hand you experience leakage because the bladder becomes so full that urine is forced to leak out. Women with this type of incontinence typically experience a diminished “need” to pee and have a slow or delayed urinary stream. Urinary tract infections are also a common factor in overflow incontinence.
So, we know that the dropping hormones are the cause of this issue, but there are some factors that can contribute and make the symptoms worse. Constipation and the fact that it can leave you straining to have a bowel movement can put excess pressure on muscles that control the bladder. It is also recognised that being overweight can be an issue as the weight puts added strain on the bladder muscles.
As some ladies get older they may need to take certain medications, such as “water tablets” that can have an effect on continence as they encourage the body to expel excess fluid. In simplistic terms, the fluid can build up due to the effects of heart failure (when the heart is not functioning at its optimum and may struggle to pump the fluids of the body as efficiently as it once did.) The medication means that you will pee more frequently so that this does not build up in the body.
Another issue that can affect continence levels is nerve damage and often people with diabetes, for example, may have nerve damage that sends the wrong signal to the bladder.
Finally, surgery can affect continence and for example having a hysterectomy in which the uterus is removed can affect the pelvic floor muscles that help control bladder function.
Now, these things are the large impact issues but of course there can be additional irritations to the bladder from caffeine and alcohol. By reducing these and moving to de-caffeinated drinks and aiming for more water in our day can have a really positive impact on improving the issue.
You will be glad to know that there are other treatments that can help too and although it can feel embarrassing to take steps to seek these, the effects of urinary incontinence can have a massive impact on one’s life if not addressed.
So, pelvic floor muscle therapy can help. If any amongst you have had children you would have been advised to do this after delivery but if you were anything like me I was, a) far too busy with a new baby, and, b) too young to think it would affect me (oh that feeling of youth when you thought you were invincible, and nothing would ever age you or affect you!!)
You will be pleased to know that although not as affective as having done it back in the day, the affects can still have a positive impact. These exercises can be provided by a GP or even by having a google and starting them at home yourself.
The GP may also be able to help by prescribing some medication that can help ease the symptoms and if symptoms persist and become worse, they may refer you to a Continence Service. They will work with you to look at every option to resolve the issue and may ultimately refer you to a Uro-gynae Consultant who may consider Botox treatment to the bladder which can have excellent results or possibly even surgery.
Now, those of you that read my blogs know that this is the point that I usually start to talk about the wonderful ways that Solution Focused Hypnotherapy can support and resolve the problem. Well, this is one that I don’t really think I can claim a cure for; however, we all know that the impact of stress can have so many affects on our health and well-being.
I don’t know about you but wetting my pants would be pretty stressful to me and I know my stress bucket would be overflowing. Imagine then as well that you feel so embarrassed that this is occurring you stop going out, exercising, seeing fiends, having sex…the list goes on.
Confidence is the key to everything and if your confidence is being knocked because of this issue your whole life can be affected. Taking the steps to see a GP may feel like an impossible ask if your confidence is low and maybe some support in reaching that level is needed.
During my initial, complimentary consultation I am always led by the client – I never pry into the problem and the consultation works along the lines of “how are we going to help you” rather than “what’s wrong with you”. This could allow you to answer with…….”I want to feel more confident as I know that my lack of confidence is holding me back from doing things that will make a difference in my life.”
We then have a starting place and a goal to achieve and not one word is needed about wet knickers!!
Contact me today and start taking the steps to make these kinds of positive changes in your life…..whether piddle related or not!!