Addressing Urinary Symptoms in Menopause: Tips for Better Bladder Health

Last updated 01.15.2024 | by Sabrina Johnson | 11 Minutes Read

This article has been reviewed and fact checked by Dr. Karen Pike, a senior physician administrator and board-certified emergency room doctor actively working in northern California. Read more at our medical disclaimer page.


Research suggests that more than 30% of women experience bladder issues during their menopausal journey. Urinary urgency and incontinence are some of the most common and troublesome symptoms, and these symptoms can severely impact your quality of life. That’s why it’s so important to look after the health of your bladder and know how to identify urinary symptoms as soon as they arise. 

During my own journey through menopause, I’ve noticed several new bladder-related issues that never plagued me before. In the last couple of years, I’ve developed three urinary tract infections. And while a course of antibiotics has been enough to stop the infection in its tracks each time, I know that the hormonal shifts of menopause mean I can expect more UTIs to come. 

I’ve also noticed that I need to urinate more frequently now, and there’ve been several occasions where I’ve had to dash to the bathroom with the sudden and uncontrollable urge to pee. Often in these situations, I know my bladder isn’t anywhere near full, but my brain still interprets the signals as urgent, and I need to go.

But why does this happen to me and so many other women, and what can we do to find relief?

In this post, I’ll explain the different urinary symptoms of menopause and why they happen. Then, I’ll share some tips that have helped me improve my bladder health, in the hopes that they can help you, too. 

What are the main urinary symptoms during menopause?

The most common bladder issues you might experience during your menopausal years are:

Increased urine frequency

Like me, you might find yourself peeing more often than you used to and waking up during the night to visit the bathroom. 

Urgency

The phrase “When you gotta go, you gotta go” takes on a whole new meaning. When the urge to urinate arrives, it’s overwhelming and immediate. 

Incontinence

There are two types of bladder incontinence. 

Stress incontinence happens when urine leaks out while you sneeze, laugh, or exercise. It’s especially prevalent in women who have had children. 

Urge incontinence happens when you need to visit the bathroom urgently, but urine leaks out before you make it to the toilet.

Urinary tract infections (UTIs)

UTIs can increase during menopause, and some women, myself included, experience recurrent UTIs. 

Symptoms of a UTI include pain or burning while urinating, frequent urination, pressure or an ache in the lower abdomen, the urge to go when the bladder is empty, and blood in the urine. 

What causes urinary symptoms during menopause?

Bladder issues become more frequent the older we get. But hitting middle age isn’t the only reason you might need to visit the washroom more often. 

The hormonal changes we go through during menopause can have a big impact on our urinary system. 

Estrogen supports the tissues in the bladder, the urethra, and the vagina, keeping them strong and flexible. But during menopause, our levels of estrogen fall dramatically. This makes our entire urinary system more delicate and prone to irritation. 

Sometimes, the bladder becomes irritated before it has a chance to fill up. So, even if you just went 20 minutes ago, suddenly, the urge to pee returns. This irritation can also be accompanied by a dull ache or feeling of discomfort. 

But it’s not just the bladder that experiences changes during menopause. Estrogen loss can lead to vaginal atrophy. This is a condition where the walls and tissues of the vagina, including the urethra, become weakened. 

This makes it harder to hold in urine and easier to develop an infection.

UTIs and menopause: is there a link?

Women are already much more likely to experience urinary tract infections than men. According to research, an estimated 60% of females will contract at least one UTI throughout their lives, compared with just 12% of men. 

One major factor behind this statistic is the length of our urethras. Most women have significantly shorter urethras than men. So, bacteria that enter have a much shorter journey to the bladder, making infection more likely. 

However, women are even more susceptible to UTIs during and after menopause. 

That’s because as estrogen decreases, the vaginal tissues can become compromised, making it easier for harmful bacteria to take over. 

To make matters worse, once you’ve had a UTI, you have a 20%-40% chance of having another one. So, recurrent UTIs are relatively common for women during their menopausal years.  

How can I prevent urinary tract infections (UTIs)?

After developing three UTIs in less than three years, I’ve been searching for solutions to stop it from happening again. Unfortunately, I’ve discovered that there’s no surefire way to completely avoid UTIs during menopause, and chances are the problem will return. 

However, according to the CDC, there are some ways we can minimize our chances of suffering from recurrent UTIs, including: 

  • Keeping well hydrated
  • Urinating before and after sexual activity
  • Avoiding the use of douches, or other feminine hygiene cleansers 
  • Wiping front to back
  • Taking showers, not baths

7 Tips for Better Bladder Health

7 Tips for Better Bladder Health

I’ve been researching various ways to keep my bladder as healthy as possible, and I’ve discovered certain interventions that have made a noticeable difference. 

Here’s what’s worked for me so far:

1. Strengthen your pelvic floor

One of the most effective interventions I’ve found to improve my bladder health so far has been to improve the strength of my pelvic floor. So, if urinary incontinence and urgency are an issue for you, I highly recommend practicing regular pelvic floor exercises (also known as kegel exercises). 

They’ve made a huge difference to the strength and tone of my bladder, but it didn’t happen overnight. It took almost 12 weeks for me to see a noticeable improvement, but now, I’m so glad I’ve put in the effort. The urge to urinate is much less frequent, and I can go for longer between bathroom visits. 

2. Cut out alcohol and caffeine

Alcohol and caffeine are diuretics, so they increase the volume of your urine. Both of these substances are also known to irritate the bladder, adding to urgency and incontinence issues. 

I notice that when I skip my morning cup of coffee, I can go for much longer without visiting the washroom. But if I have a coffee at lunchtime, I need to urinate several times throughout the afternoon. As a busy emergency room doctor, this is less than ideal. 

So, for now, I’m cutting caffeinated coffee out completely. And since switching to decaf, my symptoms have significantly improved. 

3. Drink plenty of water

It may seem counterintuitive, but if urgency and incontinence are an issue for you, avoid the temptation to drink less. Being dehydrated only leads to more issues, including an increased chance of developing a UTI. Chronic dehydration can also shrink your bladder to a smaller size, causing it to hold less volume.

4. Lose weight

If you’re carrying extra weight around your middle, shedding a few pounds can make a big difference to the amount of pressure on your bladder. As an added incentive, losing weight can also help to alleviate almost all other symptoms of menopause.

5. Practice Bladder Training

Bladder training involves holding off for a little while longer before you go to urinate. 

I’ve been practicing bladder training for four months now, and I’ve noticed that I can resist the urge to pee for much longer than I could when I first began experimenting with this method. 

To get the most out of bladder training, it’s best to seek professional guidance. You need to practice the method regularly (every day if possible) before you’ll notice an improvement in urgency and frequency. But I’m glad to report that it does indeed work.

6. Consider Vaginal Estrogens

Some menopause-related urinary symptoms can be treated with vaginal estrogen. Vaginal estrogens are applied directly to the vagina. The boost of hormones in this area can ease symptoms like vaginal dryness and irritation. But it can also have a beneficial effect on your urethra and bladder, too. 

Vaginal estrogens aren’t an overnight cure. They can often take up to three months to work. I’ve only begun using vaginal estrogen recently, so I’m still waiting to see the positive effects. However, I’ve been assured that the benefits are worth the wait.

7. Talk to Your Doctor

If you have any of the following symptoms, be sure to book an appointment with your doctor. They could be a sign of an underlying condition. 

  • Blood in your urine
  • Frequent urination with increased thirst
  • Pain while passing urine
  • Pain in your back or abdomen
  • Unintentional weight loss

Even if you don’t have any of the additional symptoms above, the best starting point to regain your bladder health is in your doctor’s office. They can rule out any underlying issues. Plus, they can help you find a treatment plan to alleviate your symptoms.

FAQs

Q. When do bladder symptoms usually start?

There are three stages of menopause. 
Perimenopause is described as the build-up to menopause. During this time, your reproductive cycle is still active, and you continue to have periods. Most women reach this stage around their mid to late 40s; however, some women are younger, and some are older. 
In official medical terms,  menopause is said to have arrived 12 months after the date of your final period. According to data, the average US woman reaches menopause at the age of 51. 
Anything after the date of menopause is classed as your post-menopausal phase. 
Bladder symptoms can develop at any time during these menopausal phases. However, they’re more likely to be at their peak when you’re close to official menopause.

Q. What other risk factors increase the chances of developing a urinary tract infection?

Changing hormones means that UTIs are prevalent in women going through menopause. But there are several other risk factors that can increase your chances of developing an infection, including:

Diabetes
Sexual activity
Pregnancy
Certain types of birth control
A suppressed immune system
A history of recurrent UTIs
Other bladder issues, such as urinary incontinence

Q. Can hormone replacement therapy (HRT) help with urinary symptoms?

Hormone replacement therapy can be an effective treatment for many of the symptoms of menopause, including those related to the bladder. But, HRT is not without risks.  

So, if bladder issues like urgency and incontinence are your only major menopausal concern, it’s best to tackle the problem using lifestyle changes, exercises, and lower-risk medications such as vaginal estrogens. 
That being said, if you are struggling with a wide range of menopause symptoms, it’s worth talking to your doctor about HRT. They can assess whether you’re a suitable candidate and help you weigh the risks and benefits so you can make an informed choice.

Conclusion

I understand just how debilitating menopause related urinary symptoms can be. Since I began my menopausal journey, UTIs and urinary urgency have been recurring issues that have begun to affect my quality of life. And unfortunately, I’m not alone. Many women struggle with similar bladder related problems during this phase of life, and in most cases, it’s a consequence of shifting hormones. 

But thankfully, I’ve discovered several interventions that have helped to reduce the severity and frequency of these symptoms. And if they can work for me, they can work for you, too. 

If urinary symptoms are affecting you, speak to your doctor. With the right professional advice and support, you can find a way to manage your symptoms and improve the health of your bladder.

References:

Author

  • Sabrina Johnson

    Meet Sabrina Johnson, a compassionate author and a seasoned expert in Obstetrics and Gynecology. She is a driving force behind Simply Menopause, where her extensive medical knowledge and empathetic nature come together to empower women in their menopausal journey. Sabrina offers culturally sensitive guidance and support through her approachable writing, making her a trusted friend on the path to menopause wellness.