Urinary Changes / Incontinence (Menopause-Related / GSM)
Urinary symptoms often increase around menopause, frequently as part of Genitourinary Syndrome of Menopause (GSM). Lower estrogen levels affect the tissues of the urethra and bladder base, leading to symptoms like urinary urgency (sudden need to pee), frequency (needing to pee often), nocturia (waking at night to pee), dysuria (painful urination), and recurrent urinary tract infections (UTIs). Stress incontinence (leaking with cough/sneeze/exercise) may also worsen due to weakened pelvic floor muscles or tissue changes. Treatments address estrogen deficiency and pelvic floor health.
Management Strategies
- Pelvic floor muscle exercises (Kegels)
- Bladder training (timed voiding, urge suppression techniques)
- Weight management
- Avoiding bladder irritants (caffeine, alcohol, spicy foods, artificial sweeteners)
- Managing fluid intake (adequate hydration, but avoid excessive fluids, esp. before bed)
- Treating constipation
- Local vaginal estrogen therapy (creams, tablets, rings - improves tissue health)
- Ospemifene (oral SERM)
- Adequate hydration
- Proper hygiene
- Vaginal estrogen (can reduce UTI risk)
- Cranberry products (limited evidence)
- Antibiotics (prophylactic or post-coital, if recurrent)
- Pessaries (vaginal support devices for SUI)
- Medications for overactive bladder/urge incontinence (anticholinergics like oxybutynin, tolterodine; beta-3 agonists like mirabegron)
- Bulking agents (injections around urethra for SUI)
- Surgery (e.g., mid-urethral slings for SUI)
Impact
- Reduced quality of life
- Embarrassment
- Activity limitation
- Sleep disruption (nocturia)
- Skin irritation
- Increased risk of falls (rushing to toilet)
Diagnostic Considerations
Based on symptoms, medical history, physical exam (including pelvic exam). Urinalysis to check for infection. Urodynamic testing may be used to assess bladder function. Post-void residual volume measurement.