Pee pads, pessaries, and PT, oh my!

menopause education Feb 16, 2023

You’re probably feeling horrified yet hopeful after last week’s post about the possible impacts of declining estrogen to your vulva and vag.

Sigh. Me too.

After writing that newsletter, I decided that Heather Corinna’s book about menopause is the most appropriately titled book about menopause ever.

It’s called, “What Fresh Hell is This”.

So perfect, right?

But the fun’s not over yet, because this week we’re talking about the “urinary” part of Genitourinary Syndrome of Menopause. And who doesn’t want to have that conversation?

I'm a rip-the-bandaid-off-quickly kind of gal so I say we just dive right in. You ready?

Give it to me straight: do I need to start buying Depends?

Maybe, but maybe not - it’s thankfully (mostly) up to you!

Approximately 50% of middle-aged women and 75% of older women experience some degree of urinary incontinence due to menopause and aging. While incontinence is common among women, it’s not normal. Meaning, that the body isn’t supposed to be leaking urine - that’s not how it’s designed to function.

Sadly, because it’s so common, female incontinence has become normalized. We’ve been brushed off, told that this is just what happens with age or after having a baby, and sent to go buy pee pads for when we leak.

Thankfully, we have options!

The reasons for urinary incontinence are varied (poor strength? poor coordination? prolapse?), so my advice is to find a pelvic floor physical therapist and/or urogynecologist who can help you get to the bottom of your specific issue and discuss your options with you.

Some women will just need PT exercises to strengthen supporting tissues and improve coordination. Other women may need the help of a vaginal incontinence device (like a pessary, incontinence ring or the over-the-counter tampon-like device called Impressa). And other women may need surgery to finally be leak-free.

What about hormone therapy? Can it help with incontinence?

Some women actually experience an increase in incontinence with systemic menopause hormone therapy. But I personally know someone whose incontinence stopped when she started MHT. So, clearly it’s a mixed bag.

Vaginal estrogen therapy (prescription estrogen formulated as a cream, tab or ring that stays in the vaginal area) can help with incontinence. Hooray!

Alright, what other totally awesome (🙄) menopause impacts should I be aware of?

Overactive bladder is common in older women, but it’s not clear (to me at least) if this is menopause-related or due to aging. Either way, there are lots of options including physical therapy, removing bladder irritants like caffeine and alcohol from your diet, prescription medication, and surgery.

Recurrent UTI’s are also common after menopause, likely because of changes to the vaginal microbiome and supportive tissue during the menopause transition. Thankfully, vaginal estrogen can help reduce recurrent UTI’s as well.

Anything else I should know?

Yep. (No surprise there. There's always something else.)

When it comes to bladder issues, it’s important to think through the long-term impacts of doing nothing. Will doing nothing eventually mean saying no to opportunities that will keep you healthy, active, and connected to your community as you age?

Take a moment to visualize how you want to spend your 50’s, 60’s, 70’s and 80’s. Can you do all of those things if you’re peeing your pants all the time or scared to leave home because of an overactive bladder?

Can you imagine your 80-year old self looking back and wishing you hadn’t prioritized resolving your bladder issues? Of course not! Future you will be SO GRATEFUL if you choose to take care of these issues if/when they arise.

Until next time,

xo, Rebecca

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