Urinary incontinence in women: menopause causes and treatment options

Leaking urine when you cough, sneeze, exercise or rush to the toilet can affect confidence, intimacy and everyday activities. Urinary incontinence means any involuntary loss of urine. Although common during midlife, it deserves assessment and effective treatments can reduce leakage and, for some women, restore continence.

What are the different types of urinary incontinence?

• Stress incontinence is leakage with coughing, sneezing, laughing, lifting or exercise. “Stress” refers to physical pressure. Leakage occurs when support around the urethra, the tube carrying urine from the bladder, or its closing mechanism cannot withstand that pressure and urine is released.

• Urgency incontinence is leakage associated with a sudden, difficult-to-delay need to urinate. It can occur with an overactive bladder, which may also cause frequent urination and night-time toilet visits. An overactive bladder does not always involve leakage.

• Mixed incontinence combines stress and urgency symptoms. Identifying the pattern matters because treatments differ.

How does menopause affect bladder control?

The vagina, urethra and surrounding tissues respond to oestrogen. As levels decline, tissues can become thinner, drier and more sensitive. These changes form part of genitourinary syndrome of menopause (GSM) and may contribute to urinary urgency, frequency and discomfort.

Menopause however, is only part of the picture. Ageing, pregnancy and childbirth, changes in pelvic support, excess weight and other health conditions can also influence bladder control. Symptoms can emerge during perimenopause or become more troublesome after menopause and even women who have never given birth can also be affected.

What causes urinary leakage and who is at risk?

Contributors include pelvic floor weakness or poor coordination, pelvic organ prolapse, chronic coughing, constipation and repeated straining. Diabetes, neurological conditions and difficulties emptying the bladder can also affect continence.

Urinary infections may temporarily trigger urgency or leakage. Medicines can contribute to, for example, diuretics increase urine production and output. Assessment may include a urine test, medication review, pelvic floor muscle strength, pelvic examination and a three-day bladder diary recording drinks, toilet visits and leakage.

Pelvic floor physiotherapy and bladder training: first-line treatments

Pelvic floor muscle training has strong clinical evidence for improving or resolving urinary incontinence. A pelvic health physiotherapist can assess how the muscles contract and relax, then tailor exercises to your symptoms. A Cochrane overview found that supervision and support to continue exercises improve results.

Guidelines recommend at least three months of supervised training for stress or mixed incontinence. Learning to contract before coughing or lifting called the “knack” can help prevent leakage.

For urgency or mixed incontinence, bladder training for at least six weeks helps gradually extend the interval between toilet visits and develop strategies for managing urgency.

Lifestyle changes that support bladder control

Reducing caffeine may help urgency and frequency. It sounds counterintuitive, but drink enough to stay hydrated, while avoiding excessive intake. Severe fluid restriction is not a solution. Address constipation, stop smoking and seek treatment for persistent coughing.

If you carry excess weight, sustainable weight loss can reduce leakage. Continue physical activity, adapting movements that provoke symptoms while improving pelvic support. These measures work best alongside an individual treatment plan.

Medicines and specialist treatment options

Low-dose vaginal oestrogen may help when overactive bladder symptoms occur alongside menopause-related vaginal or urinary tissue changes such as GSM. Systemic menopausal hormone therapy is not usually recommended specifically to treat incontinence.

Australian prescription options for overactive bladder include solifenacin, oxybutynin and mirabegron. Solifenacin and oxybutynin reduce bladder contractions but may cause dry mouth and constipation; cognitive risks require consideration, particularly in older women. Mirabegron helps the bladder relax during filling, but blood pressure and medicine interactions need review. These medicines target urgency rather than stress leakage.

Persistent symptoms may warrant a continence pessary or surgery for stress incontinence, or bladder Botox and nerve stimulation for an overactive bladder.

Can complementary medicines help urinary incontinence?

Evidence is promising but limited. Small randomised trials have reported benefits from specific pumpkin seed-containing combinations, including a formulation with pollen extracts and vitamin E. Traditionally, herbs including Bearberry, Buchu, Corn silk, Crataeva, Gotu kola and Horsetail have been used for urinary incontinence.

Complementary products should be considered alongside established care, with an interaction review. Seek prompt medical assessment for blood in the urine, persistent bladder pain, recurrent infections or difficulty emptying your bladder.

Bladder leakage affecting your confidence or daily life?

You don’t have to navigate these changes alone. A personalised naturopathic consultation can help identify dietary, lifestyle and menopause-related factors affecting your bladder health, review medicines and supplements, and coordinate care with your GP or pelvic health physiotherapist.

Book a telehealth consultation with Kay Bellingham at kaybellingham.com and take the next step towards better bladder health.

References:

Todhunter-Brown A, et al. (2022). Conservative interventions for treating urinary incontinence in women: an overview of Cochrane systematic reviews. DOI: 10.1002/14651858.CD012337.pub2.

NICE. Urinary incontinence and pelvic organ prolapse in women: management. Guideline NG123.

NSW Agency for Clinical Innovation (2024). Menopause—managing pelvic organ prolapse and incontinence: evidence brief.

Palacios S, et al. (2020). Evaluation of Femaxeen® for control of urinary incontinence in women: a randomized, double-blind, placebo-controlled study. DOI: 10.1016/j.maturitas.2019.12.008.

Schoendorfer N, et al. (2018). Urox … in the treatment of symptoms of overactive bladder and urinary incontinence: a phase 2, randomised, double-blind placebo-controlled trial. BMC Complementary and Alternative Medicine.