How menopause impacts urinary tract health

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Kate graduated with a B.A. in Journalism from San Diego State University. She is the Content Manager at Uqora and is responsible for Uqora's social media, newsletters and contributing to the UTI Learning Center.

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Why are urinary tract issues like UTIs, frequent urination, and incontinence so much more common during and after menopause? We’ll walk you through explanations and what you can do to improve overall urinary tract health.

As you age, your bladder loses its ability to expand, which means the bladder fills frequently, and it becomes more difficult to squeeze the muscles to empty the bladder completely.

There are a couple reasons for this:

• Lack of estrogen. During menopause, less estrogen is produced and this weakens the urogenital muscles, compromising the ability to carry out urinary functions.
• Pelvic organ prolapse. This happens when the muscles and tissues supporting the uterus, bladder, and rectum become weak and slip down from their normal position into the vagina. This can be from strain from vaginal childbirth that becomes evident after menopause.

Bladder control issues are very common for women in menopause, but it is a treatable condition. If you’re going to the bathroom more than 6-8 times per day, speak with your doctor about bladder training. Below we’ll explain more solutions.

Physical changes brought on by menopause can lead to bladder problems. Your pelvic floor muscles suspend your bladder and rectum like a hammock. The front wall of the vagina also keeps the bladder in place. These muscles weaken as we age and cause the bladder to prolapse, or descend into the vagina.

According to the North American Menopause Society, the most common types of bladder problems during menopause are stress incontinence and urge incontinence.

Stress incontinence happens when the pelvic floor muscles become weak. Warning signs include urine leakage when laughing, sneezing, coughing or lifting objects. Urge incontinence (overactive bladder) is caused by overly active or irritated bladder muscles. You may feel a frequent and sudden urge to urinate.

You don’t have to accept urinary incontinence as a fact of getting older. Not having control over your bladder is stressful, and restraining. Here are some ways to treat bladder problems from menopause:

• Urination habits: Dr. Hope Ricciotti of Harvard Women’s Health Watch advises, “When sitting on the toilet, make yourself as comfortable as possible in a relaxed seated position (not squatting). Start the stream of urine by relaxing the pelvic floor muscles, rather than straining to urinate. Allow enough time for your bladder to completely empty. Also empty your bladder after intercourse.”
• Bladder training: With your doctor, discuss a timetable for storing and releasing urine. As time goes on, you may not have the urge to urinate as frequently.
• Kegels: Try pelvic floor exercises to strengthen your pelvic floor muscles over time. Squeeze and draw IN the muscles UP inside of you for a count of 3 seconds. Tense the muscles for 3 seconds, then relax for 3 seconds. Do this 10 times daily.
• Diet: Avoid or cut down on items with caffeine, which can irritate the bladder. Coffee, tea, soft drinks, and alcohol are diuretics that exacerbate overactive bladders.
• Biofeedback: Besides DIY treatments for incontinence, biofeedback ensures you're exercising the correct pelvic muscles. A patch is placed over your muscles with a wire connected to a screen. The goal is that eventually you’ll be able to exercise these muscles without the help of a machine.
• Pessary: A firm ring is inserted vaginally that presses against the wall of the vagina and the urethra.

Don’t feel ashamed or embarrassed about what you’re going through. Bladder incontinence is a common issue, with various solutions. Speak with your healthcare team so they can find a treatment plan just for you.

Alternative methods for preventing and managing chronic UTIs are emerging.

Yes, low estrogen can cause urethral pain. Dr. Mache Seibel, MD, told Huffpost Health that as estrogen levels lower over time, the tissues of the upper vagina and labia minora pull back from the tip of the urethra, which exposes the tip to more bacteria, friction, and infection. If you’re feeling a pain or tension farther up your urethra, lowered estrogen could also be the reason as the tissues of the urinary tract are very sensitive to estrogen.

UTIs are common for women of all ages. But at midlife, menopause is usually the main culprit. Physical changes like producing less estrogen, the thinning of vaginal tissues, pelvic organ prolapse, and trouble emptying the bladder can all contribute to frequent UTIs.

A 2011 study discusses how estrogen plays a key role in keeping our vaginas and urinary tracts healthy. Your vagina and bladders have their own respective microbiomes that maintain a balance of “good” and “bad” bacteria.

Estrogen is responsible for producing vaginal mucus (discharge). The “good” bacteria (Lactobacillus) that naturally exist in and around your vagina feed on glycogen found in vaginal mucus. The more glycogen available, the more the Lactobacilli eat, the more they multiply and emit lactic acid, which has an antimicrobial effect on “bad,” pathogenic bacteria. Estrogen is also responsible for increased blood flow to your pelvic region, which aids overall urinary and vaginal functions.

Another fascinating effect estrogen has on the urinary tract is how it helps the bladder fight off an infection. Dr. Mache Seibel, Global Leader in Women’s Wellness and Menopause, explains that estrogen “encourages the bladder to produce natural antimicrobial substances and also helps the bladder cells to thicken in number and move closer together to keep out bacteria — like a first defense against infection.” This is why depleted estrogen levels make women susceptible to UTIs during and after menopause.

The bladder is a balloon like muscle that expands as it fills with urine. Over time, the bladder loses tone and it becomes harder to empty the bladder completely. Contrary to popular belief, urine is not sterile, but instead has its own microbiome of healthy and unhealthy bacteria. When urine is left over in the bladder, advantageous bacteria have more time to multiply and cause a UTI.

Estrogen therapy helps restore vaginal pH and reverses the microbiological changes brought on by menopause. Topical estrogen cream or estrogen pessaries are generally safe to use, but it’s imperative that you consult your doctor first. These treatments have fewer risks than a pill because a pill circulates the hormones throughout your body, while a cream or pessary is localized.

In a randomized, open-label study, an estrogen-impregnated ring or topical estriol cream was associated with a significant reduction in recurrent infections, but the researchers concluded that more studies with larger sample sizes are needed.

A recent study shed light on frequent (recurrent) UTIs in postmenopausal women. Several species of bacteria can embed themselves inside the bladder’s surface area for recurrent UTI patents. Dr. Philippe Zimmern, Professor of Urology and a co-senior author stated, "We will need to use methods other than antibiotics to treat this disease, as now we observe diverse types of bacteria in the bladder wall of these patients."

If you’re already experiencing UTI symptoms post-menopause, contact your doctor as soon as possible. UTIs do not clear up on their own and untreated UTIs can spread to your kidneys. Your doctor will prescribe you a course of antibiotics to kill off the infection. Once you’ve completed your prescription, take these steps to prevent your next UTI:

• Pee after sex. This flushes out any bacteria that might have been introduced into the urinary tract during sex.
• Try vaginal estrogen creams or rings. They may help restore the “good/bad” balance of bacteria in your vagina. Speak with your doctor to see if this method works for you.
• When you sit down to pee, make yourself comfortable. Don't squat or rush yourself.
• Ask your doctor to check for pelvic organ prolapse, which can be associated with an inability to fully empty your bladder.
• Take antibiotics exactly as prescribed. It is important to take the entire course to completely eliminate the infection and prevent it from coming back.
• Stay hydrated.
• Opt for showers instead of baths.
• Avoid douching and using feminine sprays or scented soaps in the genital area.
• Wear cotton underwear.
• Do not have intercourse while being treated for a UTI.
• Wipe front to back.