Bladder problems in women after menopause, urinary tract infections, urinary incontinence, and prolapsed bladder

By: Dr. Victor Marchione | Bladder | Monday, September 12, 2016 - 12:11 PM

Bladder problems in women after menopause, urinary tract infections, urinary incontinence, and prolapsed bladderBladder problems commonly occur in women after menopause and can include urinary tract infections, urinary incontinence, and prolapsed bladder. There are many reasons why bladder problems are more predominant after menopause, including a reduction in estrogen levels, along with the consequences of pregnancy and giving birth.

Being aware of bladder problems can make you more comfortable talking about them to your doctor. For many issues, there are viable solutions that can help you live a normal life. Unfortunately, if you do not address these conditions with your doctor, you may continue suffering in silence.

Urinary tract infections

A reduction in the hormone estrogen is the primary reason why post-menopausal women have an increased susceptibility to UTIs. This is because urinary tract infections develop when unhealthy bacteria such as E. coli grow in the bladder. Normally, the healthy bacteria – lactobacilli – prevent urinary health problems by stopping the growth of these unhealthy bacteria, and estrogen encourages a robust level of lactobacilli. However, estrogen levels drop after menopause, which can also mean a drop in lactobacilli and consequently, an increased susceptibility to bacterial bladder problems such as UTIs.

Physical changes in the vaginal wall are also responsible for the increased susceptibility to UTIs experienced amongst post-menopausal women. More specifically, the reduction in estrogen post-menopause causes the lining of the vagina to get thinner, which makes it easier for unhealthy bacteria to multiply. The vaginal fluid also becomes less acidic, which is problematic because acid kills harmful bacteria and unhealthy bacteria thrive in alkaline environments. The reduction of estrogen can also prevent the bladder from emptying completely, and any bacteria that are in the urine will then remain in the bladder, increasing the likelihood of developing bacteria-induced bladder problems such as UTIs. Other factors that increase the risk of urinary tract infections in elderly women include dehydration, a weakened immune system, kidney problems, immobilization, and catheterization.

Lifestyle changes along with medical intervention can help reduce the risk of future urinary tract infections.

Urinary incontinence in women

Up to a third of women in the United States suffer from urinary incontinence (UI). About 33 million have overactive bladder, or OAB, which means they feel urgency, and/or frequency with or without urge incontinence.Research shows that while urinary incontinence risk can be linked to aging, it can also be associated with pregnancy, delivery, and the number of children you have. It doesn’t matter whether you have a vaginal or C-section delivery, the risk is still the same. Studies also indicate that women can experience urinary incontinence after menopause due to the drop in estrogen, yet taking estrogen doesn’t seem to help those who suffer from UI. As mentioned above, excess weight can also increase your risk of getting urinary incontinence.

There are different types of urinary incontinence. Figuring out what type you have will lead you to proper treatment.

  • Stress incontinence happens when a person makes movements that put pressure on the bladder, causing the leaking of urine. Often, childbirth can injure the scaffolding that helps support the bladder and can lead to this kind of leaking. In these cases, urinary incontinence symptoms include leakage when you cough, laugh, sneeze, exercise, or do any heavy lifting.
  • Urge incontinence is when you lose urine for no obvious reason after you feel the urge to urinate. Urge incontinence can happen after drinking a small amount of water or after hearing water running. Some medications are also known to activate urge incontinence. Urge to urinate may come during a sudden change in position, when you hear running water or during sex, especially during orgasm.
  • Overactive bladder occurs when nerves send signals to the bladder at the wrong time. It causes muscles to squeeze. Women with overactive bladder go to the washroom over seven times a day. The symptoms can include the urge to urinate that is difficult to control, involuntary loss of urine, frequent urinating (more than eight times in 24 hours), and waking up two or more times during the night to urinate.
  • Functional incontinence is a type of UI associated with medical problems that interfere with thinking and moving or communicating, so a person may have difficulty reaching a washroom. People with this type of UI may have dementia, poor eyesight, poor dexterity, poor mobility, or mental health problems such as depression. Functional incontinence is more common among the elderly population and is frequently seen in nursing homes.
  • Overflow incontinence can happen when the bladder doesn’t empty properly, causing the overflow. It can take place when bladder muscles are weak or the urethra is blocked. Urinary incontinence symptoms in this situation include a feeling that your bladder is not empty, frequent dribbles of urine, or constant dribbling of urine.
  • Mixed incontinence is a combination of stress and urge incontinence.

Prolapsed bladder

A prolapsed bladder can be categorized into one of the following grades: mild, moderate, severe, and complete. In a mild grade, only a small portion of the bladder falls into the vagina. In moderate, the bladder drops enough to be felt at the opening of the vagina. In severe, the bladder begins to protrude through the vaginal opening, and in complete, the entire bladder protrudes out of the vagina. This last stage is often associated with other forms of organ prolapse.

The most common cause of bladder prolapse is aging. The muscles that support the bladder become weaker over time, especially when women enter menopause. This is associated with a reduced production of estrogen, which is responsible for keeping the muscles strong.

Childbirth can also cause bladder prolapse with stress to the vaginal tissues and supporting muscles.

Lastly, straining caused by heavy lifting, bowel movements, or long-term coughing or constipation can also weaken the muscles, thus contributing to a prolapsed bladder.

Signs and symptoms of a prolapsed bladder include:

  • Frequent urination or a strong urge to urinate
  • Incontinence
  • Not feeling relief even after urinating
  • Frequent urinary tract infections
  • Pain in the vagina, pelvis, lower abdomen, or groin
  • Heaviness or pressure in the vaginal area
  • Pain during sexual intercourse
  • Tender or bleeding tissue sticking out of the vagina

To help prevent a prolapsed bladder, you should perform pelvic floor muscle exercises to stay strong. You should also avoid constipation (eat plenty of fiber!), heavy lifting, and straining as much as possible.

Keeping a healthy weight is also important because obesity puts added stress onto the pelvic muscles, further increasing the risk of a bladder prolapse.

It’s important to know when to see your doctor for a prolapsed bladder in order to prevent complications.

You should speak to your doctor about any bladder problems or changes you experience. More often than not, they can recommend effective treatments to help you better take control of your bladder problems after menopause.

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