Women often report an increase of urgency in menopause, learn the risk factors for urinary leakage in menopause and how to empower women to seek help for continence symptoms.
Women’s Health Physio and Menopause Movement co-founder, Christien Bird explains:
Urinary leakage in menopause - exercise, hormones, ageing and the things that have happened to you earlier in life, matter.
Women often report an increase of urgency in menopause. It is that key in the door moment when you need rush to the loo, sometimes not making it in time. If you are training and working with women in menopause, they may not tell you about any leakage, choosing instead to stop exercising, or modifying what they do.
A recent study found that for menopausal women who took part in sports activities, 55% reported accidental urinary leakage and 37% accidental flatulence – a problem needing more attention.
Perimenopause and the changes that come with, it can be risky time, increasing the possibility of disordered exercising for a minority of women, due to a number of different factors, including:
Declining levels of oestrogen, our reproductive sex hormone, in menopause cause significant changes in the vagina and bladder.
Blood flow decreases. Collagen, the tissue that helps things stretch, weakens. The layers of cells lining the vagina become thinner, more fragile and lose the storage sugar which helps to both keep them plump and feed good bacteria. When there is nothing left for the good bacteria to feed on, the vaginal microbiome changes, bringing more symptoms, including bladder issues. Production of mucus, which helps to lubricate the vagina and protect the vagina and bladder from potentially harmful bacteria, also declines. Typically, this is treated with vaginal oestrogen and would ideally include pelvic floor muscle training. (PFMT). Both treatments are safe and effective option for most women.
A large Scandinavian study found that it is not just hormonal changes in menopause that can cause urinary leakage. Earlier risk factors that do not appear to be related to hormonal changes or age, can become more prevalent in this stage of a woman’s life.
The study compared the prevalence and risk factors for urinary incontinence (UI) for women, twenty years after a vaginal delivery, with a caesarean section. The prevalence of UI was higher in women after a vaginal delivery than after a caesarean section. The lower rate of leakage was the same for women who had had acute, or elective, caesarean section.
It’s well recognised in the physio world that leakage is an obstacle to exercise. Studies show that women who exercise have three times the likelihood of experiencing UI. Whatever the cause, we must all encourage women experiencing this, to seek professional help if they have any symptoms, or the early risk factors.
This is a good place to remind ourselves that there is level 1A evidence - the most rigorous and highest level of medical evidence - that physio led pelvic floor training works for UI. The NICE guidelines say PFMT is mandatory, unless there is a clear and compelling rationale for an alternative approach. This is also the case for not doing anything - effectively it is mandatory for health professionals to act where there is pelvic floor dysfunction.
Improving women's knowledge of pelvic floor health is important because this increases the chance that they will take action to prevent, or to seek help for, pelvic floor dysfunction. Fitness coaches, PT’s, yoga & Pilates teachers, and other fitness professionals are often the people women go to, to get health advice. As professionals in their localities, they are in the best place to signpost women, and through coaching, empower women with increased health awareness, and create safe communities where women feel they can ask questions.
Making women aware of the evidence of the effectiveness of supervised PFMT will hopefully lower the threshold to seek help. If childbirth was years and years ago, or constipation is chronic, it’s never too late, the aim is for all women to be sign posted to a women’s health assessment, through their GP, or a pelvic health physiotherapist.
June 2023
Further resources:
NHS-approved Squeezy App offers pelvic floor muscle exercise programmes.
Positive Pause 'Pelvic floor dysfunction' video is a free resource for your clients.
