Menopause and urinary symptoms at a glance:
·
Changes
in a woman’s urinary function often accompany menopause. A primary cause is
urogenital atrophy, which is the deterioration of the urinary tract and vagina.
·
These
urinary changes occur for two reasons: Menopause reduces the amount of the
female hormone estrogen, and a lack of estrogen reduces the urinary tract’s
ability to control urination. Advanced age, which usually coincides with
menopause, also has various debilitating effects on the pelvic area organs and
tissues.
·
Symptoms
include the need to urinate more frequently, the inability to control urination
(incontinence), dryness and itching in the vagina, and increased urinary tract
infections.
·
Frequent
urination is the need to urinate more than you normally would. The urge can
strike suddenly and can cause you to lose control of your bladder. It can feel
uncomfortable, like your bladder is extremely full. This is also referred to as
having an overactive bladder. According to a 2009 study, urinating every two
hours or more is considered to be frequent urination.
·
Treatments
vary and include dietary changes, strengthening exercises, topical estrogen for
the vagina, and surgery.
·
In this
post, we will review the causes, other than urinary tract infection, which has
been already separately reviewed in one of the previous posts: http://menopause-aid.blogspot.com/2014/06/urinary-tract-infection-prevented.html
Causes of menopausal urinary symptoms
When menopause
occurs, estrogen production is reduced, which is the major cause of urogenital
atrophy. Atrophy means a wasting away of muscle mass, and urogenital atrophy
involves atrophy of the vagina as well as atrophy of the urinary tract.
The lack of
estrogen weakens the bladder (which holds urine) and the urethra, the tube that
carries urine out of the body, compromising their ability to control urinary
functions. Reduced estrogen also alters the acidity of the vulva and the
vagina, which can make the area more prone to infection by bacteria or yeast
overgrowth.
Menopausal
urinary symptoms can also be caused by pelvic organ prolapse, in which one
or more organs of the pelvic area drops down into the vagina. This can be due
to stress from vaginal childbirth that becomes evident after menopause. Such
stress may also cause damage to pelvic floor muscles, also resulting in urinary
problems. Whether specific urinary symptoms are related to menopause, aging or
a combination of the two is the subject of continuing study.
Menopause urinary symptoms
Symptoms
associated with urogenital atrophy can range from minor inconveniences to
emotional distress. Unlike other symptoms of menopause, such as hot flashes,
urogenital atrophy symptoms can become worse as the woman ages.
The most common
urinary tract problem that urologists see in their offices are women with
frequency of urination and the severe urge to urinate, a non-ending feeling of
a fullness of the bladder. Many of these women tell horror stories about having
to go to the bathroom every 15 minutes, 30 minutes or an hour. Everyday. And
many women say they do not even make it to the bathroom, causing not only
embarrassing social moments, but psychological pain as well.
Many women have
had multiple tests, x-rays, drugs, urethral stretching (dilatation) and still
continue with this major annoyance. While most cases are not serious, and not
life-threatening they are life-style threatening. It is often embarrassing,
uncomfortable, a major nuisance, and affects activities of daily living. The
first stop is a health care professional.
Symptoms related
to urinary atrophy are:
·
Stress
incontinence: the leaking of urine due to the stress of laughing, coughing or
sudden movement
·
Urge
incontinence (irritable/overactive bladder): the sudden, strong urge to
urinate, which can result in a loss of bladder control before one can reach a
bathroom.
·
Overflow
Incontinence - two seemingly opposite problems: the bladder does not empty
sufficiently (either due to a weak bladder muscle or a non-relaxing urethra), while
experiencing leakage when the bladder becomes so full that urine is forced to
leak out.
·
An
increased frequency in the need to urinate
·
Waking
up several times during the night to urinate (nocturia).
Symptoms related
to vaginal atrophy are:
·
A
reduction in the fullness of the vulva and the vagina
·
Dryness,
itching and burning in the vagina or on the vulva
·
Pain
during sexual intercourse
·
Vaginal
bleeding
·
An
increase in urinary tract infections due to a change in the acidity of the
vagina.
Urinary symptoms
of pelvic organ prolapse are urge incontinence and painful urination.
Hormonal treatments
As lack of
estrogen is the primary cause of urogenital atrophy, the treatments for it in
postmenopausal women involve hormone therapy (HT). These can help restore the
vagina to premenopausal condition and relieve many symptoms of urogenital
atrophy.
Systemic HT
(taken orally and affecting the whole system) may reduce the urinary symptoms
of urgency, frequency, nocturia and painful urination, but there is continuing
debate about the effectiveness of systemic HT in treating urogenital atrophy.
Local estrogen,
applied externally, is helpful in relieving the symptoms of urinary urgency,
frequency and stress incontinence, and can also help prevent urogenital atrophy
and the recurrence of urinary tract infections.
The most common
treatment for vaginal atrophy symptoms is low-dose vaginal estrogen
replacement, utilizing creams, tablets or vaginal rings.
However, some
women are not able to have HT for any menopausal urinary symptoms such as women
with breast cancer. For symptoms of vaginal atrophy, they can use vaginal
moisturizers for normal relief and vaginal lubricants to relieve dryness prior
to intercourse.
Behavioral Modification
Behavioral modification
can be very effective in managing overactive bladder symptoms, including
urinary urgency, frequency, and urgency incontinence. The goal of behavioral
modification is to retrain the bladder and to help you regain control over how
often you need to urinate.
Another important
aspect of treatment is fluid and dietary management. Remember—what goes in,
must come out! Therefore, drinking large amounts of fluids or drinking
frequently may cause you to void more frequently. Most women should drink eight
8-ounce glasses of fluid per day (64 ounces total). If you are having problems
with urinary frequency, try to drink smaller amounts of fluids spread out
evenly throughout the day. Water or milk are the beverages of choice.
Drinks that
contain a lot of acid (e.g. carbonated beverages, coffee and tea) can irritate
the bladder and increase urgency and frequency. Vitamin C (ascorbic acid) is
another common bladder irritant and should be avoided.
Non-hormonal Treatments
Non-hormonal
treatments for bladder control symptoms, including those related to pelvic
organ prolapse and weakening of the pelvic floor muscles, can involve lifestyle
changes and medical procedures. These include:
·
Bladder-training
techniques that increase the capacity to hold urine, control the timing of
urination, and control body functions with the help of a machine (called
biofeedback).
·
Acupuncture - an ancient Chinese form of healing
that has been used to treat illness for centuries. According to the Journal of
Chinese Medicine, acupuncture can help with frequent urination and an
overactive bladder in women. Urinary incontinence and frequent urination can
potentially be eased by manipulating specific acupuncture points.
·
Maintaining
a healthy weight.
·
Constipation
can also contribute to frequent urination by putting pressure on the bladder,
so increasing your fiber intake to maintain regularity may be helpful.
·
Avoiding
stress to the pelvic area and doing Kegel exercises. Kegel exercises strengthen
the pelvic floor muscles. These exercises can help control stress urinary
continence, urge urinary incontinence, overactive bladder, fecal incontinence
and can help slow the progression of vaginal prolapsed. Kegel exercises must be
done correctly and regularly to work.
·
Applying
pelvic floor therapy. Pelvic floor therapy consists of a series of visits to a
physical therapist with specialized training in the treatment of pelvic floor
problems. The physical therapist uses a combination of the techniques listed
below depending on the type of urogynecological condition present.
·
Electrical
stimulation of the bladder muscles. A device that can be used intravaginally or
externally that delivers a gentle electrical current to activate or relax the
nerves and muscles in the pelvis.
·
Manual
therapy: pressure applied to and released from muscles in spasm to relax them
and increase blood flow to the area for healing.
·
Joint
and tissue mobilization: gentle manipulation to help calm the muscles and
nerves of the pelvis.
Overactive bladder
medications
There are several brands of overactive bladder
medications on the market to treat urge urinary incontinence. These medications
work by relaxing the bladder muscle. Side effects are usually mild and include
dry mouth, dry eyes, blurred vision, urinary retention, constipation, dizziness
or drowsiness. Changing the brand or dose of medication can decrease side
effects. The different brands of overactive bladder medications include:
·
(tolterodine tartrate) Detrol
·
(oxybutynin) Ditropan
·
(darifenacin) Enablex
·
(oxybutynin) Oxytrol
·
(trospium) Sanctura
·
(solifenacin) Vesicare
Marijuana and Urinal
problems
Several recent studies confirmed the suggestion that that
medical marijuana might be very useful for treating urinary disorders such as
overactive bladder and urinary incontinence.
In a groundbreaking study published in the May 2012
edition of International Urogynecology Journal, a team of British researchers
observed interactions between cannabinoids – the active ingredients of
marijuana – and their receptors located on various parts of the bladder. By
administering cannabis compounds to human cell lines, they were able to
modulate the transmission of outgoing signals that are usually sent from the
bladder to the brain – signals involved with the urge to urinate. The research
was spurred by a previous study conducted on patients with multiple sclerosis,
who reported improvements in their urinary incontinence episodes after being
treated with cannabis extracts.
Another older study found that daily treatment with pure
THC (Marinol) resulted in a reduction in overactive bladder symptoms in 15
patients with spinal cord injuries. The symptoms of overactive bladder are
thought to arise from abnormal signaling between the bladder and the brain,
which happen to be the very same signals that were found to be affected by
cannabinoids in this study.
Surgical
Treatments
InterStim Therapy
InterStim Therapy is an FDA-approved treatment for
urinary urgency, frequency, urge incontinence and retention. The InterStim is a
small device that is implanted under the skin of one of the upper buttocks. It
works by gently stimulating the sacral nerves to help the bladder function more
normally.
BOTOX (botulinum
toxin type A)
Currently Botox is considered investigational in the
management of urge urinary incontinence. It can be very effective in patients
with neurogenic bladder or with urge incontinence not responsive to
anticholinergic medications.
Sources and
Additional Information: