What is Menopause?
Menopause is the change of life where a woman no longer menstruates and their period stops permanently.
One of the changes many women notice is increased difficulty with bladder and bowel control. A woman is considered to have gone through menopause when she has not had a period for 12 months.
After menopause our sex hormones, oestrogen, progesterone and testosterone slowly decline to a very low levels.
These hormones are responsible for maintaining tissue elasticity including vaginal tissue and they cause our lining of the uterus to thicken during the menstrual cycle. These hormones also preserve bone and muscle mass, they maintain vaginal blood flow and lubrication and they contribute to libido.
What are some of the Common Symptoms Associated with Menopause?
- Hot flushes
- Night sweats
- Vaginal dryness
- Bone loss (reduced bone density/osteoporosis)
- Heavy or irregular bleeding
- Leakage of urine with coughs, sneezes, or exercise
- Leakage of urine on the way to the toilet
- Getting up twice or more overnight to pass urine
- Frequent urinary tract infections
- Rushing to the toilet to open bowels
- Being unable to control wind,
Menopause and bladder and bowel control
There are a few ways that menopause can impact your bladder and bowel control. These include:
1. Weak pelvic floor muscles
With the onset of menopause the pelvic floor muscles (like most muscles in the body) tend to be weaken.
As these muscles help to control both the bladder and bowel, any weakness may result in a more frequent urge to visit the toilet and decreased ability to hold on and get to the toilet in time.
Weak pelvic floor muscles can make it harder to control wind or gas, and may also play a part in the onset of prolapse.
2. A less elastic bladder
As we age, the bladder becomes less elastic and therefore has more difficulty in stretching.
As the bladder fills with urine this loss of stretch may irritate the bladder muscle causing it to be ‘overactive'. An ‘overactive' bladder will cause you to pass urine more frequently.
Combined with weaker pelvic floor muscles, this makes it much more difficult to hold on or to put off going to the toilet to pass urine. A program of bladder training and pelvic floor muscle exercises may help you regain control.
Vaginal oestrogen cream or an oestrogen pessary is sometimes prescribed to help with these symptoms
3. Vaginal dryness
The loss of the hormone oestrogen results in vaginal dryness as the lining of the vagina produces less mucus.
The urethra (outlet tube for the bladder) also develops similar changes.
This dryness can put you at higher risk of developing a urinary tract infection as a result of normal bowel bacteria moving into the urethra.
Oestrogen cream or an oestrogen pessary may be prescribed to prevent further urinary infections.
Personal hygiene is particularly important and all women should wipe from front to back.
Cranberry juice or capsules may help prevent urinary tract infections.
4. Weight gain
Many women find they begin to gain weight with the onset of menopause. If your weight gain is significant, you run the risk of developing bladder and bowel control problems.
The pelvic floor muscles support most of your body weight. Any excess weight further strains these muscles, weakening them.
Weak pelvic floor muscles do not support the bladder and bowel as they should. If this happens you may notice leakage when coughing and sneezing (also known as stress incontinence) or the need to frequently or urgently visit the toilet. We recommend you keep your weight in the healthy range.
5. Other health problems
Other chronic health problems may start to play a part in your health and these may cause or worsen incontinence. Diabetes has specifically been identified as putting women at higher risk of developing incontinence. Nerve damage (neuropathy) is a common complication of diabetes. Nerves to the bladder and bowel can be damaged causing loss of sensation, poor emptying and constipation. Keeping your diabetes well controlled is the best way to prevent or stop nerve damage.
A hysterectomy is an operation to remove the uterus (womb) from a woman. Some women who have a hysterectomy or prolapse repair find they have a problem with bladder control. It can be unclear if it is the surgery that causes the problem. Pelvic floor exercises before and following surgery should be part of the treatment you are offered.
7. Anal trauma / surgery
Many women who have had babies may find bowel control problems occurring with the onset of menopause. During birth, the anal sphincter (muscle around the anus) can be damaged but this may not become a problem until later in life. An exercise program for pelvic floor muscles may fix the problem; however, some women will need to have surgery to repair this damage.
Preventing and managing poor bladder and bowel control
There are five things you can do to regain control of your bladder or bowel. These are:
- eat well
- drink well
- exercise regularly
- tone up your pelvic floor muscles, and
- practice good toilet habits.
Bone Changes after Menopause
After menopause, changes to the female sex hormones affects the body’s natural bone remodelling process. The loss of the female sex hormone oestrogen accelerates bone loss (oestrogen helps to preserve calcium stores and prevent bone breakdown).
In the first 5 years after menopause most women will have lost around 10% of their bone mass. This loss of bone mass increases the woman’s likelihood of developing osteoporosis.
Guidelines for Exercises to Prevent Osteoporosis
• Exercises need to be moderate to high Osteogenic to continue to stimulate healthy bone growth.
• Exercise at least 3 x /week for 30 mins.
• Exercises should be progressed, e.g. increase weight used, increase the hill intensity, increase time, distance etc.
• Exercises should be challenging to stimulate bone growth.
• Exercises should be varied in their routines.
Balance Exercises to Prevent Falls
It is important to incorporate balance exercises as part of an exercise regime to help improve proprioception.
Reduced strength, balance, poor vision and tripping hazards around the home can cause falls. Women and men with low bone mass are at greater risk of fractures from falls.