Why does menopause affect bladder control?

Dr. Michael Roizen, MD
Internal Medicine
Urination, believe it or not, is a very complex process that relies on three processes working together well:
  • the overall health of the urinary system
  • well-coordinated messages between the nerves and brain
  • the position and strength of pelvic floor muscles and ligaments.
Weaken the supportive sling that keeps the bladder from falling down and suddenly you are crossing your legs with every cough or sneeze.
Estrogen, the hormone that women say ta-ta to during menopause, maintains that the lining of the bladder and urethra stays healthy. So the lack of estrogen may result in bladder control problems by affecting the lining of the bladder and urethra. This issue is exacerbated by the fact that damage during pregnancy, childbirth, and weight gain results in stretching the pelvic floor muscles, making it harder to support the bladder and keep the urine in. Kegel exercises can help strengthen the pelvic floor, as can specialized surgical procedures.
A woman who already has stress incontinence (leaking urine when she sneezes, coughs, laughs, or exercises) often finds that the condition gets worse after menopause, when the body no longer produces the female hormone estrogen. Researchers think estrogen helps keep the lining of the bladder and urethra in good condition. When you make less estrogen, the bladder and urethra become less flexible and stress incontinence symptoms worsen.
Dr. Mehmet Oz, MD
Cardiology (Cardiovascular Disease)
During menopause, a woman gradually stops making the hormone estrogen. This transition triggers many changes in a woman's body and her overall health. One role of estrogen may be to keep the muscles that control the bladder strong and taut. If these muscles become weak, you may not be able to hold urine in your bladder when your body comes under stress--even from something as simple as a sneeze or laugh. That's why we think the loss of estrogen during menopause may cause some women to develop bladder problems such as urinary incontinence.
Feel like you're taking more trips to the bathroom than you used to? Like our biceps and quads, pelvic floor muscles, which are responsible for bladder control, weaken as we get older. In addition, the ovaries begin to stop manufacturing estrogen, which helps protect the lining of the bladder and urethra (the tube that empties your urine). When the body slows production of estrogen during menopause, some women may become more prone to urinary tract infections (UTIs) or incontinence. That means you may have a tough time holding your bladder long enough to get to the bathroom (urinary urge incontinence), or you might experience a trickle when you cough, laugh, or sneeze (urinary stress incontinence).
Patricia Geraghty, NP
Women's Health
The tissue of the bladder, the opening from the bladder (the urethra) and genitals rely on estrogen to stay supple and strong. After menopause these tissues may become weaker and thin. Additionally weight gain or overall poor conditioning may allow the muscles that support the pelvis to decrease in strength and function. All this can be treated. Local estrogen, applied directly to the vagina, avoids the systemic concerns this hormone may cause in this age group while restoring tissue health. Exercise and weight management preserve or enhance muscle function.
Estrogen is a female hormone that helps keep the bladder and urethra strong and healthy. When estrogen production stops with menopause, bladder function can weaken. Also, as women age, pelvic muscles become weaker over time. The combination of lack of estrogen and weaker muscles can affect bladder control.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.