Menopause and Urinary Dysfunction

A woman's urinary health can start to deteriorate with menopause. The official name is urogenital atrophy. While this term includes the vagina as well as the urinary tract, we are going to focus on the urinary system. Atrophy means to deteriorate or the wasting away of muscles. Common symptoms include the need to urinate more frequently, incontinence (or the inability to control urination) and being prone to urinary tract infections.

The main cause of urogenital atrophy is the lack of estrogen. As estrogen levels reduce, the bladder starts to weaken as does the urethra (the tube that carries urine out of the body), reducing their ability to control urinary function. 

Another cause of urinary dysfunction is pelvic prolapse. Here, organs of the pelvic area drop into the vagina. This may be due to the trauma of vaginal childbirth and the weakening of pelvic muscles due to the reduction of estrogen. Pelvic organ prolapse weakens the pelvic floor muscles, and this results in urge incontinence (frequent, sudden, strong urges to urinate, with the possibility of not making it to the bathroom in time) or painful urination.

Do you know there are specifically trained physiotherapists called pelvic physios? They focus on the health of a women's pelvic region. If you are struggling with urinary dysfunction, this is where I would start. They will investigate you for prolapse and design an exercise program to help you strengthen your pelvic floor muscles. They can also see if you are a suitable candidate for:

• Biofeedback therapy. This technology helps retrain your pelvic floor muscles and increases the amount of urine your bladder can hold plus helps control the timing of urination.
• Electrical stimulation of the bladder muscles—another possible treatment path.
• Vaginal pessary ring. This device is inserted into the vagina to help it hold up a prolapsed bladder.
• Urethral insert. This is a small tampon-like disposable device that is inserted into the urethra before a specific action such as exercise, that could normally trigger incontinence. This acts as a plug and needs to be removed before you next urinate.
• Surgery. There are various surgical techniques they can look at if you are not improving

Acupuncture could also be beneficial.

If you don’t currently have urinary symptoms but want to reduce your risk of developing them, daily general pelvic floor exercises can help. If you have never done these before, the easiest way to isolate these muscles is on the toilet. Start a urine flow and then stop it, think about what muscles you are using. Continue starting and stopping until your flow is finished. Stay on the toilet and continue to contract and release these muscles. The next step is to try to isolate these muscles when you are not urinating. The great thing about pelvic floor exercises is that they can be done anywhere, and no one will notice.

Most women will experience a UTI (urinary tract infection) sometime during their lifetime. But for some women (one in five) this painful infection can become recurrent, and a vicious cycle of reinfection occurs. Infections are more common with pregnancy, menopause, diabetes, MS and other urinary issues such as using a catheter or having kidney stones. Unfortunately, many cases are triggered by sexual activity.

Signs and symptoms of urinary tract infections include:

• Pain, stinging or a burning sensation with urination (I’ve heard it explained as feeling like peeing out razor blades).
• A feeling of urgency and frequency with urination (and not much urine comes out).
• Some women experience fatigue and fever, including other general signs of infections.
• Urine might look different; it could be cloudy, dirty, dark and strange smells. If you have blood in it, head straight to see your GP.
• Pain in your lower abdomen or lower back.
• Some women have minimal symptoms and simply discover an infection with routine testing.

Prevention is definitely better than cure. Here are a few ideas to help you prevent an infection in the first place:

• Wipe front to back! Hopefully, your parents taught you this as a child, but just in case, after every trip to the toilet, you should wipe from your front to your back. This prevents bacteria from getting to your urethra.
• If possible, consider showering (cleaning your genitals) before and after sex.
• Make sure you are well lubricated for sex (dryness downstairs is one of the reasons UTI risk can increase with menopause).
• Urinate after sex. This helps flush bacteria out and away from your urethra.
• Are you using contraception? Certain oral contraceptive pills can make you more susceptible to infections. So can a poorly-fitted diaphragm.
• Wear cotton underwear and consider wearing nothing underneath when at home. It’s good to let the air circulate down there. If you have a private yard or balcony or if you like nudist beaches, fresh air and sunshine are even better. My old university lecturer swore by sunshine therapy as a treatment for a UTI or even candida.
• Avoid wearing stockings/tights or living in activewear (they block airflow!).
• Avoid very tight clothes such as jeans.
• Empty your bladder frequently and completely.
• Have showers instead of baths and look at your soap or body wash. It’s best to use a natural product like goat’s milk soap without fragrances or chemicals.
• Check that all your female hygiene products (if you still use them) are organic. Cotton is one of the most heavily sprayed crops. You don’t want to be putting pesticides directly on your genitals. If you are using incontinence products consider buying organic machine washable pads, e.g., organic continence pads, disposable organic pads, or reusable underwear.

Diet for prevention and treatment:

• Processed carbohydrates (bread, pasta, cereal, cakes) and sugars feed infection, so avoid like the plague.
• Protein (meat, eggs, tofu, nuts, seeds, fish, chicken) builds immune cells and fights infections, so eat a protein source in every meal.
• Good fats (avocado, eggs, coconut, olive, seafood) helps reduce inflammation and pain.
• Cranberry juice but only the sugar-free variety found in a health food store, not in a supermarket. This prevents bacteria from sticking to the bladder wall. Bacteria need somewhere to attach, to be able to divide and replicate. Therefore, the juice flushes it out and the infection is over. Cranberry contains the active ingredients of proanthocyanidins and D-mannose. D-mannose is also found in blueberries, apples, peaches, and oranges.  Other foods that contain proanthocyanidins include blueberries, bilberries, strawberries, and grapes.
• Probiotic-containing foods such as fermented food help prevent infections by increasing the good bacteria available.
• Water! This may seem like a catch-22, as the last thing you want to do is urinate again due to the burning sensation. However, you need to drink heaps of water to flush out the infection.
• Eats lots of immune-boosting foods such as garlic.
• Increase alkaline foods, e.g., fruits, salads, and vegetables. The more acidic your body is, the more prone to infection it is.

Additional supplements to consider for an infection:

• High-dose cranberry tablets or straight D-mannose products.
• High-dose immune-enhancing, urinary specific probiotics.
• Herbal medicine combination that includes a combination of urinary tonics, antiseptics, anti-inflammatories and diuretics (such as alfalfa, bearberry, celery seeds, dandelion, chamomile, chickweed, cornsilk, couch grass, echinacea, goldenrod, horse-chestnut, juniper, marshmallow, parsley, slippery elm, thyme, yarrow).
• Magnesium, if you are experiencing lots of cramping pain.
• Antioxidants and immune enhancers like zinc and vitamin C.