“Leaky bladder” is a common problem women are embarrassed to talk about, even with close friends. If they summon the courage to say something to a doctor, they are often told to do Kegel exercises or take Detrol for “overactive” bladder. Menopausal loss of estradiol is not often discussed as a cause. Here’s one woman’s experience:
Dear Dr. Vliet,
I enjoyed reading your article on how estrogen loss affects incontinence. I wish I had known this years ago. My stress incontinence began after menopause. I would leak when I laughed, coughed, or sneezed, and I had to wear protection every day.
I am sure now that my estrogen level had dropped tremendously, but this connection was never mentioned by my doctor. He just said my bladder had dropped and I needed surgery to tack it back up. But after surgery, I leaked constantly. He said I needed more surgery. That didn’t help.
I tried many other treatments without relief. After reading your book, I asked my doctor to try the 17-beta estradiol (Vagifem) nightly for a month, and then four times a week. After three months, it dramatically reduced the urinary leakage. I am so grateful. I want other women to know what helped me so they don’t have to go through all I have suffered.
Accidental loss of urine is called incontinence. It is not true that incontinence is inevitable as we age. Incontinence means something is wrong. It is not “normal.”
Urinary incontinence is embarrassing, and uncomfortable, and it has a devastating economic impact. Americans spend more than $10 billion annually on products to hide or cope with incontinence, yet often have not been evaluated for ways to treat or eliminate the cause.
Even more staggering: Over age 65, Medicare costs for incontinence diagnosis and treatment are over $26 billion annually ... more than the costs for dialysis and coronary artery bypass surgery. Costs are even greater if incontinence in younger women due to pelvic surgery, such as hysterectomy.
Loss of bladder control is also a common reason older women are admitted to nursing homes. Once there, patients are even less likely to have a complete diagnostic evaluation, often “managed” with catheters and antibiotics, frequently with adverse consequences.
Different types of incontinence have different causes and treatments. More than 50 percent of incontinence problems can be cured, 35 percent markedly improved, and the remaining 15 percent made more comfortable, if patients are correctly diagnosed and get the right treatment.
Stress incontinence is loss of bladder control due to physical stress of increased pressure in the abdomen from such activities as laughing, coughing, sneezing, sexual orgasm, jogging, or straining to have a bowel movement.
It does not refer to emotional “stress” causing loss of urine. It results from weakness or loss of tone in the bladder muscles due to hormonal decline or to mechanical factors, such as damage to the bladder muscles in childbirth, or ligaments and muscles weakened by age or loss of hormones needed for healthy tissue.
Urge Incontinence typically results from bladder spasms, and is a sudden urge to urinate and inability to hold urine long enough to reach the bathroom. It is associated with increased frequency of urination. Causes include menopausal loss of estradiol, overuse of diuretics, or serious medical conditions (e.g., herniated disks, bladder infections, bladder cancer, or fibroids exerting pressure on the bladder). Urge incontinence is worse with excessive fluid intake, overuse of alcohol or caffeine, and cigarette smoking.
At menopause, when estradiol declines and remains low, several things happen that lead to “leaky” bladder:
• Cells lining the bladder, urethra and vagina are fewer and thinner (atrophic), and easily torn with friction (e.g intercourse).
• Muscles of the bladder, urethra and vagina lose strength, which causes decreased urethral closure pressure and allows more “leakage.”
• Healthy estradiol levels maintain normal pain sensation in the bladder and vagina. When estradiol is low, pain threshold is lowered, making nerve endings in the bladder and vagina more sensitive to pain, causing increased urge to void.
• Estradiol stimulates fibroblasts to make collagen, a structural protein for connective tissue of the vagina, bladder, and pelvic floor. Menopausal loss of estradiol causes loss of collagen (and skin wrinkling) that also means the urethra doesn’t close properly and there is more leakage. Loss of collage also means less ligament bladder support.
Incontinence, vaginal-bladder pain problems often respond well to low dose vaginal estradiol therapy that restores healthy estrogen effects. Options like Estring, Estrace cream, and Vagifem often improve symptoms without having to add other medication or surgery. But women often are not told about these hormone options, particularly if they are older than 60. Non-invasive behavioral techniques such as biofeedback and pelvic floor exercises can be combined with vaginal estradiol for even better results.
Here are five action steps to help improve bladder function:
1. Avoid overuse of alcohol and caffeine – they increase urine flow and aggravate incontinence
2. Stop cigarette smoking. Nicotine increases bladder pain and chemicals in tobacco increase the risk of bladder cancer.
3. Do Kegel exercises daily to increase strength of the muscle that controls urine flow.
4. Read It's My Ovaries, Stupid! for details about bladder and vaginal pain, types of incontinence, and treatment approaches.
5. See a knowledgeable, caring physician, get hormones tested, and ask about FDA-approved bioidentical vaginal estradiol (Estring, Vagifem, or Estrace cream) to reduce vaginal dryness and urinary leakage.
Do not sit home and suffer in silence.
For more information about Dr. Vliet, visit www.herplace.com.
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