Menopause & Incontinence

The need for more awareness of management strategies.

There has been a strong push towards more active screening for urinary incontinence by health care professionals, and it’s likely that such an approach will improve the management of symptomatic menopausal women. In this population, the incidence of urinary incontinence is reported to be around 50% 3, yet the condition goes largely unreported unless discussions are initiated by the doctor or health care professional.

Many older women do not seek help for urogenital symptoms in the mistaken belief that such things are an inevitable consequence of the ageing process.4 Other reasons may include embarrassment or a lack of awareness that symptoms can be improved. Although lifestyle changes and pelvic floor muscle exercises can improve incontinence, many older women simply don’t know what changes or exercises are required.

Management approaches

First-line treatment of urinary incontinence is conservative; it includes addressing lifestyle factors and undertaking pelvic floor muscle exercises. Modifiable risk factors include constipation, obesity, chronic cough, inappropriate exercise and heavy lifting. Some women simply don’t eat enough fibre and drink enough water to maintain healthy bladder and bowel function. Although it may seem obvious to health care professionals, these women may not see the connection between their diet and incontinence symptoms. Others are unaware of the link between obesity and urinary incontinence. Apart from one-on-one education, patient education materials from the National Conference Helpline may help women identify simple lifestyle modifications that can improve their symptoms.

Physiotherapists can also help with bladder retraining and pelvic floor exercises in menopausal women. In fact, experts are calling for more proactive education on pelvic floor muscle function in this population, similar to the education provided to postnatal women.

3.Sherburn M, et al. Is incontinence associated with menopause? Ostet Gynecol. 2001; 98(4):628-33. 4. Robinson D, Cardozo L. Urogenital effects of hormone therapy. In: Best Practice & Research Clinical Endocrinology & Metabolism, 2003; 17:91-104.