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Menopause is a time of change in a woman's life. One of the changes many women notice is increased difficulty with bladder and bowel control.

Common symptoms

Passing urine frequently and rushing to the toilet (urgency) to pass urine are the most common symptoms. Other symptoms include:

  • 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, and
  • constipation.

You should not ignore these problems because without help, they rarely go away and usually get worse over time. They can interfere with work, social activities, and sexual and personal relationships. Yet many women do not seek help. It is important that you seek help because the good news is that these problems can be treated, managed and often cured. Talk to your doctor or call the National Continence Helpline on 1800 33 00 66.

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 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.

6. Hysterectomy

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.

Who to contact for information, advice and support

For further information, free brochures and advice contact the National Continence Helpline freecall 1800 33 00 66.

For more information on menopause please visit the Jean Hailes Foundation for Women's Health.

If you are caring for someone with bladder or bowel problems, practical tips and advice are available to assist you with your care. Read more on caring with someone with incontinence.