Reduced levels of estrogen starting around menopause can cause thinning of the lining of the urethra, the short tube that passes urine from the bladder out of the body. The surrounding pelvic muscles also may weaken with aging, a process known as "pelvic relaxation." As a result, women at midlife and beyond are at increased risk for urinary incontinence, or the involuntary leakage of urine. The main risk factors for developing urinary incontinence are vaginal childbirth and increased age.
The most common types of urinary incontinence in women are:
- Stress incontinence, which is caused by weak pelvic floor muscles. The most common symptoms are leakage of urine with coughing, laughing, sneezing, or lifting objects. Stress incontinence is common during perimenopause but typically doesn’t worsen because of menopause.
- Urge incontinence (also called "overactive bladder"), which is caused by overly active or irritated bladder muscles. The most common symptom is the frequent and sudden urge to urinate, with occasional leakage of urine.
Although urinary incontinence is common during perimenopause and beyond, it’s not an inevitable result of aging and should not be considered normal or passively accepted if it proves bothersome.
Sex is one area where urinary incontinence can prove troubling. Urinary leakage during intercourse is estimated to affect up to a quarter of women with incontinence. This can be embarrassing for women and lead them to avoid intercourse or to worry about leakage to the point that they are unable to relax and enjoy sex.
You need not endure problems with urinary incontinence. Exercises to train and strengthen the pelvic floor muscles may help (see the discussion of Kegel exercises later in the program), as may a number of medications and surgical treatments. The simple practice of urinating right before intercourse can also be helpful.