Menopause and incontinence: why bladder changes happen and how to treat them

Irregular periods? You probably expected those. Hot flashes, joint pain, and fatigue? You’ve likely encountered those symptoms, too. But leaking urine when you cough, laugh, sneeze, or exercise? That’s one menopause symptom many women may never see coming.

“This may be because women are increasingly talking about menopause symptoms in small circles, but incontinence can still feel taboo. Wearing a pad for leakage may be common but can be uncomfortable to discuss with providers or even friends,” says Lori Walter, PT, DPT, a pelvic health physical therapist at Hinge Health. 

More than 60% of postmenopausal women experience some form of urinary incontinence, or involuntary urine leakage. Declining estrogen and other changes during perimenopause and menopause can affect your bladder and pelvic floor, making leaks more common.

While urinary incontinence is common during this life stage, it isn’t something you simply have to accept as part of aging. Pelvic floor physical therapy, targeted exercises, and other treatments can help improve bladder control.

Here’s what causes menopause-related incontinence and, importantly, what you can do to help prevent and treat it — including gentle exercises recommended by Hinge Health physical therapists. 

What is genitourinary syndrome of menopause? 

One of the biggest reasons urinary incontinence becomes more common during menopause is genitourinary syndrome of menopause (GSM). GSM describes a group of changes that affect the vagina, bladder, and urinary tract as estrogen levels decline.

Estrogen helps keep the tissues that support your bladder, urethra, and pelvic floor healthy and resilient. As estrogen levels fall, those tissues become thinner, drier, and less elastic, making symptoms like urinary urgency, frequent urination, vaginal dryness, painful sex, and urine leakage more likely.

Causes of urinary incontinence during menopause

Several factors can contribute to urinary incontinence during menopause, and often more than one is involved.

• Hormone changes. Estrogen plays an important role in keeping the bladder, urethra, and pelvic floor healthy and strong. During menopause, estrogen production drops by about 95%. As hormone levels decline, the muscles and connective tissues that support your bladder become thinner and less elastic, making it harder to control urine flow.

• Weakened pelvic floor muscles. Your pelvic floor is a group of muscles that supports your bladder, bowel, uterus, and vagina. As estrogen declines, these muscles and the connective tissues around them can weaken, reducing the support your bladder and urethra rely on to prevent leaks.

• Pregnancy and childbirth history. Pregnancy and childbirth can change the pelvic floor in ways that don't always show up until years later. Pregnancy places extra pressure on the pelvic floor, while vaginal delivery can stretch or weaken the muscles that support your bladder and urinary sphincter. Those changes may increase your risk of urinary incontinence even decades after your last pregnancy. “Think of it like a house of cards,” says Dr. Walter. “You might have had your last child years ago, but your body was able to manage and compensate for those changes through hormone support and other factors. As estrogen declines during menopause, that support changes, which can contribute to symptoms.”

• Carrying extra weight. Extra weight increases pressure on the bladder and pelvic floor, which may raise the risk of urinary incontinence.

• Changes in posture. Lower estrogen can also contribute to changes in bone mineral density (BMD), muscles, and joints, which can trigger new aches and pains or even cause flare-ups of old injuries. When this happens, it’s been coined the musculoskeletal syndrome of menopause (MSM). The changes in bone density and muscle strength can also affect your posture. “As posture changes and the upper back becomes more rounded, it can make it harder for the diaphragm to expand fully,” Walter says. “That increases pressure in the lower abdomen, which may contribute to incontinence.”

• Previous pelvic surgery. Hysterectomy and other pelvic surgeries can affect the muscles, connective tissues, and nerves that support bladder function, increasing the likelihood of urinary incontinence for some women.

• Certain neurological conditions. Conditions such as Parkinson’s disease, multiple sclerosis, and Alzheimer's disease can affect the nerves involved in bladder control and contribute to urinary incontinence.

Types of incontinence common during menopause

Urinary incontinence in women takes different forms and can trigger leakage for different reasons. Types of urinary incontinence common during menopause include:

• Stress incontinence. Leaks happen when pressure on your bladder suddenly increases, such as when you cough, sneeze, laugh, lift something heavy, or exercise.

• Urge incontinence. You experience a sudden, intense urge to urinate and may not make it to the bathroom in time, even if your bladder isn’t entirely full.

• Mixed incontinence. This is a combination of stress and urge incontinence, which is the most common pattern during menopause.

How movement can help menopause and incontinence

If you’ve started avoiding exercise because you're worried about leaking, you’re not alone. Many women skip workouts, long walks, or other activities they enjoy because they’re afraid of having an accident.

Movement is one of the most effective first treatments for urinary incontinence. “Pelvic floor physical therapy is the perfect first-line treatment for incontinence,” says Walter. Research shows it can significantly improve bladder control and quality of life.

Pelvic floor muscle training strengthens and improves coordination between your pelvic floor, diaphragm, core, hips, and lower back so they can better support your bladder during everyday activities. Exercises like kegels help build pelvic floor strength, while other targeted movements improve mobility, reduce tension, and increase the support your bladder needs to function well.

With consistent practice, you may notice fewer leaks, which in turn can help you get back to the activities you love that you may have avoided due to your bladder symptoms.

These exercises work together to help manage incontinence during menopause in several ways. Deep squats and single leg stance build strength in your core, hips, and back muscles, providing better support for the pelvic floor. The butterfly stretch eases pressure on your bladder, which can help reduce or prevent leaks. Doing Kegel lunges can strengthen your pelvic floor muscles and improve bladder control during movement. Standing Kegels with quick flicks or squeezes help calm your bladder and can give you extra time to reach the bathroom.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatment for menopause and incontinence

The right treatment depends on the type of urinary incontinence you’re experiencing, how severe your symptoms are, and what’s contributing to them. Many women notice improvements with simple treatments, such as pelvic floor physical therapy and lifestyle changes, while others may benefit from medication, vaginal estrogen, or procedures. Some common approaches include: 

• Try pelvic floor physical therapy and targeted exercises. Targeted pelvic floor exercises can help improve bladder control by strengthening the muscles that support the urethra and bladder. A physical therapist may also recommend exercises to strengthen your hips, core, and lower back muscles so your pelvic floor muscles can relax and relieve incontinence. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Bladder training. This helps gradually increase the amount of time between bathroom visits so your bladder can comfortably hold more urine. This often involves following a regular bathroom schedule and using strategies such as Kegel exercises to manage sudden urges instead of rushing to the toilet.

• Practice diaphragmatic breathing. Your diaphragm and pelvic floor work together every time you breathe. Practicing this type of deep belly breathing helps coordinate your pelvic floor muscles, improving their function and even your bladder control. It can also help you relax so that you can engage your pelvic floor quickly when needed, such as before coughing, sneezing, or lifting something heavy.

• Make a few lifestyle changes. Small daily habits can also support bladder health. Staying hydrated, avoiding constipation, practicing healthy bathroom habits, and limiting foods or drinks that irritate your bladder may all help reduce leaks.

• Vaginal devices to help prevent leaks. Some women benefit from devices that provide extra support for the bladder and urethra. Urethral support inserts are disposable devices placed into the vagina before physical activity to help prevent leaks. Pessaries are reusable silicone devices fitted by a healthcare provider that support the bladder and other pelvic organs. “Think of a pessary like a sports bra for your pelvis,” Dr. Walter says. They can be especially helpful if leaks happen during walking, exercise, or other activities.

• Ask your doctor about certain medications. If pelvic floor physical therapy and lifestyle changes aren’t enough, your healthcare provider may recommend medication. Some medications help the bladder hold more urine, while others reduce urgency or improve the function of the muscles involved in bladder control.

• Try vaginal estrogen. Because estrogen plays an important role in bladder and vaginal health, some women benefit from low-dose vaginal estrogen. It helps restore moisture, elasticity, and thickness to tissues around the urethra and bladder, improving support and reducing symptoms such as urgency, irritation, and urine leakage. Talk with your healthcare provider about whether vaginal estrogen is appropriate for you.

• Explore procedures if needed. If your symptoms continue despite trying simple treatments, your healthcare provider may recommend injections that help support your urethra or even surgery to provide additional support for the bladder or bladder neck. They’ll help determine which option best fits your symptoms and goals.

Tips to manage menopause incontinence 

Managing urinary incontinence often comes down to small habits practiced consistently. These strategies may help reduce leaks and improve bladder control.

• Try not to hover over the toilet seat. Sit down and allow your pelvic floor muscles to fully relax so you can properly empty your bladder.

• Skip “just in case” bathroom trips. Going before you actually feel the urge can train your bladder to hold less urine over time. Instead, try to gradually space bathroom visits about every two to three hours.

• Brace your pelvic floor before coughing or sneezing. Gently contracting your pelvic floor just before you cough, laugh, sneeze, or lift something heavy can help reduce stress leaks.

• Limit bladder irritants. If certain foods or drinks seem to worsen your symptoms, keeping a bladder diary may help you identify patterns. “Estrogen affects the entire body, including the gastrointestinal and nervous systems,” Walter says. “Foods that didn't bother you before menopause may begin to irritate your bladder as hormone levels change.”

• Stay hydrated. When you feel like you can’t hold in your urine, you may be hesitant to drink water, but it actually supports your bladder health. Dehydration can irritate your bladder and increase urgency, while also contributing to constipation. 

• Manage constipation. Constipation puts additional pressure on your bladder and pelvic floor, making leaks more likely. Staying hydrated, eating enough fiber, and staying active can all help.

When to see a doctor

Incontinence during menopause often improves with pelvic floor exercises and lifestyle changes. But if your symptoms are severe, getting worse, or significantly impacting daily activities, see a healthcare provider. It’s also a good idea to get care if you have:

• Blood in your urine

• Fever or chills

• Severe or sudden pelvic or abdominal pain

• Difficulty emptying your bladder

• Symptoms of a urinary tract infection (UTI), such as burning with urination, cloudy urine, or foul-smelling urine

A healthcare provider can determine whether menopause is contributing to your symptoms or if another condition needs treatment.

PT tip: Know what’s normal

Many women aren’t sure whether their bladder habits are typical until they talk with a pelvic floor physical therapist.

“One of the first things I ask is how many times someone urinates in a day,” Dr. Walter says. “Many have no idea, and others are hesitant to answer because they don't know what's considered normal.”

In general, urinating about 8 to 10 times a day with a stream that lasts 8 to 20 seconds falls within a typical range, Dr. Walter says. If you’re going much more or less often, or your symptoms are affecting your daily life, a pelvic floor physical therapist can help identify contributing factors and develop a personalized treatment plan.

“The goal isn’t just to stop leaks,” Dr. Walter says. “It’s to help you get back to living your life without constantly thinking about where the nearest bathroom is.”

How Hinge Health can help you

If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

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