Bladder weakness in menopausal women
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Hardly anyone talks about it openly – and yet incontinence in and after menopause becomes an issue for many women: according to estimates, almost every second woman suffers from involuntary urine leakage after menopause. The number of unreported cases is high because many sufferers are so embarrassed by the problem of “pee in their pants” that they don’t even bring it up when they go to the doctor. Instead, they try to make do with incontinence pads and hope that no one notices. As long as they can.
But unfortunately, urinary incontinence tends to get worse over the years. That’s why it’s important to do something about it as early as possible. Fortunately, there are now numerous treatment options for bladder weakness during and after menopause.
Doctors distinguish between two main forms of urinary incontinence. In urge incontinence, the urge to urinate suddenly becomes so strong that you can no longer make it to the toilet in time. More frequently, however, menopausal women suffer from so-called stress incontinence. This is caused by involuntary loss of urine during physical exertion – for example when laughing, coughing, jumping or heavy lifting. Usually there is no urge to urinate beforehand. In so-called mixed urinary incontinence, symptoms of both forms occur.
Causes of bladder weakness/incontinence during menopause
The main reason for continence problems during menopause is the decline in estrogen production. The hormone deficiency weakens the pelvic floor: it loses elasticity and tone. This impairs the function of the external sphincter. Excess weight, chronic constipation, poor posture and frequent heavy lifting put additional strain on it. Pregnancy and vaginal deliveries can also put long-term strain on the pelvic floor.
When the pelvic floor muscles can no longer withstand the weight of the abdominal organs, the bladder and uterus can sink down slightly. This causes the urethra to bend more. This can further impair the function of the bladder closure.
As estrogen levels drop, blood flow to the mucous membranes throughout the genital tract also decreases. In the urethra, too, the mucosa becomes thinner, drier and less elastic. This makes it more difficult for the sphincter to seal.
Thin mucous membranes with poor blood supply also promote the penetration of germs and the occurrence of bladder infections. This in turn is also a risk factor for urinary incontinence.
What helps against incontinence during menopause?
The best remedy for stress incontinence is a strong pelvic floor. Targeted pelvic floor training can effectively counteract bladder weakness – the sooner, the better. The costs of such courses are usually covered by health insurance.
Muscle training can be optimized with biofeedback, vaginal cones (love balls or cone-shaped plastic objects that are inserted into the vagina) or electrical stimulation. These aids are also available for independent use at home. However, which methods are suitable depends very much on the individual condition of the pelvic floor. A pelvic floor trainer or gynecologist can help assess this.
You can also get a handle on it with a pessary. This is a disk-, ring- or cube-shaped silicone structure that is inserted into the vagina to stabilize the urethral wall. The gynecologist fits the shape and size best suited to the individual. It is worn permanently or only on certain occasions, for example during sports.
Drug therapy for bladder weakness during menopause
Local hormone treatment with estrogen cream or suppositories has been shown to be effective for menopausal stress incontinence. They plump up the thinned-out vaginal and urethral mucosa. In most cases, such preparations contain the bioidentical “mucosal hormone” estriol in a low dosage that has virtually no side effects and is also considered safe for women who have had breast cancer. Systemic hormone replacement therapy – i.e. hormone tablets or preparations for application to the skin – on the other hand, can increase the risk of incontinence and worsen existing symptoms.
In the case of severe stress incontinence, the doctor may prescribe a drug that increases the muscle tension of the bladder closure muscle (active ingredient: duloxetine). For the treatment of urge incontinence, there are various prescription drugs that can curb excessive urination.
Surgical interventions for stress incontinence
By injecting a special gel (“bulking agent”) in the area of the urethra and the external sphincter, the tightness of the bladder outlet can be improved. However, the effect usually lasts only a short time; long-term studies are still lacking for this relatively new method. Laser treatment of the anterior vaginal wall or urethra also reduced symptoms of stress incontinence in studies. Laser therapy stimulates the formation of new collagen and thus strengthens the tissue. However, the study situation is still thin here as well. Statutory health insurers generally do not pay for laser therapy for incontinence.
In a so-called sling operation, a surgeon places a tension-free plastic tape around the urethra (tension-free vaginal tape, TVT). This raises it and improves bladder closure. This is done minimally invasively from the vagina. In studies, the long-term success rate was up to 90 percent. Instead of plastic bands, the body’s own fascial loops are sometimes used.
An older but still commonly performed surgical method for stress incontinence is elevation of the bladder neck using fixation sutures (Burch colposuspension). It can be performed through an abdominal incision or minimally invasive. Success rates are similar to those of sling surgery, but the risk of subsequent uterine prolapse increases.
Clara Wildenrath from wechselleben.de