Do you plan your day to make sure bathroom stops will be available at short notice and scope out buildings so you always know where the nearest bathroom is? Do you tell yourself to wait an hour for that glass of iced tea so you won't have to dash for the ladies'? If so, it's likely you have a condition called overactive bladder, or OAB. And if you're between 40 and 55, you may be one of the many women for whom OAB is a menopause- and age-related problem.
One comfort: You're in good company. Studies show overactive bladder affects at least -- and probably more than -- 17 percent of women in the U.S. Why more? Because this problem is vastly underreported, due to the embarrassment factor. (It's not the easiest thing to talk to your doctor about.) But help is available. In the meantime, here's what you should know about the connection between OAB and menopause -- along with available treatments.
What's the connection between menopause and OAB?
During perimenopause, the period leading up to menopause, and menopause itself, the level of estrogen -- which helps to keep the tissues of your bladder and urethra healthy -- begins to drop significantly. If you've begun to notice dryness and sensitivity during sex, it's likely you're at risk for bladder problems as well. The reason: Just as the tissues of the vaginal wall begin to thin and dry out, so does the tissue that lines the bladder. When that happens, your bladder becomes more sensitive to irritants and more susceptible to "hair-trigger" releases.
What's more, lack of estrogen can cause the pelvic muscles, which are responsible for maintaining bladder control, to weaken, eventually resulting in incontinence.
What kinds of bladder control problems can happen with menopause?
Overactive bladder problems take several forms:
Urgency: When you have to go, you have to go now.
Frequency: You have to go all the time, defined as a problem if you need to go more than eight times in a 24-hour period. And yes, this problem is a doozy for sleep disruption.
Urge incontinence: The need to go now comes on suddenly, and if life conspires to keep you from a bathroom, you're likely to have an accident.
How is overactive bladder diagnosed?
To diagnose a bladder control problem, your doctor will perform a physical exam, including a pelvic exam, and order lab tests to look for signs of a urinary tract infection or other problems. The doctor will likely ask you to keep a "voiding diary" in which you write down when you go, note any associated symptoms, and describe accidents or other problems. Keeping a diary can also help you reconstruct the circumstances prior to an accident (what you ate and drank beforehand, for example) or any overwhelming urges you can recall.
What treatments are available for menopause-related overactive bladder?
There are treatments for overactive bladder that help you control urges, treatments that strengthen muscles or improve muscle control, and treatments aimed to reduce irritation. Your primary care physician or a specialist can work with you to analyze the type of bladder problems you're having and devise the best treatment plan. Doctors are likely to suggest lifestyle changes, muscle-strengthening exercises, and bladder retraining before they start considering medications -- which might have side effects -- or surgery. What follows are the most common treatment strategies for bladder problems associated with menopause, in the approximate order a doctor might suggest them.
Treatments for menopause-related OAB
Many women are surprised to learn how dramatically what they eat and drink can affect bladder function. With that in mind, try eliminating these foods and beverages -- all known to irritate the bladder, triggering urges -- one at a time:
coffee and black tea
citrus fruits and juices
regular and diet sodas
tomatoes and tomato-based foods and sauces
vinegar and vinegar-based salad dressings
To protect your bladder from irritation and urges:
Drink eight glasses of water, spaced throughout the day.
Drink milk, almond milk, or soy milk to see if this soothes the bladder.
Take a probiotic supplement, which helps control yeast growth and promotes a healthy bladder.
Strengthening bladder muscles with Kegel exercises
With menopause and age, the pelvic floor muscles known as Kegels that control the bladder's ability to hold in urine can weaken. Strengthening these muscles is one of the best ways to control leakage. To do Kegel exercises, squeeze and hold the pelvic muscles and then relax them. You can locate these muscles by stopping the flow of urine midstream. Although it's possible to strengthen Kegels on your own, it's most effective to work with a nurse or physical therapist (PT) who specializes in pelvic floor strengthening.
Bladder retraining for OAB
Your bladder muscles have been conditioned over time to influence the sudden need to urinate -- probably in ways you're not even aware of. Bladder retraining is a therapeutic approach to relearning the ability to resist or inhibit the feeling of urgency. Working with a physical therapy nurse, you retrain your bladder by timing visits to the bathroom according to a strict schedule, gradually extending the intervals between bathroom visits. In addition, the therapist will teach you ways to distract yourself between bathroom visits. A bladder retraining program usually takes at least six to eight weeks to produce results.
If your bladder symptoms first appeared during perimenopause or if you're experiencing other menopause-related symptoms, working with your ob/gyn to control these symptoms with hormone therapy may be the best solution. Many women find that vaginal estrogen, applied as a ring or cream, is extremely effective in treating overactive bladder. This is different from systemic hormone therapy, which uses oral hormones distributed throughout the body, and has fewer risks.
Weight gain -- often associated with menopause -- puts pressure on the bladder, urethra, and pelvic floor muscles. Many women have found that when they lose weight, their overactive bladder problems are gone along with the extra pounds. If you're overweight, try using your frustration with overactive bladder problems as a motivator to embark on a diet and exercise regime.
A number of medications can help with OAB, but they're not usually the first treatments of choice, since they can have side effects. Known as anticholinergic agents, they block the action of acetylcholine, a neurotransmitter that stimulates the bladder to contract. By reducing contractions, they control sudden urges to go. Common brand names include Ditropan, Detrol, Oxytrol, Enablex, Sanctura, and Vesicare. The problem with anticholinergics is that they can block other bodily functions as well, causing side effects such as dry eyes, dry mouth, and constipation. Some women also report memory and cognitive problems from these medications.
Many experts now recommend using biofeedback to aid in the process of retraining the bladder and strengthening pelvic floor muscles. Biofeedback uses electrodes to measure your heart rate, skin temperature, and breathing. It's designed to help you become more aware of your bladder and the muscles you use when you urinate, so you can develop more control.
Sacral nerve stimulation surgery
Electrically stimulating the nerves that control the bladder can greatly reduce or prevent incontinence. Sacral nerve stimulation uses a small neurotransmitter that's implanted under the skin and sends mild electrical impulses to a nerve located in the lower back (the sacral nerve) to influence the bladder and the pelvic floor muscles. The surgery doesn't have a permanent effect on nerves; it only works as long as the neurotransmitter is operational. This means it's a symptom treatment rather than a cure, but it also means it can be discontinued at any time.