Urine Luck! Peeing Problems in Perimenopause (Pee Pee Pee)
Urine Luck! Peeing Problems in Perimenopause (Pee Pee Pee)
Where's the bathroom, please?
Let's dive into a topic that's all too common in perimenopause: urinary tract problems. These issues can arise even if you've never had a history of them. The urinary tract includes the urethra, bladder, two kidneys, and two ureters. In perimenopause, the most prevalent problems tend to be with the urethra and bladder, which is where our focus will be in this article.
I’m such a potty girl; I have so much to cover on this topic. However, today’s overview will provide basic information. Over time, I’ll review each of these symptoms individually. Consider subscribing so you’ll receive all of the latest information. If you’ve already subscribed, my sincerest thank you!
How Did My Bathroom Suddenly Become My Best Friend?
Estrogen, once thought of as “just a sex hormone”, was revealed in the 1990s to be much more. As neuroscientist Lisa Mosconi, author of The Menopause Brain, explained to me, it’s a full-body hormone essential for the proper functioning of our entire female body, including the urethra and bladder.
When estrogen levels fluctuate and then decline, our cells are deprived of the necessary hormone to grow healthy tissue. This leads to tissue thinning, weakening, sensitivity, and loss of elasticity in the urethra and bladder tissue.
When this happens, urinary problems occur because the tissue becomes more fragile and prone to irritation and infection. It can’t do its job correctly. Tight and weak pelvic floor muscles, those muscles that hold everything up in your pelvic “bowl,” can also cause urinary issues and symptoms of discomfort. Tight pelvic floor muscles will constrict the normal flow of urine, and weak ones will let everything pass right through. Below are the most common urination issues, collectively known as Genitourinary Syndrome of Menopause (GSM).
Leaking – leaking urine from drops to dribble to drain. The medical term for this is urinary incontinence. The most common types of incontinence:
stress incontinence due to coughing, sneezing, laughing, exercise, etc.
urge incontinence which is a sudden and immediate urge to urinate and can cause leaking. (Note: if you’re leaking urine, please use products designed for this purpose and not menstrual products, which will trap the moisture incorrectly for your need and may increase your risk of a UTI).
combo incontinence is a combination of both types of incontinence
Frequency – peeing more frequently than average; may disrupt sleep. You can have frequency by itself or combined with urgency.
Urgency – got to GO NOW! See “leaking” above.
Prolapse – bladder falling out of place within the pelvic cavity (this can happen with the uterus, vagina and rectum too). This is usually caused by weak pelvic floor muscles, from the demands of pregnancy, or injury. Poor posture and being overweight may also contribute. When the bladder falls out of place, it falls into the wall of the vagina, causing a feeling of pressure or a bulging sensation.
UTI – burning, pressure, frequent urination of small amounts, bladder and urethra discomfort caused by bacteria
Non-UTI Symptoms – The loss of estrogen can cause you to feel like you have a UTI when you don’t have any bacteria present.
Side Note: GSM was previously called vaginal atrophy or vaginal dryness, but the medical community felt that the name didn’t address the entirety of the symptoms, so now it’s called GSM. GSM symptoms can show up in perimenopause, however most of the research to date is done on menopausal women.
Now What Do I Do? Or, How Not to Live Your Whole Life in the Bathroom
The good news is that there is plenty of help for these symptoms. Seeing a medical provider is key, but there are some things you can do on your own. I’m all about the tips, so I won’t leave you hanging. Here is a short list of things that can help:
Pelvic Floor Rehab – A pelvic floor physical therapist can help you address any of the above issues by re-training the muscles in your pelvic floor to work correctly. Tight and weak pelvic floor muscles can cause additional pressure and urinating problems. If you can’t afford a physical therapist, there are a ton of great physical therapists with YouTube videos showing some of the stretches and exercises they do with clients. (helpful for leaking, frequency, prolapse, urgency)
Vaginal Estrogen Cream (Brand name: Estrace in the US1, generic is available) – This ain’t your mother’s old lady crotch cream. This is a prescription product that can help heal and repair the urethra (vulva & vagina, too). A little dab of the cream on the outside of the urethra (where your pee comes out), plus the vaginal application, will do the trick. It’s been shown to help with UTIs, urgency and frequency symptoms and keep you out of the bathroom longer day and night. 2 (helpful for urgency, frequency, as well as UTIs3 )
Double Voiding – This means peeing twice in the same bathroom trip. The purpose is to get your bladder to empty completely. There’s always a little bit of urine left over when you pee, so hang out a bit and see if more comes out. Emptying your bladder fully will give you more time before bathroom trips and help reduce your risk of UTIs. There are techniques explained online, but basically you:
Sit down per usual, pee, wait a few minutes, pee again -OR-
Sit down per usual, pee, stand up to do a hula hooping motion both ways for 10 seconds, and then sit back down to pee.
Personally, I like the hula hooping motion because it gets me to dance in the bathroom which causes me to laugh. That, in turn, relaxes my pelvic floor. (helpful for frequency, UTI)
Act Like a Dude Taking a Dump - aka “time on toilet.” Your goal is to sit, get comfy, and let the pelvic floor relax. Don’t strain to push out urine, just let the pelvic floor and bladder do its job. Hopefully, when you do this, your family won’t scream in public like mine do, “What took you so long in there?” For some reason, they never ask Dad this question.
Avoid Constipation - What do backed-up bowels have to do with urination? Everything! When poop gets backed up, hard, and compacted, it builds up a lot of pressure and can affect urination by decreasing the sensitivity of nerves for bladder signaling, causing difficulty urinating, and leaking issues.
Bladder Irritants - Okay, team, this is hard. Our favorite things can irritate the urethra and bladder, making you feel like you constantly have to go or causing burning urination. Try reducing coffee, tea, alcohol, spicy foods, smoking, and using artificial sweeteners, especially when symptoms are flaring.
Pessary – a device that gets fitted into the vagina to support the bladder and can help prevent leaking. See your primary physician, GYN physician, urologist, or pelvic floor physical therapist for more information.
There are plenty more solution options, and some of them are pretty high-tech, but I recommend seeing a medical provider for those.
Who Should I See About This?
I realize that dealing with anything “down below” can be embarrassing and make women feel shameful. However, you don’t have to feel this way about one of your body parts or an issue that you’re struggling with. It’s easy to push off a symptom and not see someone about it or ignore it entirely, but I know how debilitating urinary problems can get. Hold your head up high and make that call. If you take the time to address it, you’ll be much happier you did. Just picture me right there with you!
“Hold your head up high and make that call. If you take the time to address your symptoms, you’ll be much happier you did.”
I’ve lost count of the number of urologists I’ve seen in my lifetime, as this has been a lifelong issue with me. Sure, sometimes you have to sit in waiting rooms filled with old men or patient rooms displaying anatomically correct models of penises, but while it was once a male-centric specialty, more and more women are getting into the field and catering to women. My last two urologists were both women and it’s a refreshing experience.
You can discuss ongoing urination issues with your primary care doctor or your gynecologist. Either one can help. If you think you have a UTI, you can also go to an urgent care clinic. If you have something going on that’s more complicated, like recurring UTIs, a prolapsed bladder, or severe incontinence, your doctor may refer you to a urologist (a doctor who specializes in the urinary system), and possibly a pelvic floor physical therapist. For a list of which doctor does what, visit my Which Doctor page for a lighthearted review of medical specialties.
Special thanks to my daughter for creating the graphic art for this article. She made my husband’s dream coffee table book idea come true, Urinals Across Europe.
I recently learned that Estrace or any chemically matched (aka bioidentical) vaginal estrogen cream is not yet available in Canada and has to be custom-made. Kim Volpi, The Vagina Coach, June 2024.
(Source: Rahn, David D. MD; Carberry, Cassandra MD; Sanses, Tatiana V. MD, et al.; Vaginal estrogen for genitourinary syndrome of menopause: A systemic review; Obstetrics & Gynecology; 124(6):p 1147-1156; December 2014)
Ferrante, Kimberly L. MD∗; Wasenda, Erika J. MD†; Jung, Carrie E. MD†; Adams-Piper, Emily R. MD‡; Lukacz, Emily S. MD†. Vaginal Estrogen for the Prevention of Recurrent Urinary Tract Infection in Postmenopausal Women: A Randomized Clinical Trial. Female Pelvic Medicine & Reconstructive Surgery 27(2):p 112-117, February 2021. | DOI: 10.1097/SPV.0000000000000749