Ever laughed so hard you peed? Ever laughed not so hard and still peed?

You’re certainly not alone!

There’s no plumber you can call for this kind of leak… time to burst open the conversation on incontinence and menopause.

Urinary incontinence affects 50% of women, according to the Mayo Clinic. During our menopausal journey, our reproductive hormones decline. As a result, we can experience over 30+ menopausal symptoms. Of course, we are all familiar with hot flashes and night sweats, but did you know this loss in hormones can cause vaginal atrophy?  Who knew?!?!

There are so many symptoms of vaginal atrophy that the Menopause Society (NAMS) put them under one category and named it Genitourinary Symptoms of Menopause or GSM for short. (Don’t get me started on the choice of name. Suffice it to say that the sisterhood could come up with a better name, but that’s another blog! ) Symptoms of GSM include vaginal dryness, burning, irritation, discomfort/pain during sex, urinary urgency, dysuria, and recurrent urinary tract infections. Many of these symptoms overlap.

Coping with Menopause and Incontinence

There are many ways to cope with menopause and urinary incontinence. The first thing to do is make an appointment with your menopause specialist. If you don’t have one, I have some helpful tips here.

Your menopause specialist will examine you and determine your urinary incontinence type. The most common types are:

• Urine incontinence is when you have a sudden compelling urge to void that cannot be delayed and results in urine leakage.
• Stress incontinence is when leakage happens because of physical movement or activity — such as coughing, laughing, sneezing, running, or heavy lifting.
• Mixed Incontinence is a combination of both.

Incontinence Treatment Options:

Non-Surgical: Depending on your diagnosis, your treatment needs may involve one or more of the following non-surgical options:

• Pelvic Floor Health/Therapy: Pelvic floor therapy is a safe and effective technique that has helped many of my subscribers! A physical therapist uses massage and gentle pressure to relax and stretch tightened tissues in the pelvic area. A Female Pelvic Medicine and Reconstructive Surgery/Urogynecologist (FPMRS) can also help. If you want to read more tips straight from a pro herself, read this blog where I spoke to Dr. Varuna Raizada.
• Kegel Exercises: You’ve been told to “do your Kegels,” but doing them correctly is tricky. Practicing these exercises regularly can improve muscle tone and help you regain control over your bladder.
• In-Home Pelvic Floor Muscle Training Devices: They are application-based biofeedback devices that are inserted vaginally and measure the strength of the pelvic floor contraction.
• Intravaginal Pessary: This is commonly used and inserted by your doctor.
• Protective Products: Various products, such as incontinence tampons, absorbent pads (oh joy…we thought we eliminated those!) or underwear, can provide an added layer of protection and give you the confidence to continue your daily activities without worrying. You can insert other devices for the day or during certain activities.
• Local Estrogen Therapy (LET): Vaginal estrogen is one of the most effective treatments for GSM. It improves the quality of the vaginal skin and tissues in and around the vagina. It thickens the skin of the vaginal canal and increases natural lubrication. It also restores the normal pH of the vagina. I recently had an 84-year-old subscriber reach out to me who was interested in dating again (!) Loved that! She was worried that “there were cobwebs down there.”  I suggested she make an appointment with her gynecologist for an exam.  I was horrified she hadn’t had one in 15 years!  She was immediately put on LET.  She reached out to me two weeks later and told me the date didn’t work out, but she no longer needs diapers due to the LET she is now using!!  
• Medications: There are medications to relax the bladder muscles.
• Botox: I know – I was surprised too! Women with severe symptoms may find relief with bladder muscle Botox injections.
• Peripheral Tibial Nerve Stimulation: This is done in the clinic setting. They use an acupuncture-like needle and mild electric stimulation. This would be a series of treatments and then a maintenance protocol.

Surgical Options:

My girlfriend recently shared her surgical journey with me.  I asked her if she would mind me sharing it with the sisterhood.  She was happy to share!

Q: Can you give us a brief history (including age) of when you started experiencing urinary incontinence?

I may have had it before, but it became an issue when I was pregnant with my second kid at the age of 40.  I had a bad cold, and every time I sneezed, coughed, or cleared my throat, boom.  A leak.  It went away after the birth, but by 45, I was no longer jumping in the jumpy house. 

Q: Do you know what caused this?

The doctor said it could be due to pregnancy, vaginal birth, age, and/or being active.  I’m a hiker (I did Kilimanjaro in 2019!), which is when it became more of an issue— long training hikes with a heavy pack. 

Q: What healthcare professional did you see with this issue?

I talked it over with my OBGYN, who suggested getting surgery.  I saw the gynecologist urologist who suggested I do Kegel exercises.  I did Kegels for a  year or more.  Didn’t really help.  Then saw a different doctor, and she talked me through all my options. 

Q: Did you try pelvic floor muscle exercises, local estrogen therapy, and/or incontinence products?

Tried the pelvic floor exercises.

Q: What type of sling surgery did you have?

I had a mid-urethral sling inserted through a small incision in the vaginal wall. The mesh sling ends are passed-out incisions above the pelvic bone. 

Q: Were you under full sedation? Yes.  

Q: What was the recovery period like after surgery?

Waking up was a little groggy but good. Walking was a bit shaky. I could pee normally, so I didn’t need a catheter.  They gave me ibuprofen, Tylenol, and an oxo-based painkiller.  Recovery was easy— very little spotting. If I walked too much, there would be some discomfort deep inside.  The incision points were very tender and sore.  The whole recovery was six weeks, with zero exercises allowed.  I could walk on flat trails. 

Q: What are the key benefits you have experienced, and are there any drawbacks or potential risks we should be aware of? 

I loved going for a hike, sneezing, and not worrying about it.  It is amazing how automatic crossing my legs is when I sneeze, cough, or laugh, especially now that I don’t need to.  There is a lot of peace of mind that I don’t have to worry about leaking again. 

Q: In hindsight, would you choose to undergo the mesh sling insertion again?  Yes!! 

Remember, although urine incontinence is common – it is not normal! Make an appointment with your menopause specialist and get an evaluation to determine the type and cause of your issues. There are lots of treatment options.  No need to change the quality of your life. [ss_click_to_tweet tweet=”Remember, urinary incontinence is common but not normal. Consult your menopause specialist for an evaluation to determine the type & cause of your issues. Multiple treatment options are available to maintain your quality of life.” content=”” style=”default”]

Get the help you need and deserve to find a watertight solution!

My Motto:  Suffering in silence is OUT! Reaching out is IN!

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