19 Sep 2013

Gotta Go, Gotta Go, Gotta Go RIGHT NOW!

If you’re a woman who’s entered perimenopause, you may be noticing that trips to the bathroom are becoming more frequent and less in your control. This can be annoying and embarrassing, especially if you don’t make it quite in time!

What’s the connection between menopause and that “gotta go right now” feeling?

During perimenopause and menopause, 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, this may be a clue that you’re at risk for bladder problems as well.  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 (like caffeine and spicy foods) and more susceptible to “hair-trigger” releases.

Lack of estrogen can also cause the pelvic muscles, which are responsible for maintaining bladder control, to weaken, eventually resulting in incontinence. Women who have had hysterectomies may experience these issues to an even greater extent because the surgery itself affects pelvic floor muscles.

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. This is especially problematic if you have issues pre-existing issues with insomnia!
  • Stress incontinence: that good hard laugh or unexpected sneeze can result in an unwelcomed wetness just when you least expect it.

The good news is that there are ways to lessen the impact of roller-coaster hormones. You might think that hormone replacement therapy would help here, but the data actually suggests it may worsen the situation. Dietary changes (avoiding spicy foods, caffeine and other bladder irritants) and pelvic floor exercises may be helpful.

Unfortunately, this one of those topics rarely comes up in casual conversation. No one likes to discuss it…even with their doctors! So many women suffer in silence and end up feeling isolated and alone. There are several medications that can help with bladder control, so if you have problems that are beyond annoying and infrequent, it’s time to speak up. You have LOTS of company!


Dr. Anna Garrett

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