I love the way the new campaign for pads for urinary weakness has been renamed as for ‘sensitive’ bladders, it is so much more appealing to be thought of as sensitive when many of us have reached the point where sneezing or laughing can be hazardous. This is particularly true at menopause when up to 40% of women are affected. Unfairly perhaps, but women do suffer urinary incontinence four to five times as often as men.

Some of that has to do with pregnancy and childbirth, which can weaken the vagina, the pelvic floor muscles, and the ligaments that support the bladder. This can cause the bladder to be pushed out of place, making it harder for the muscles to perform. That’s why you may leak a little urine when you sneeze, cough, or laugh.

Symptoms of an overactive bladder:

* increased urinary frequency
* a sudden urge to urinate
* the need to urinate during the night
* difficulty getting to the bathroom without leaking

There are two separate types of incontinence:

Type 1: Stress incontinence leads to leakage of urine when the pressure in the abdomen is higher than the sphincter pressure. Normally, contraction of the pelvic floor muscles compresses the urethra [bladder outlet] and prevents loss of urine and stress incontinence. Loss can happen with sneezing, coughing and during exercise such as lifting, jumping and walking.

Type 2: Urge incontinence is when an uncontrollable need to pass urine occurs due to overactivity of the bladder wall muscle. Typically this occurs as you put the key in the front door or when water is running. There is generally no weakness in the pelvic floor muscles or muscles controlling the bladder outlet. This is also known as overactive bladder syndrome.

Mixed incontinence occurs when there is muscle weakness and and uncontrollable urge to go to the toilet together.

The hormone factor

For women, the bladder and urethra have hormone receptors and it is oestrogen that affects the health of the pelvic muscles and the urinary tract. It is oestrogen that helps to preserve the strength and flexibility of supportive pelvic and bladder tissues so low levels may be part of the reason these supportive tissues sometimes weaken as a woman ages and may also contribute to muscular pressure around the urethra.

Oestrogen can improve the flow of blood and strengthen the tissue around the urethra so women who are low in body weight at menopause may not be producing sufficient for this purpose. Often prescribed are low-dose topical oestrogen creams or patches but according to the Mayo Clinic, scientific evidence to support this treatment is lacking.

Low oestrogen generally indicates even lower progesterone levels so a combination cream of both hormones can be effective.

When to get help

Bladder weakness can affect many areas of your life from disturbed sleep, to your sex life and embarrassment in public over potential ‘accidents’. This can make it hard to enjoy everyday activities and so many women don’t seek help but these signs indicate you have a problem:

• urinate more than eight times in a 24-hour period
• get up in the night to urinate
• experience frequent leaking
• have changed your activities to accommodate your symptoms

How to help yourself

There are many types of surgery for stress incontinence and although this can be helpful, as time goes by a number of women will get a return of their urine leakage between 5 to 10 years after surgery. It is better to try and manage the condition yourself and pelvic floor muscle exercises are the most effective method of treating stress incontinence to date.

Often referred to as Kegel exercises you could follow the plan below. First you need to be able to identify your pelvic floor muscles and learn how to contract and relax them. To do this, stop urination in midstream. If you succeed, you’ve got the right muscles. Then practice this as below:

* Once you’ve identified your pelvic floor muscles, empty your bladder and lie on your back. Tighten your pelvic floor muscles, hold the contraction for five seconds, and then relax for five seconds. Try it four or five times in a row. Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions.

* Maintain your focus. For best results, focus on tightening only your pelvic floor muscles. Be careful not to flex the muscles in your abdomen, thighs or buttocks. Avoid holding your breath. Instead, breathe freely during the exercises.

* Repeat 3 times a day. Aim for at least three sets of 10 repetitions a day.

Don’t make a habit of using Kegel exercises to start and stop your urine while emptying your bladder as this can actually weaken the muscles. It can also lead to incomplete emptying of the bladder — which increases the risk of a urinary tract infection.

If you have stress incontinence then try contracting the pelvic floor before you do a movement that increases your abdominal pressure that leads to leakage. That is before you cough, sneeze, jump or pick up an object. Now you are using the ‘knack’ to control and prevent incontinence episodes.

More information:

Unfortunately at menopause women tend to put on weight, and being overweight can make bladder problems more common. Sleep at menopause is also often disturbed for this reason and for this progesterone does help aid sleep and rebalance hormones to help with any weight loss.

However for women who do need additional oestrogen as well as progesterone and are not overweight a combination cream is usually more effective for the bladder.