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Urinary Tract and the Menopause

Menopause and urinary tract. During menopause, we go through countless changes. Some are obvious and some other quite unnoticed. These changes will most likely only be noticed when you start feeling uncomfortable. Urinary tract changes are one of those: very annoying.

In fact, many women report to have this discomfort when the menopause starts. Let’s see why this happens. A primary cause is urogenital atrophy, which is the deterioration of the urinary tract and vagina. The atrophy is defined as “decrease in size or wasting away of a body part or tissue atrophy of muscles” and it can be caused by ageing, disuse or even in a minor extent, hormonal changes (of course it is!)

Most times, this symptom seems to just magically appear once you hit menopause!  The debate is : Are the changes in a woman’s urinary tract with age due to menopause and the lack of oestrogen, or just ageing alone?

What we do know is that the bladder is loaded with oestrogen receptors, so the lack of oestrogen that we all know comes with the menopause, probably really doesn’t help! With age, the bladder itself begins to lose both its volume and its elasticity, this is why we find ourselves rushing to the bathroom more often! At the same time, the number of bacteria that you find in your genital region increases (and this is often due to weakening of the vaginal walls which is mostly due to ageing) your urethra as well may thin, then allowing bacteria easier access to your bladder. A lot of those changes are influenced by the pH adjustment which is due to the lack of oestrogen.

Are the changes in a woman’s urinary tract with age due to menopause and the lack of oestrogen, or just ageing alone?

So weaker bladder + more bacteria =bigger risk of urinary tract infections (bladder infections and/or kidney infections).

Kidney infection is a bit rarer as usually you start having cystitis first, which is so painful and annoying that women seek for help and medication quite immediately. This risk begins to increase within four or five years of your final menstrual period. The bladder also begins thinning, leaving women more susceptible to incontinence, particularly if certain chronic illnesses (such as diabetes) or recurrent urinary tract infections are also present.

The pelvic floor muscles weaken as you age as well, partially due to the lack of oestrogen. Research showed that oestrogen acts as a regulator of muscle energy metabolism and muscle cell viability. Since menopause leads to the end of ovarian oestrogen production there is a concurrent partial deterioration of muscle function. After menopause, the risk of metabolic diseases also increases.

Weaker bladder + more bacteria =bigger risk of urinary tract infections

You may find that some type of exercise, coughing, laughing, lifting heavy objects, or any other movement that puts pressure on the bladder can cause small amounts of urine to leak, and this is due to the pelvic floor not being elastic and strong anymore (of course, having had children doesn’t help. Giving birth puts a lot of strain on pelvic floor muscle).

Lack of regular physical exercise can make it worse. Did you know that incontinence doesn’t have to be something you like your whole life with and just cover it up with adult diapers! It is usually a treatable condition. In fact, recent research has shown that bladder training is a simple and effective treatment for most cases of incontinence and is a way less expensive and safer than medication or surgery. So, if you experience one of those symptoms/problems you may want to seek for professional help. Another way to improve your pelvic floor health, is to use small devices, like Pelviva, which has been used successfully by Meg. You can see more info in this video!

In postmenopausal women UTIs often accompany the symptoms and signs of the Genitourinary Syndrome of Menopause (GSM). The genitourinary syndrome of menopause (GSM) is a new term that describes various menopausal symptoms and signs including not only genital symptoms (dryness, burning, and irritation), and sexual symptoms (lack of lubrication, discomfort or pain, and impaired function, but also urinary symptoms, urgency, dysuria, and recurrent urinary tract infections). The terms vulvovaginal atrophy and atrophic vaginitis, which were generally used until recently, has been found to have some limitation because they did not cover the full spectrum of symptoms experienced by women and did not imply that the symptoms are related to a decreased oestrogen level in menopause.

Evidence based research shows that topical oestrogen normalise vaginal flora and greatly reduce the risk of UTIs. The use of intravaginal oestrogen may be reasonable in postmenopausal women not taking oral oestrogen. Several other strategies have been used to prevent recurrent UTIs: probiotics, cranberry juice and d-mannose have been studied. Oral immunostimulants, vaginal vaccines and bladder instillations with hyaluronic acid and chondroitin sulfate are newer strategies proposed to improve urinary symptoms and quality of life.

In the meantime, to decrease the discomfort caused by vaginal dryness it is always a good idea to use a lubricant. You can find natural range of lubricants and intimate washes MM products range.