So, you're having night sweats, hot flashes, vaginal dryness, and on top of all that ? you leak. Welcome to the transition toward menopause (sometimes called perimenopause.) Perimenopause is that time in life when your periods diminish and eventually come to a stop. The transition affects every woman differently. Your passage may be smooth sailing, or you may experience any number of symptoms in varying degrees. Menopause (the permanent end of menstruation and fertility) is typically reached once you experience 12 consecutive months without a menstrual period.
During this transition, a decline in estrogen levels may result in weakening of the pelvic floor muscles that support bladder control, contributing to LBL (light bladder leakage.) Though not all menopausal women experience LBL, it is common. One in three women experiences it. We reached out to urologist, Jason Gilleran, MD at Beaumont Women's Urology Center in Royal Oak, Michigan for his insights on ways to manage LBL during menopause.
"The sooner women address their bladder leakage, the better their results," Dr. Gilleran said. By changing the habits that contribute to light bladder leakage during menopause, you may sidestep, reverse, or even eliminate those little leaks.
Seek out support
LBL can improve dramatically in some women by strengthening the pelvic floor muscles with Kegel exercises. However, telling a woman to do Kegels without instruction is a lot like sending someone to the gym without telling her how to use the equipment. Dr. Gilleran recommends pelvic floor therapy as a first course of action. "I refer a lot of young women, who are perimenopausal and noticing early signs, to a pelvic floor physical therapist," he said, "They can accelerate your ability to do Kegel exercises correctly and get results. They're not as expensive as some of the other treatments, and there are no harmful side effects."
If you aren't getting the kind of support you'd like from your regular physician or gynecologist, be proactive and ask to be referred to someone with special training, like a pelvic floor physical therapist or urogynecologist.
What else can you do to prevent, reverse or eliminate LBL in menopause? Dr. Gilleran suggests the following:
Stop smoking. Smoking is a contributing factor for bladder leakage during menopause.
Minimize weight gain. Women tend to gain weight during menopause. A noted research study showed that women with an average weight of about 200 pounds who lost 10% of their body weight, had a 70% reduction in leakage.
Treat chronic coughs and allergies. A chronic cough causes ongoing pressure on the pelvic floor and, over time, can weaken it. Get pulmonary issues like persistent coughing and sneezing under control.
Go to the gym. There are many benefits to exercising. It can even improve your mood and outlook. Some patients have told Dr. Gilleran, "I don't let LBL stop me from exercising. I wear a pad and get on with things." Others say they don't want to go to the gym because they're self-conscious about leaking. "High impact exercise may not be the best thing for the pelvic floor," Dr. Gilleran said, "Doing core strengthening exercise like Pilates or yoga is better from that stand point."
Be gentle with yourself
While some factors contributing to LBL are within your control, others are not. "Childbirth or a family history that predisposes you to issues, like prolapse, can contribute to a weakened pelvic floor," Dr. Gilleran said. "If you're predisposed then you're more likely to experience some level of leakage after menopause." Remember, you are not alone. One in three women experiences LBL, and there are ways both surgical and non-surgical to manage it.
"Once a woman has gone through menopause completely, LBL is a factor of what has happened to the pelvic floor tissue," said Dr. Gilleran. "Some women come in with signs that they have changes in their vaginal tissues, while other women's tissues are still in pre-menopausal shape. After menopause, women, in their mid-50's or 60's, who have intact muscles in their pelvic floor, tend to have better results with a pelvic floor physical therapy." When women experience bladder leakage and wait too long to see a pelvic floor physical therapist, it's more likely that muscle loss may have taken place. The earlier you intervene, the better results you'll have long term.
When to consider surgery
The reason some women are likely to opt for surgery is that they've tried conservative treatments, like pelvic floor therapy, and it failed. The surgery for LBL has changed over the years. "It used to be a fairly invasive surgery involving a bladder lift or bladder suspension, which would be done sometimes through a cut in the abdomen," Dr. Gilleran said, "Now, most everything, is done through three small incisions in the vagina, sometimes only one. The most common type is called a sling surgery."
The goal of the sling surgery is to place a type of backboard under the urethra. It acts as a mechanism to stabilize the tissues so that with exercise, coughing, and sneezing, the urethra itself doesn't fall down. "It's not designed to lift it up like we did in the past, but keep it from falling down," Dr. Gilleran said, "To better understand it, picture yourself trying to sit down and you have no chair. What we're doing is putting a chair there."
Sometimes Dr. Gillleran has patients use a tampon. A tampon can actually act to stabilize, a bit like what a sling does except they use it externally. When women use a tampon and they don't leak as much, it's a good sign sling surgery will help them."
Controversy over hormone replacement
Some women wonder if hormone replacement is the answer to eliminating LBL during menopause. "From a risk/benefit standpoint, it's not something I use as an everyday practice for LBL alone," said Dr. Gilleran, "I tend to avoid it because of the concerns with breast cancer, uterine cancer, blood clots, heart attack, and stroke - those things that have been associated with it. Hormone replacement is a very controversial issue."
You are not alone
Dealing with menopause can be challenging, especially when it includes light bladder leakage. If you find yourself feeling down, resist the urge to withdraw and isolate yourself. You are not alone. One out of every three women experiences LBL ? that's about 40 million women! This is a time to reach out to your close friends and family. Many of them may be going through it too. When you start the conversation about LBL, you will find support and camaraderie with the women in your life. It's possible to manage LBL, and move on to living your life to the fullest. Choose to be your most vibrant self, and enjoy your mid-life adventure.
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