I know that menopause and frequent urination, especially during the early morning hours of the night, affects many of your clients. That’s because it’s a frequent question in my live zoom calls for the Practitioner course.
I also know that it affects numerous women as they transition menopause. When I take my live Masterclass events, it’s a question that gets a lot of surprised laughter. Hundreds of hands would shoot up in the air when I asked who was waking up because they needed to pee in the night. Everyone laughed when they looked around the room and saw that they weren’t alone.
Increased urinary frequency is a common menopause symptom. But it’s one that many women keep to themselves.
The changes to the urinary system during menopause can be such a challenge for many, not only during the night, but for those women who experience the sudden urge to pee and some leakage when they are exercising. That was the experience of Romany from the UK – that’s her in the banner below.
This is because the irritable bladder and urge to pee more frequently, is another symptom of menopause. However, a word of caution too – it can also be a sign of Urinary Tract Infection (UTI).
Hence, if your clients are experiencing painful urination, or if they have any pelvic or back pain, then they need to head to their Doctor right away.
The Mystery of Bladder Issues in Menopause
Urinary urgency, urinary incontinence, increased bladder activity and reduced bladder control are all bladder symptom experiences impacted by menopause. Here’s why.
After my very anecdotal survey of hundreds of women during my live events, I wasn’t surprised to find that epidemiologic studies report that approximately 1 in 4 women are affected by pelvic floor and urinary tract disorders with the highest rates in menopausal women. [Wu, Vaughan et al, 2014].
“There is clear evidence that oestrogen regulates the uro-genital tract. The abundance of estrogen receptors (ERs) in the urogenital tract explains why the natural reduction of endogenous oestrogen, the hallmark of menopause, can cause or potentiate Pelvic Floor Disorders (PFDs) and Urinary Tract Infections (UTIs).” [Alperin, Burnett et al. 2019].
The female hormone oestrogen is known to have an important role in the function of the lower urinary tract throughout our life.
Oestrogen and progesterone receptors demonstrate an influence in the vagina, urethra, bladder and pelvic floor musculature and like most of our organs, when we go into peri-menopause (the start of menopause) and move towards post-menopause, our renal system is experiencing the result of declining estrogen production.
You may not know that females have an abundance of oestrogen receptors in the bladder and urethra. Because of this, as oestrogen levels decline during our menopause transition, this may impact the function of the urinary tract in mid-life women.
Furthermore, with the loss of the role of oestrogen in ligaments and joints, the pelvic floor ligaments may change too. This may cause many women to experience stress incontinence and/or increased frequency and urgency in needing to pee.
Whilst it always pays to see a healthcare professional who specialises in this area, it also helps to understand what is going on and how women can help themselves as well. So, first things first. If you are coaching women and the topic of their bladder frequency and urgency comes up, then you need to understand that during the menopause and post-menopause transition, their bladder and urinary tract is ageing and changing.
Physiological factors that cause bladder symptoms
Age-related reduction in bladder capacity, reduced urine flow, diminished urethral pressure, and the inability of the bladder to empty fully after voiding are known changes that occur as we age.
But the thing that can upset many midlife women the most, is the feeling of urgency. And this is all to do with the changes that occur to the nerves that infiltrate the bladder wall. As such, stress impacts bladder function in menopause too.
The bladder is responsive to stress hormones, adrenaline (epinephrine), and nor-adrenaline (nor-epinephrine).
This is because the sympathetic nervous system exerts influences on the urethra and bladder for urine collection and storage. Hence, the urethra and bladder are replete with adrenergic receptors. These receptors respond to the stress hormones, adrenaline, and nor-adrenaline as well as cortisol.
As women move into menopause and oestrogen levels decline, there is an effect on the response of the adreno-receptors in the urinary tract. Yes, they can get out of balance, resulting in an overactive bladder.
This is more commonly known as ‘overactive bladder syndrome’ (OAB) or detrusor overactivity.
The term ‘detrusor’ refers to the involuntary contractions during the filling phase of the bladder that may be spontaneous or provoked and is associated with urgency. This is why the most common symptoms of OAB are urgency, nocturia (night-time urgency), frequency and urge incontinence.
As our bladder fills up and stretches, and because oestrogen levels are declining, changes also occur to the nerve signals in the bladder wall.
Disruption to these nerve signals can cause nerve irritability and/or urgency and urinary incontinence. All effects which can impact on your client’s home, working and recreational life.
I know this has occurred for many MyMT™ women, as it did for me too. Learning how to override these sensations is an important aspect of the MyMT™ programs and I teach you about solutions for the ageing bladder in the MyMT™ Practitioner Course as well.
How Waking Up To Pee Frequently Impacts the Health of your Clients
Night after night of getting up to have a pee is devastating for your client’s energy levels. But researchers suggest that women with OAB have greater physiologic and psychologic stress reactivity than healthy controls.
Importantly for women experiencing OAB, stress appears to exacerbate bladder urgency. That’s why an overactive bladder can have a huge impact on the quality of your client’s daily life.
When women are experiencing higher levels of stress or they aren’t sleeping well, then their chronic stress hormone called cortisol, typically increases as does their blood pressure and heart rate.
Inflammation increases too and I’ve written about this numerous times in my education newsletters for Practitioners. When cortisol is high, and there is a subsequent increase in both heart rate and blood pressure, this affects the ageing bladder and urethra as well. Bladder control stems from the nervous system which is replete with receptors that respond to stress hormones.
At night when women don’t sleep well, cortisol levels remain high, as does blood pressure.
This affects the nervous system regulation of the bladder. It’s no surprise that women feel the urge to go more frequently, especially at night. Research suggests overactive bladder symptoms affect up to 80% of women in menopause (Alperin, Burnett et al, 2019).
But as I mentioned earlier, other medical conditions could be at play, such as a UTI or pelvic floor disorder. Be sure to get clients’ to talk to their doctor, because there are other treatment options they can discuss too, including oestrogen gels and creams that are suited to the vulvo-vaginal and genito-urinary tract.
If your clients are struggling with OAB symptoms, then please get them to get these checked out from Specialists in your area when you can.
Then if you are confused about how to help them with their symptoms and/or their weight gain, I hope you can join me on one of the MyMT™ Courses for Health Practitioners. You will be amazed at what you learn and how simple changes to your client’s lifestyle can turn around their symptoms.
I hope that you can spend a few minutes reading some of the wonderful stories from Practitioners who have kindly shared their journey with you on the Practitioner Testimonial pages on the website.
Alperin, M., Burnett, L., Lukacz, E., & Brubaker, L. (2019). The mysteries of menopause and urogynecologic health: clinical and scientific gaps. Menopause (New York, N.Y.), 26(1), 103–111. https://doi.org/10.1097/GME.0000000000001209
Harvard Health (2013). Overcoming an overactive bladder. Harvard Health Publishing Online.
Siroky, M.B. (2004). The Aging Bladder. Reviews in Urology, 6(1), 53-57.
Wu, J., Vaughan, C., Goode, P., et al (2014). Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet. Gynecol. 123, 141 – 148. [PubMed: 24463674].
