Medically reviewed by Dr. Tamara Neuhaus MD

Urinary Incontinence and The Urge to Pee. Is This Perimenopause?

It cannot be normal to wake up 3-5 times a night to pee. And even during the day, I’m going way more often than I ever did. - Lisa, 52

What is it?

For a lot of women in peri/menopause, multiple, late-night trips to the bathroom have become the new normal (as if night sweats weren’t enough to keep you awake). And often, the ability to “hold it” during the day may suddenly plummet. When you gotta go, You. Gotta. Go. This is called Urge Incontinence. Alternatively, some women may start to experience Stress Incontinence. This is when a wee bit of urine comes out when you cough, sneeze, laugh or lift something heavy. 

Why does it happen?

When estrogen goes MIA, the tissues that line your urethra—that little pipe that connects your bladder to the outside world—start to get thinner and weaker. The pelvic muscles that support your urethra and bladder also start to weaken, especially if you have a history of pregnancy, vaginal delivery, or obesity. Another cause could be a fibroid on the front, outer surface of your uterus, putting pressure on the bladder. 

What can you do about it?

Once infection is ruled out, there are a few different ways to take back control of your bladder, depending on the kind of incontinence you’re experiencing.

Urge Incontinence is very easily and effectively improved with vaginal estrogen. This is available by prescription in the form of creams, rings, or tiny pills inserted directly into the vagina. Because it works locally, and not systemically, this form of hormone therapy (HRT) is safe for just about all women, regardless of breast cancer or stroke history. If estrogen doesn’t solve the problem for you, there are two other classes of medications (antimuscarinics and beta adrenergics) which your doctor might prescribe after an in-person evaluation. 

Stress Incontinence is an anatomical issue, caused by waning muscle tone in the pelvic area. It can also be a symptom of a condition called prolapse, which is when the weakening muscles in your pelvic floor allow your uterus or bladder to drop lower into your pelvis. Other symptoms of prolapse are lower back pain, difficulty moving your bowels or a bulging inside your vagina. There are several treatment approaches you can take here.

  • Kegels. These are exercises you can do to strengthen your pelvic muscles. We recommend working with a gynecologic physical therapist to learn to do them the right way, as doing them the wrong way could make matters worse.

  • Vaginal Estrogen. The same creams, rings or tiny pills used to treat urge incontinence can also help increase tone and elasticity of the tissues in your urinary tract, and sometimes help with mild stress incontinence.

  • Pessary. This small device would be inserted into your vagina to hold your uterus and bladder in place.

  • Surgery. There is a way to “remodel and waterproof” by putting the wayward organs back where they belong, and sometimes adding a urethral sling to stop urine from escaping the urethra.

Emerging studies are showing that treatments with radio frequency, light, and laser devices may help improve the tone and elasticity of tissues in the urinary tract. If so, this could decrease symptoms of both urge and stress incontinence. We’re eagerly awaiting FDA approval of this exciting technology for these indications.

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At The Cusp, we provide expert menopause care. We are a comprehensive, convenient virtual healthcare service dedicated to help you feel better.