The Link Between Menopause and Overactive Bladder (OAB)

OAB is an embarrassing problem for many older women and takes a heavy toll on their quality of life. The prevalence of overactive bladder in older women is 19% – Approximately 1 in every five women above the age of 65 suffer from it.

Understanding what OAB is and how it’s related to your menopause can help you manage this condition better and lead a more comfortable life. In this blog, we’ll see what an overactive bladder is, its symptoms, its relation to menopause, risk factors and options to manage it.

What is an Overactive Bladder (OAB)?

Overactive bladder is a problem related to your bladder function, which causes an urgent need to pee. Normally, when your bladder is full, the brain triggers the contraction of your bladder muscles to eliminate urine. However, in an overactive bladder, the bladder muscles (detrusor muscle) start to contract before your bladder is full, even if the volume of urine in it is very low. 

This causes a compelling desire to urinate, which might be difficult to control and result in unintended leakage of urine. This leaves women self-conscious and makes them hesitant to leave home or go to work. 

Overactive bladder is not a disease; it’s a group of symptoms. It is generally not a life-threatening condition and can be treated effectively.

Here are the symptoms of an overactive bladder (OAB):

• A sudden urge to urinate that is difficult to control.
• Increased frequency of urination (eight or more times) during the day.
• Nocturia or increased frequency of urination at night (urinating more than twice a night), resulting in disturbed sleep.
• Involuntary leakage of urine associated with a sudden uncontrollable desire to pee, called urgency urinary incontinence.
• Passing small quantities of urine many times a day.

In women, OAB severity tends to increase with age - women of perimenopausal and postmenopausal age groups mostly report it.

How does an OAB impact your life?

OAB can affect your daily life, leading to disturbed sleep and making you hesitant to go out or take part in social activities or gatherings. It may also reduce your quality of life and may have an effect on your overall well-being. 

How Menopause Contributes to OAB

Wondering why OAB is more common in perimenopausal or postmenopausal women? How are they related? Let us find out.

1. Hormonal Changes and Bladder Health

The urinary bladder and surrounding structures are rich in oestrogen receptors (proteins found in cells that bind to the hormone oestrogen and trigger biological responses). During menopause, oestrogen levels in your blood drop significantly, influencing the functioning of the bladder and urinary tract.

2. Effects of Low Oestrogen

How do the low oestrogen levels in postmenopausal women affect the bladder? Low levels of oestrogen reduce blood flow to your bladder and surrounding tissues, which causes it to gradually become weak. This causes degenerative changes and thinning of the bladder lining, making it more prone to irritation and contractions.

3. Associated Symptoms

The symptoms of OAB during menopause include:

• Urinary urgency which makes it difficult to hold urine and may cause leaking.
• Increased frequency of urination, both during the day and night (nocturia).
• Increased likelihood of urinary tract infections.

What’s the link between menopause and bladder dysfunction? Yes, it’s the hormones. Understanding this link can give you a clear idea of why many women experience the onset or worsening of OAB during menopause. 

Risk Factors That Exacerbate OAB During Menopause

Let us now look into the risk factors that worsen urinary issues during menopause.

1. Age and Hormonal Shifts

OAB is very common among older women – more than 45% of women aged 65 and older experience it. With advancing age, the sensation of bladder filling is reduced, and bladder capacity falls, leading to an older woman having less time to respond to the call to urinate. 

Oestrogen helps maintain the strength and flexibility of the bladder and pelvis in women. Low levels of oestrogen during menopause make the bladder weak and more sensitive, resulting in OAB.

2. Lifestyle Choices

• A study showed that 48.1% of people over 60 years of age suffering from overactive detrusor symptoms consume more than 300 mg of caffeine daily. This shows that increased caffeine intake can lead to or worsen the symptoms of an overactive bladder.
• Excessive intake of alcohol can also exacerbate OAB symptoms.

3. Other Health Conditions

• According to a 2020 study, diabetes mellitus is an independent risk factor for overactive bladder, which may also be associated with diabetic complications such as diabetic neuropathy.
• Another study concluded that OAB symptoms are more prevalent in diabetic people than in non-diabetic people.
• Obesity and fat accumulation in the abdominal cavity increase the pressure inside your abdomen, which may lead to the development of urinary incontinence and overactive bladder.

4. Genetics

Genetic factors may also increase the risk of an overactive bladder. If your family members, like your mother or sister, experience OAB in the postmenopausal years, it means you are susceptible to it, too.

Managing OAB During Menopause

An overactive bladder is not just a physical symptom; it can impact your quality of life. When combined with menopause, it can become even more challenging, throwing your daily life off-balance and lowering your self-esteem. The good news, however, is that OAB can be easily treated and managed. Here are some OAB management strategies:

1. Lifestyle Modifications

Making certain simple yet effective changes in your lifestyle can help manage OAB better.

2. Bladder Training

Bladder training is a form of behavioural training to help control the urge to urinate and make your bladder store more urine. It helps improve the quality of life by reducing the frequency of peeing.

3. Kegel Exercises for OAB

Increasing age and low oestrogen levels in postmenopausal women cause the pelvic floor muscles to become weak. Kegel exercises focus on strengthening the pelvic floor muscles and supporting the bladder, uterus and other pelvic organs. Practising Kegel exercises for OAB can improve bladder control and even prevent urinary incontinence.

Read more – Mastering Kegel Exercises: Benefits, Techniques, and Tips for Pelvic Floor Health.

4. Diet Adjustments

To prevent the irritation of your bladder, avoid foods such as alcoholic beverages, carbonated drinks, excessive sugars, artificial sweeteners, coffee, tea, tomatoes, spicy foods and citrus fruits and juices.

Make sure your diet is a balanced one and includes fresh fruits and vegetables, whole grains, nuts, fibre-rich foods, healthy fats, and lean proteins.

5. Conventional Medical Treatments

If your symptoms of OAB are severe or disrupt your daily life activities, you should seek medical treatment. The different treatment options available for OAB during menopause are:

a) Hormone Therapy
We have already seen how oestrogen deficiency increases the risk of OAB. A 2021 study showed that in postmenopausal women, use of vaginal oestrogen improves symptoms of OAB. Oestrogen, especially when administered locally as creams or patches, has proven to be beneficial in reducing the symptoms of overactive bladder.

b) Medications
In women who are contraindicated for hormone therapy or those who do not wish to undergo hormonal treatments by choice, medications like anticholinergics (a class of medicines that relieves cramps in the stomach, intestines and bladder) and beta-3 agonists may be useful. 

A study on the efficacy and safety of Mirabegron, a beta-3 agonist, for the treatment of overactive bladder showed that it was effective in reducing mean number of micturitions and incontinence episodes per 24 hours, as well as improving other secondary outcomes like OAB symptoms and quality of life measures.

8. Alternative Therapies

Alternative treatments like the use of supplements or herbs may also be beneficial in reducing the symptoms of OAB.

• Acupuncture 
  Acupuncture is effective in improving OAB symptoms and is as effective as medical therapy. Combining acupuncture and medications had more favourable effects than medicines alone for the treatment of OAB.
• Biofeedback
  Biofeedback (a therapy that helps bodily functions that happen involuntarily) teaches you how to strengthen the pelvic floor muscles and when and how to contract them. Studies have found that biofeedback may improve your bladder function by as much as 94%.
• Herbal Supplements
  Certain herbal ingredients like pumpkin seeds, cleavers and saw palmetto may help support bladder health and reduce the symptoms of OAB in postmenopausal women. 

Other herbal supplements like cornsilk (Zea mays), horsetail (Equisetum) and capsaicin (extract from chile peppers) may also be beneficial, but scientific studies on its effects on OAB are yet to be carried out.

When to Seek Medical Help

Is the urgency and frequency of peeing interfering with your daily activities? Your doctor can help you decide on the right treatments to manage your symptoms with minimal side effects.

For diagnosis of OAB and ruling out other possible conditions, your healthcare provider may recommend additional tests like:

• Urinalysis:
  This refers to the medical testing of a urine sample to check for infections or blood in the urine.
• Urodynamic Testing:
  Tests that measure the functioning of your bladder, urethra and sphincters and how well they work together to store and eliminate urine.
• Consultation with a Specialist:
  Sometimes, you may be advised to consult a gynaecologist or a urologist for further treatments of your symptoms.

The Bottom Line 

An overactive bladder during menopause can make life more difficult than it needs to be. Fortunately, many treatments and management strategies are available to reduce discomfort and improve your quality of life.

Even though overactive bladder is a common issue in women who have reached menopause, it is often overlooked. If you experience symptoms like an urgent need to pee or an inability to hold back urine, get medical help. Treatment combined with lifestyle and diet changes can improve comfort and enable you to lead a healthy life.