Pee & Peri

As quickly as I typed the word “pee,” I cringed. Why? Although I am a very grown woman, I was raised by my mom and Mudea, and we (my cousins and I) were not allowed to say the word “pee”. I come from a lineage of astute, etiquette-poised women, and we don’t use such words! So what did we say? We used words like “urinate”, “potty,” and “use the restroom”.

I must admit. I still reference those words, but look, I couldn’t resist the alliteration of pee and perimenopause, and it flows better. So we’re gonna stick with it. Mama and Mudea, I am so sorry, excuse me this one time. 😏

This convo is for the women who get it. We’ve heard about it from our elders and may have even chuckled. We thought we were beyond their struggles and would NEVA identify with such unmanageable woes.

Well, look at us, we have reached the wildly adventurous middle-aged years, and we are faced with the unsuspecting experience of novelty pee, as I call it.

There is a name for it. That odd urge you feel to urinate and the unexpected urge to go and go right now?! Yeah, there’s a reason for it. My motto is “blame it ALL on perimenoPAUSE.” 🤭

But seriously, let’s talk.

What’s Going On?

The shift/decline in estrogen levels makes it very challenging to predict the need for a restroom break. The tissue in the pelvic area weakens in elasticity, making it less supportive. Our pelvic floor is going through a mid-life crisis of its own, regardless of whether or not she’s been used for delivering babies. I’ve spoken endlessly about how the many roles estrogen plays in our bodies, and YES once again, it’s estrogen. Our bladder and urethra rely on estrogen to maintain their strength and flexibility. As estrogen continues to fluctuate, the tissues become thinner and less responsive. This is what leads to incontinence.

It’s not you, it’s biology.

Incontinence is not one-dimensional, so let’s look at the different types.

Stress Incontinence

This is the most common type of incontinence, the one that startles you, makes you blink your eyes, and say “oops.”

When physical pressure is applied to your bladder and exceeds its ability to lock down that pressure you experience a leak. It can happen from a cough, sneeze, hearty laugh, or while exercising. This one can create a stressful situation simply because it is so unpredictable.

Urge Incontinence

This type may give you a little time to do a sprint to the bathroom, but it depends. You may hear the phrase “overactive bladder” referred to more often than urge incontinence. This is the one. These are immediate, intense urges to use the restroom. Your bladder mimics the behavior of that one child who, all of a sudden, has to go to the bathroom after you’ve already left the house and asked them relentlessly to go potty. 😩 Urge Incontinence responds to the sound of running water, being in cold weather, and every now and then no reason at all. I’ve heard a Physician advise against urinating in the shower as it trains your brain to relate running water with permission for your bladder to release.

Mixed Incontinence

Call it a spirit of confusion, your bladder doesn’t know what it wants to do. It may be triggered by pressure on the bladder or have a sudden urge just because. It’s the type of incontinence that wakes up and chooses violence against you.

Overflow Incontinence

Overflow happens when your bladder is not fully emptied and may leak or dribble at any given time. While this is the experience of some women in perimenopause, it can also be a result of pelvic organ prolapse (when one or more pelvic organs drop from their position).

Exhale, Let’s Discuss Solutions

Alright, let’s discuss a few available options; some are lifestyle-based while others are medicinal. I encourage you to talk with your Physician about all of the options. As a matter of fact, I want you to carefully select a Physician specifically for your Peri/Menopause years; someone you feel comfortable with having all of the odd talks with. They should be knowledgeable in menopause health and able to provide effective treatment, options, and/or suggestions.

Compromise Your Lifestyle Choices

What changes would you be willing to make?

Here are some to consider.

Dietary Adjustments

These are known to irritate the bladder for some women: Caffeine, alcohol, spicy foods, and artificial sweeteners. You don’t have to give up things like coffee, but remove some of these items for a while and see if you notice a difference. Log these changes so you can start creating a tracking system for yourself.

Bladder Training

Bladder training can be somewhat compared to potty training, in my opinion. Back in the day, potty training consisted of a schedule for your toddler to get accustomed to a routine. With bladder training, you are encouraged to schedule your restroom breaks; retrain your bladder. Gradually increase the time between breaks and keep a journal to log when you urinate, leak, and what may have triggered it.

Pelvic Floor Exercises: Kegels and Beyond

Kegel exercises can strengthen your pelvic floor muscles, but technique matters. Contract your pelvic muscles as if you're stopping urine midstream, hold for three to five seconds, then relax for the same amount. Work up to three sets of ten repetitions daily. However, some women benefit from working with a pelvic floor physical therapist who can ensure you're doing exercises correctly and address any muscle imbalances. Look for one in your area.

Medical Treatments

Topical estrogen therapy can help restore tissue health in the vaginal and urethral areas. Unlike systemic hormone therapy, topical estrogen has minimal absorption into the bloodstream while providing targeted benefits.

For urge incontinence, medications called anticholinergics can help calm an overactive bladder. Beta-3 agonists are another class of medications that can improve bladder function.

In some cases, medical devices like pessaries can provide support for pelvic organ prolapse, or procedures like Botox injections into the bladder muscle can reduce overactivity.

Alright, Another Deep Breath

I know it can feel surreal to be at this point in your adulthood, but it doesn’t have to be a life sentence, and you’re not alone. Research indicates that at least 50% women in their pausy seasons experience some form of incontinence. Consider any sanitary support needed right now.

Revisit the suggestions above, talk them over with your Physician, and give them a try.

Live, Age, Be Well and Whole…with fewer screams!