About Incontinence - Contributing Factors - Hormonal Changes in Women
Medical Reviewer: Karen Sasso, MSN, RN, APN, CCCN
Due to shifts in their hormonal balance, some women experience urinary incontinence. Women may experience leakage of urine either with physical activity such as coughing, sneezing, or lifting (called "stress urinary incontinence" or "SUI"), or preceded by a strong and sudden urge (called "urge urinary incontinence") or both ("mixed incontinence").
Why?
Women have the hormone "estrogen" in their body. Estrogen helps develop female characteristics, and is also responsible for your monthly period by causing the lining of your uterus to build up before being released every 28 days or so. Estrogen also helps your pelvic floor to be strong, supple and stretchy, which gives you greater control over your bladder and bowel function. Stress urinary incontinence is the most common type of incontinence experienced as a result of a loss of tissue strength from declining estrogen levels in the peri (before) and post (after) menopausal stage of life. Prior pelvic floor injury from multiple or traumatic vaginal deliveries tends to contribute to a higher incidence of stress urinary incontinence in menopause. Estrogen depletion can contribute to more urgency, frequency of urination and sometimes urge urinary incontinence.
As mentioned above, the following can all cause changes to your estrogen levels, and thus cause incontinence:
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Menopause: During menopause your estrogen levels naturally decline, which can lead to increased incontinence. Additionally, during the time leading up to menopause, called “premenopause” or “perimenopause”, a woman’s estrogen levels begin to gradually decline.
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Changes during your monthly menstrual cycle: Estrogen levels change throughout your monthly cycle. Estrogen is highest while ovulating. Right before, during, and right after your period is generally when your estrogen levels are at their lowest, making you more likely to experience leakage during that time in your cycle.
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Hormone Replacement Therapy: There is conflicting evidence regarding whether or not hormone replacement therapy can affect urinary incontinence, although some women claim to notice a difference in bladder control when either starting or stopping HRT. In some cases, women feel that the HRT helps them gain more bladder control, and in other cases women feel that it causes further incontinence.
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Hysterectomy: A hysterectomy can cause incontinence for a couple reasons: 1) Removing the womb (uterus) changes the pelvic floor and can cause the muscles to weaken and sag, which can cause incontinence; 2) Your ovaries are responsible for creating most of the estrogen in your body. Sometimes the ovaries are removed during a hysterectomy, which can lead to a significant drop in estrogen levels.
Prevention
For most women, shifts in hormone levels are a part of life, whether from the menstrual cycle during reproductive years or during menopause in later years - these factors can't be changed. However, there are a few preventative steps that women can discuss with their doctor:
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Pelvic floor exercises: Because the type of incontinence experienced due to hormonal changes is usually stress urinary incontinence, strengthening the pelvic muscles can help to prevent possible future problems with incontinence. Also, for women who experience urge urinary incontinence, strengthening these muscles and contracting them when you feel an urge to urinate can make the urgency subside and give you enough time to get to the toilet.
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Hysterectomy options: If you are in need of a hysterectomy, discuss your options with your doctor. If leaving your ovaries intact is an option, you may find that it lessens your risk of incontinence because even though the uterus is removed, the ovaries will function independently from this.
Treatment and Management
Although changes in hormones may increase your chances for incontinence, incontinence should never be accepted as a normal part of life. A doctor who is interested in incontinence, and knowledgeable about diagnosing and treating it, can help you find a treatment or management technique. Some of these options are listed HERE.
Karen Sasso, RN, APN , is the Program Manager and Urogynecology Clinical Nurse Specialist at the Evanston Continence Center at NorthShore University HealthSystem in Evanston , Illinois .
Ms. Sasso received her nursing diploma from the Medical College of Pennsylvania, Philadelphia , Pennsylvania , a Bachelor of Science degree in nursing at Alverno College , Milwaukee , Wisconsin , and a Master of Science in nursing at the University of Wisconsin-Milwaukee .
Her clinical practice involves the evaluation and treatment of women with urinary incontinence, voiding dysfunction, and pelvic floor disorders. She has extensive experience in clinical research for the treatment of women with stress urinary incontinence, detrusor overactivity and genital prolapse.
A regular contributor to the medical press, Ms. Sasso has authored and coauthored a number of articles on female urinary incontinence, genital prolapse and treatment options. Her work has appeared in such journals as Obstetrics and Gynecology, Urologic Nursing, RN, and Wound, Ostomy and Continence Nursing. She has also coauthored a book chapter published in Textbook of Female Urology and Urogynecology. She has presented at numerous symposia within the United States and abroad including the 29th Annual Scientific Meeting of the American Urogynecologic Society in Chicago, Illinois, the Society of Urologic Nurses and Associates Annual Symposium: Disorders of the Bowel, Bladder and Pelvic Floor in New York, NY and the 21st and 25th International Uro-gynecological Association Conferences in Rome, Italy and Vienna, Austria. She is also a reviewer for the journal Urologic Nursing, a committee member for the Wound, Ostomy and Continence Nursing Certification Board and a Project Advisory Council member for the National Association for Continence.
She is certified by the Wound, Ostomy and Continence Nursing Certification Board as a Certified Continence Care Nurse (CCCN) and licensed in the State of Illinois as an Advanced Practice Nurse. Ms. Sasso is a member of the Society of Urologic Nurses and Associates; the American Urogynecologic Society; the Wound, Ostomy and Continence Nurses Society; and the International Urogynecological Association. She was presented with the 2004 Continence Care Champion Award by the National Association for Continence and the Urologic Nursing Journal’s 2006-2007 Literary Excellence Award.
Page last modified 26 July 2009