Are Vaginal Atrophy and Incontinence connected?
Vaginal atrophy, or atrophic vaginitis, is a condition that affects postmenopausal women, where the walls of the vagina become thinner, drier, and less flexible due to a decrease in the hormone estrogen. This decline in vaginal health often goes hand in hand with urinary incontinence, which is an involuntary leakage of urine.
One might wonder how the two are linked. This connection can be attributed to the shared embryological origins of the urinary and genital structures. The tissues of the lower urinary tract (including the urethra and bladder) and vagina are responsive to estrogen, which helps to maintain their strength and flexibility. When estrogen levels decrease during menopause, these tissues can weaken and become dry, making it more difficult to control the release of urine.
What symptoms should you know?
Typically, vaginal atrophy may present itself through vaginal dryness, burning, or discomfort during sexual intercourse. Urinary incontinence, on the other hand, often shows itself in the form of stress incontinence (leaking urine while coughing, laughing, or exercising) or urge incontinence (a sudden, intense urge to urinate followed by an involuntary loss of urine).
Beyond these usual indicators, there are lesser known signs that could signal vaginal atrophy and its link to incontinence. These include recurrent urinary tract infections (UTIs), a feeling of urgency even after urinating, and discomfort during urination. Uncommon signs of vaginal atrophy could also include light bleeding after intercourse or a decrease in vaginal lubrication during sexual activity.
How does Estrogen play a part?
Estrogen is a pivotal player in maintaining the health of our genitourinary system. It maintains the strength and flexibility of the vaginal walls and the urethra. It also supports the balance of beneficial bacteria in the vagina, which can prevent UTIs. So, when estrogen levels drop during menopause, not only do the tissues in these areas become weaker and drier, but the risk of infection increases as well.
Treatments within NHS and Over-the-Counter Solutions
Navigating this complex territory of menopause, vaginal atrophy, and incontinence needn't be a solo journey. The NHS provides several treatment options such as:
Topical Estrogen Therapy
This involves applying estrogen directly to the vaginal area to help replenish local estrogen levels. It comes in the form of creams, vaginal rings, or pessaries and is usually the first line of treatment for symptomatic vaginal atrophy.
Pelvic Floor Muscle Training
This can help strengthen the muscles that support the bladder and prevent incontinence. The NHS offers access to physiotherapists specialised in this training and we have an excellent beginners guide here.
Lifestyle Changes
Quitting smoking, reducing alcohol and caffeine intake, and losing weight if you're overweight can reduce symptoms of incontinence.
Over-the-counter, non-prescription options include:
Vaginal Moisturisers and Lubricants
These can alleviate vaginal dryness and discomfort during sexual intercourse. They are safe to use regularly and can be found in most pharmacies.
Absorbent Pads and Pants
These can be used to manage urinary leakage and come in a variety of shapes and sizes. Jude's leak-proof pants are a brilliant option as they are designed specifically to manage urine leaks. The triple-layered gusset traps urine whiffs, keeps you dry and holds up to 8tsp of urine.
Alternative Therapies and Lifestyle Adjustments
Some women might find relief in alternative therapies like acupuncture and mindfulness-based stress reduction, which have been reported to improve symptoms of incontinence.
Maintaining an active lifestyle can also be beneficial. Regular exercise can strengthen the pelvic floor muscles, while a balanced diet rich in fruits, vegetables, and whole grains can maintain overall health and hormonal balance.
If you are concerned that you are experiencing incontinence and vaginal atrophy, discuss your symptoms with your GP.
