Up to 84 percent of women will experience genitourinary syndrome of menopause (GSM). This can cause a wide range of uncomfortable symptoms, including bladder leaks, urinary incontinence, vaginal dryness, and urinary tract infections (UTIs). Some will also experience constipation or bowel leakage.

While bathroom problems can feel embarrassing to discuss, they’re incredibly common during menopause, and most won’t go away on their own. Fortunately, treatment options and lifestyle changes can help with bladder leaks and other GSM symptoms.

“It’s not taboo to talk about these things,” said Cindi Rauert Lanners, a doctor of physical therapy and board-certified clinical specialist in women’s health and pelvic health. “If you’re having symptoms, keep track of them and talk to your healthcare team.”

Lanners shared tips to manage menopause-related bathroom problems.

Why Does Urinary Incontinence Occur in Midlife?

Urinary incontinence is when small amounts of urine leak out due to reduced bladder control. Two of the most common types of urinary incontinence are:

• Stress incontinence — Leaking urine when you laugh, sneeze, cough, or jump
• Urge incontinence — Having a sudden, strong urge to urinate that may cause urine leaking

While urinary incontinence can occur at different times throughout life, declining estrogen levels often play a role when it happens in perimenopause and menopause.

“As estrogen declines during the menopause transition, the pelvic floor muscles can weaken and start to atrophy,” Lanners explained. “That can affect bladder control and sometimes bowel function as well.”

Many women in midlife are also juggling careers, parenting, caring for aging parents, and other daily demands. With so many responsibilities, Lanners said it can be difficult to start or stick with exercises and routines that can help improve pelvic floor strength and reduce bladder control problems.

“This is also the time when women start to lose muscle mass,” Lanners said. “So it all seems to come to a head.”

Are Other Bladder or Bowel Issues Possible?

Bladder leaks aren’t the only problem you may have noticed. Other bladder and bowel issues can develop during the menopause transition. These include:

• Frequent urination — Urinating more than eight times per day
• Painful urination — Feeling burning or discomfort while urinating
• UTIs — Developing infections of the urinary system
• Overactive bladder — Having frequent and sudden urges to urinate
• Constipation — Having difficulty passing stools
• Bowel incontinence — Leaking stool accidentally due to weakened sphincter muscles

To help track your symptoms and identify trends, Lanners recommends the Pelvic Floor Distress Inventory. “It’s a series of questions that asks about pelvic pressure, bowel challenges such as constipation or bowel leakage, and urinary symptoms like overactive bladder, frequent urination, and leakage with coughing, laughing, or sneezing,” Lanners explained.

Below is a version of the Pelvic Floor Distress Inventory you can take now to get a sense of how many pelvic floor symptoms you may be experiencing and how bothersome they are. If you don’t have a symptom, choose “Not present.” If you do, choose how much it has bothered you over the past three months.

Keeping a bladder diary can also be helpful. Writing down the symptoms you’re experiencing and when they occur can make it easier to explain them to your doctor and get the care you need.

“I want women to talk to their primary care provider or OB-GYN and say, ‘How can you support me with the symptoms I’m having?’” Lanners said. “Because these symptoms can have a long-term impact.”

Treatment Options for Bladder Leaks

If you’re experiencing bladder leaks or other issues, your healthcare provider will typically start with a physical exam and a discussion of symptoms. From there, they can create a treatment plan or refer you to specialists as needed.

Here are a few options they may recommend.

Pelvic Floor Therapy

Pelvic floor therapy is a type of physical therapy that helps strengthen and relax the muscles supporting the bladder, bowel, and uterus. A pelvic floor physical therapist can evaluate how well your pelvic floor muscles are working and identify issues such as weakness, tightness, or poor coordination.

“We can put pressure on those muscles with our physical exam and see if they’re doing their job in the best way possible,” Lanners explained. “Everyone is a little different, so we can create a specific program based on your symptoms and how your muscles respond.”

Kegel exercises are one pelvic floor exercise a physical therapist might teach you. Kegels involve squeezing and relaxing the pelvic floor muscles to strengthen them. It’s often recommended to practice them daily. However, they might not be the best exercise for everyone experiencing bladder leaks.

Other techniques may help you relax, or lengthen, your pelvic muscles. “The lengthening of the pelvic floor is a great place to start because it can help with overactive bladder, pelvic pain, and constipation,” Lanners said.

If you have questions about the process or exercises, it’s always OK to ask.

Medication

Several medications can help with overactive bladder, urgency symptoms, and urine leakage. Some work by helping your bladder empty completely, while others stabilize muscle contractions.

Other medications used to treat bladder leaks and related symptoms include:

• Vaginal estrogen cream — This is inserted into the vagina to improve tissue health and reduce GSM symptoms, including urinary issues.
• Anticholinergic medications — These help calm an overactive bladder and reduce urgency and frequency of urination.

Procedures and Surgery

When symptoms are severe or don’t respond to physical therapy or medications, surgery and other procedures may be considered.

Examples include:

• Botulinum toxin (Botox) injections — These help relax bladder muscles to reduce urgency and urine leakage.
• Neuromodulation devices — Gentle nerve stimulation helps regulate bladder signals.
• Sling procedures — These provide support to the urethra to help prevent bladder leakage.
• Urethral bulking — These injections support the urethral lining.

Your healthcare provider can determine whether medications or surgical procedures are appropriate for you and explain the potential risks, benefits, and side effects.

Lifestyle Changes That Can Help

Lifestyle and diet changes can also help manage bladder and bowel symptoms.

Some strategies to consider:

• Practice bladder training by gradually increasing the time between bathroom visits.
• Use an over-the-counter vaginal insert or pessary for support.
• Wear absorbent pads or underwear if needed.
• Practice Kegel exercises daily to strengthen the pelvic floor muscles.
• Maintain a healthy body weight, as extra weight can increase bladder pressure.
• Avoid bladder irritants such as caffeine, carbonated beverages, alcohol, spicy foods, and certain diuretics.

• Eat fiber-rich foods and drink more water to prevent constipation.

It can take some trial and error to identify your personal triggers, especially because sensitivities can change over time.

“Some foods are bladder irritants and can cause the bladder muscle to spasm, making you feel like you always have to go to the bathroom,” Lanners explained. “This may not have been an issue earlier in life, but over time, many people seem to become more sensitive to certain triggers.”

The right healthcare provider can help you make these adjustments.

Finding a Healthcare Provider

Your primary care provider can help with menopause symptoms, but if you’re experiencing bladder leaks or other bathroom problems, you may benefit from seeing a specialist. Lanners recommends working with a pelvic floor physical therapist.

“The American Physical Therapy Association has a great PT finder on their website,” Lanners said. “The Academy of Pelvic Health Physical Therapy also has a pelvic health PT finder, and there are other organizations that can help you find someone in your area.”

Other specialists who may be able to help include urologists, gynecologists, and urogynecologists. Urogynecology combines gynecology and urology to treat pelvic floor and bladder conditions. Wherever you turn for support, it’s important to rely on trusted sources for information.

The Menopause Society also offers an online search tool to help women find providers with specialized training in menopause care.

While urinary incontinence is common as people get older, especially during the menopause transition, it’s not something you simply have to accept. Many treatments and strategies are available to help manage symptoms and improve your comfort and quality of life.