Perimenopause and urinary incontinence

Peeing My Way Through Perimenopause

Perimenopause and Urinary Incontinence

Sometimes, I pee my pants. I’m 50 years old and sometimes (more often than I’d like to admit) I actually pee my pants. I am in perimenopause and I have urinary incontinence.

It’s true. It’s embarrassing. And It’s absolutely mortifying when it happens in public. Unfortunately, it has on more than one occasion. I can’t (nor would I) make this shit up. 

It’s gotten to the point where I never leave the house without first making a pit stop in the bathroom. It doesn’t matter if I’m heading out for a three hour drive or a 20 minute dog walk. It doesn’t matter if I just peed 15 minutes before. I will not, for any reason, leave the house without stopping to pee. 

I first noticed a little leakage after giving birth to my son. It would happen at the gym doing jumping jacks or after a really big sneeze or a good belly laugh. 

And then, over the last 4-5 years, it started happening more and more frequently. And without any of the usual triggers. Granted, I do drink a ridiculous amount of water every day, but still, this is out of control. It seems that every time I pull into the driveway I have an alarming, urgent need to get to the bathroom. And there are many days when I don’t get there in time. 

And even though my bathroom is within 20 feet of my desk, part of my writing process includes closing my mailbox, turning off my phone ringer and going to the bathroom. The goal is to have two hours of uninterrupted writing time. But even as I write this, I already feel an urge to pee again. Let’s see how well I do. 

Menopause Incontinence

Apparently menopause incontinence is a thing. Just one more crazy and unusual symptom that no one bothered to tell us about. It can be as simple as a little dribble here and there, or you might have a full bladder release before you get to the toilet. You might find yourself needing to pee more frequently, or you may find that you never feel like your bladder is completely empty. Any which way it happens, you should probably say goodbye to your one piece rompers and button fly jeans.

Why is this happening?

According to the North American Menopause Society (NAMS), menopause incontinence is “due to loss of elasticity in the vaginal tissue and weakening of the pelvic floor muscles that is associated with the loss of estrogen production.”~  

And things that put added pressure or strain on our bladder muscles can make it worse. Things like constipation, being overweight, medications (think water pills) and surgeries like hysterectomies.++ 

This could be my doorbell camera most days of the week:

Types of incontinence

– Stress Incontinence is the most common type. It’s when you cough, sneeze, laugh, exercise, or jump and accidentally leak a bit of pee.  It’s a result of weak pelvic floor muscles. These are the muscles that support your urethra, bladder and bowels. They get weaker from stuff like pregnancy, pushing out a baby, straining to go to the bathroom, and hormone changes that make the vaginal tissues less supportive. 

– Urgency incontinence is when you’ve got to pee suddenly and urgently. Like right now! And you might end up leaking before you can make it to the bathroom. 

This kind of incontinence can be triggered by stuff like drinking lots of fluids, or even hearing running water. 

This is the one I suffer from most frequently, hence not leaving the house, ever, without first peeing. And if I don’t stop drinking fluids before 7pm, I can expect to wake up multiple times at night just to pee. Some women actually deal with bed-wetting or leaking during sex. More on this later.

– Overflow incontinence is like having two problems in one: your bladder doesn’t empty properly. Either because your bladder muscle is weak or your urethra just won’t relax.  Your bladder gets so full that the pee has no choice but to leak out. 

If you’re dealing with overflow incontinence, you’ll probably notice that your urge to pee isn’t as strong as it should be. And when you do go, it can be a frustratingly slow flow. 

If you’ve got overflow incontinence, chances are you’re getting pretty regular urinary tract infections.

Other bladder-related perimenopause symptoms 

Let’s unpack a couple of the ones we just mentioned:

– Urinary Tract Infections (UTIs) run the spectrum of uncomfortable to brutally painful. They are the result of an infection in the urethra, uterus, bladder or kidneys. If you’ve got one you’ll notice an increased urge to pee, a burning sensation when you do, cloudy or smelly urine, and discomfort in the lower abdomen. Usually, you’ll need antibiotics to effectively treat a UTI.

– Urinary Leakage during sex affects about 25% of women dealing with incontinence. It can happen during sexual activity, when having an orgasm, or both. It’s caused by a combination of weak pelvic floor muscles and pressure put on the bladder or urethra during intercourse.

As you can imagine, most women find this super embarrassing and so they often avoid having sex.

Don't panic when you urgently need to pee

It’s more common than you think

Urinary incontinence affects about 30-40% of middle-aged and perimenopausal women, with rates escalating to 50% among postmenopausal women.** Moms are at a higher risk than their friends who haven’t been pregnant. Weight, alcohol, caffeine intake, and certain medications can also trigger urinary incontinence.

And unfortunately, according the National Association for Incontinence, women typically delay seeking professional diagnosis for an average of 6.5 years from the onset of initial symptoms.


Like all things perimenopause, women should never accept incontinence as a part of an aging process that they need to just ‘get through’. You might want to begin with some absorbent pads and a waterproof mattress pad. Just to tie you over until you’ve tried some of our suggestions and found a solution that reduces your struggles:

Keep a journal

Sounds bizarre, I know. But seriously, record bathroom visits, any instances of leakage or sudden urges, what you were doing when it happened, and your fluid intake. Take this diary to your next doctor’s appointment, It’ll provide some important information for finding the best solutions.

Pelvic Floor Therapy

This is a must! The types of exercise you do will depend on the type of incontinence you’re experiencing – stress, urgency, overflow, or heaven forbid, all three. 

Kegals will almost always be part of the therapy. Remember those? We tried them in the 90’s to have better sex. Then we were told to be diligent with them after delivering a baby, but who really had the energy for that? And now they’re back. This is usually a starting point of your pelvic floor therapy. 

From there your pelvic floor therapy may include:

– Internal manual manipulation to help relax the pelvic floor muscles and alleviate trigger points. 

– Electrical stimulation designed to stimulate pelvic floor muscle activation.

– Devices like vaginal dilators and weighted cones to gently stretch and relax the muscle


It’s not just for your wrinkles anymore. Botox is now FDA-approved for the treatment of Urgency Incontinence. Botox injections disrupt the communication between muscles and nerves, preventing misleading signals from the bladder to the brain that falsely indicate fullness. And like it does for our crows fee, it temporarily paralyzes the bladder muscle to reduces spasms.

when the urge hits, sometimes getting to the toilet is a challenge

Bladder training

This is a behavior therapy technique to help manage incontinence. The main goal is to gradually increase the time between bathroom visits to increase the bladder’s ability to hold fluids. 

Next time you feel the need to pee, don’t. Start by resisting the urge for about five minutes, then over a few days gradually extend the duration to 10 minutes. Keep at this for a few weeks, gradually increasing the time between bathroom visits every couple of days. Apparently many women find this technique has helped them achieve a three to four hour window between bathroom breaks. I’ll believe it when I see it. 


Surgery can be an effective treatment option for many cases. The type of surgery will depend on the type of incontinence you’re experiencing. Surgical procedures might be vaginal or abdominal, but most are minimally invasive day surgeries. 

There’s Hope

So there you have it. Your life doesn’t need to become one long Depends commercial. There are actually quite a few things you can try to help reduce and improve your incontinence. 

And of course, it’s always important to talk with your health care practitioner about your incontinence. Don’t wait 6.5 years to get help. Book an appointment today. I am! 

Because in case you were wondering, I peed two more times during the 2.5 hours it took me to write this blog. It’s definitely time to get serious about these kegels!  

urgent need to find a bathroom



++ Mainline Health 

** Stella Health