I was recently interviewed by Emily Barclay, Founder of the Perimenopause Hub.
The following is the transcript of this interview where we discuss how perimenopause and menopause affects both bladder and pelvic health in women going through these transitions.
I recently chatted with Susan Farrell, about how a woman’s bladder and pelvic health are affected during perimenopause, menopause and beyond.
Welcome Susan to the Perimenopause Hub. Would you kindly introduce yourself to our audience?
Hi Emily, and thank you for having me on the Perimenopause Hub to address women’s issues which are near and dear to my heart.
I’m a board-certified nurse practitioner, a continence and pelvic floor biofeedback specialist, and a certified health coach.
I’ve also had additional training on biofeedback evaluation and treatment for bladder and bowel disorders, as well as pelvic floor disorders with a focus on complex pelvic floor cases.
And I’ve been honored to serve on the Project Advisory Council for the National Association for Continence here in the USA.
In my clinical practice I focused on common bladder control problems in women.
I’ve transitioned my clinical practice to essentially a virtual holistic health coaching practice where by using my evidence-based holistic health coaching method, I guide women with embarrassing bladder control problems to empower themselves to take back control of their bladder and life by helping them to create their own Your Healthy Bladder Solutions ProgramTM .
Since the Perimenopause Hub has an international audience, would you tell us what is a nurse practitioner?
Yes, of course. Here in the USA, I have a Master of Science degree in Nursing and I am licensed as an Advanced Practice Registered Nurse.
I have advanced clinical training beyond my initial professional registered nurse (RN) preparation. I'm also board-certified as a Gerontological Nurse Practitioner.
What sets nurse practitioners apart from other health care providers is our unique emphasis on the health and well-being of the whole person.
With a focus on health promotion, disease prevention, health education and counseling, nurse practitioners guide patients in making smarter health and lifestyle choices, which in turn can lower patients' out-of-pocket costs.
As far as the actual practice, this may vary from state to state, but overall a nurse practitioner may practice autonomously and in collaboration with health care professionals.
Nurse practitioners provide a full range of primary, acute and specialty health care services, including:
Ordering, performing and interpreting diagnostic tests such as lab work and x-rays.
Diagnosing and treating acute and chronic conditions such as diabetes, high blood pressure, infections and injuries.
Prescribing medications and other treatments.
Managing patients' overall care.
Educating patients on disease prevention and positive health and lifestyle choices.
How common are bladder control problems in women?
Great question Emily and I’d like to paint the picture of magnitude of this common women’s health problem.
There is a stigma surrounding bladder control problems in women. And it creates a silence among both women and health care professionals.
If urinary incontinence were a country, it would be the third largest in the world behind India and China.
This is a huge health problem that is severely under-reported.
Many women don’t ask for help from health professionals and many health professionals don’t ask women if they are having bladder control problems.
Wow, that's a lot of people. I never would've imagined this many.
Yes, and women are three times more likely to suffer from urinary incontinence than men.
Worldwide estimates are that urinary incontinence affects about 423 million people over the age of 20. This affects women about 303 million women and 121 million men
Of the 25 -30 million adult Americans suffering from some form of urinary incontinence, almost 75% of those are women.
One in four women over the age of 18 experience episodes of leaking urine involuntarily. This number increases for women in their 40s, 50s and 60s
Between the ages of 18 and 44, approximately 24% of women experience incontinence.
Some estimates report that 43% of 50- to 64-year-old women suffer from incontinence. And for women 65 and older, this number is estimated to be over 50%.
And these numbers are likely to be even higher than reported.
On average, women wait about seven years before they seek professional help for their bladder control problems. But over 50% and possibly up to 75% never seek professional help.
Many women simply rely on coping strategies like using pads, wearing special underwear, limiting fluid consumption and wearing dark clothing to disguise signs of leakage.
Then they start a cycle of withdrawing from social interactions. And once a woman stops socializing, it's easy to see how the withdrawal can lead to depression.
Her bladder control problems start to control her life now.
Urinary incontinence leads to lower self-esteem, impaired well-being, and reduced sexuality compared to women without incontinence.
This affects relationships with their partner, family and friends, work.
Urinary incontinence affects all aspects of a woman’s life. In many ways this is a disability.
Why is it that women don’t seek help for this common problem?
Embarrassment, shame, denial and fear are probably the main drivers. Loss of control.
The stigma of bladder control problems in women results in silence. This runs so deep. Women often hide this from their closest friends.
The denial is that women often think of urinary incontinence associated with older, frail women.
But many women are still very active in their lives with work and families and friends, so they don’t relate to this.
It’s very difficult for women to accept that this is happening to them.
And many believe that the bladder control problems won’t get worse. But it will and it does, it won’t just go away.
Women begin to develop their own coping mechanisms and will actually change their lifestyle to compensate living with embarrassing bladder control problems.
Women keep moving their personal goalposts on how much they are willing to accept living with their bladder control problems.
As I mentioned before, many women do not even bring this up with their health professional.
Many women are afraid that medications or surgery are only option. Many are misinformed about the causes and the treatments available.
And way too many women are losing the freedom to live life on their terms because of common, and often reversible, bladder control problems.
If the bladder control problems are not reversible, they can definitely be managed better.
How does perimenopause and menopause contribute to bladder control and urinary incontinence problems?
Let’s look at the changes that happen as we age.
Our bladder muscle ages and this decreases the bladder's capacity to store urine, as well as the inability to completely empty.
There’s a decrease in urethral resistance pressure. The urethra is not staying closed like it’s supposed to, and this is what we see with stress incontinence, in addition to a relaxed pelvic floor.
And involuntary bladder contractions are more frequent as we get older.
Pregnancy and vaginal childbirth also contribute to bladder control problems that begin to appear during perimenopause and menopause.
Fluctuating hormone levels occur during perimenopause and menopause, especially a decline in estrogen levels.
There’s not a defined start to perimenopause or a smooth transition into menopause.
We use a term in menopause called Genitourinary Syndrome of Menopause (GSM). Genitourinary refers to a woman’s genital and urinary systems.
Declining estrogen levels play a critical role in both bladder and pelvic health.
Highlighted areas represents concentration of estrogen recptors.
(Diagram courtesy of Chronic UTI Info)
The bladder and urethra (tissues) are highly responsive to the presence of estrogen.
Estrogen helps keep the lining of the bladder and urethra healthy.
As shown in the illustration above, the darker the color, the more estrogen responsive.
As women produce less estrogen, this causes deterioration of these tissues, and this can lead to urinary incontinence or bladder control problems.
The same goes for the vagina being estrogen responsive.
Declining estrogen levels contribute to vaginal dryness, burning, irritation and decreased lubrication with sexual activity.
The common urinary symptoms that women experience are frequency and dysuria which is pain or discomfort when urinating.
This is also the time when women are at increased risk for urinary tract infections.
We often see women starting to develop bladder control symptoms such as urge, with and without urine leaks, and leaking urine when they do activities such as coughing, sneezing, lifting something or laughing during perimenopause and menopause.
It’s a sad day when women feel they need to control their laughing for fear of bladder leaks. Deep belly laughs, either by yourself or with friends, are very healthy.
Think about how good you feel after a deep belly laugh.
Women don’t need to live like this. There are so many options available to help them with their bladder control problems.
Wow, this all sounds overwhelming, never knew this was such a serious and overlooked problem. How difficult is it to treat or manage bladder control problems?
Yes, I know this looks overwhelming to many and you’re probably thinking that your perimenopause, menopause and beyond years are going to be pretty bleak.
But it’s really not once you break this down into small steps. It’s like figuring out a puzzle.