Menopause Incontinence: Bladder Leaks and What Helps

A little leak when you sneeze. A cough, a laugh or a run for the bus, and you're damp. Or a sudden, desperate need to pee that comes from nowhere, so you start planning every trip around where the toilets are. Some nights you're up more than once.

Yes, menopause incontinence is real, and it's common. The NHS lists needing to pee more often, including at night, and not being able to control when you pee among the symptoms of perimenopause and menopause. The Menopause Charity says bladder leaks affect up to half of all adult women.

It's also something that can be helped. The NHS says incontinence "is not an inevitable part of ageing", and that you should not feel embarrassed talking to a GP about it.

Call 999 or go to A&E if you have back pain and:

a loss of feeling around your genitals or bottom
pain, tingling, weakness or numbness in both legs
new changes in your bladder or bowels, such as difficulty peeing, or peeing or pooing yourself

This comes from the NHS back pain page. These can be signs of cauda equina syndrome, a rare but serious problem where the nerves at the bottom of the spine are squashed (Torbay and South Devon NHS). Don't drive yourself to A&E.

Ask for an urgent GP appointment or call 111 if:

you have blood in your pee, or think you might (NHS)
it hurts or burns when you pee and you also have a high temperature, feel shivery, or have pain in your back just under the ribs (NHS)

What kind of bladder leaks do you have?

The NHS describes a few types. These are the ones women most often notice in midlife:

Type	What happens
Stress incontinence	You leak when there's sudden pressure on your bladder: coughing, sneezing, laughing, lifting something heavy or exercising
Urge incontinence	You get a sudden, very strong need to pee and can't put off going. It's often linked to overactive bladder
Mixed incontinence	You have both

There's also overflow incontinence. This is where your bladder can't empty fully when you pee. You may pass small trickles often and feel as if you've never quite finished. This one needs checking by a GP.

Frequent urination and overactive bladder

The NHS says an urgent or frequent need to pee is common as people get older.

Bladder & Bowel UK lists the bladder changes it sees around menopause:

needing to pee more often
a sudden, urgent need to go
leaking when you cough, sneeze or exercise
urine infections
waking more than once a night to pee (doctors call this nocturia)

"Overactive bladder" is the name doctors use when the bladder sends that sudden, urgent signal. The NHS says urge incontinence is often linked to it.

Why does menopause cause incontinence?

Mostly, it's about oestrogen.

The Menopause Charity explains that falling oestrogen can weaken the muscles and tissues that support your bladder and urethra (the tube you pee through). It can also make the vagina and urinary tract thinner and drier. That can make you need to pee more often and more urgently, and it can raise the chance of urine infections.

Bladder & Bowel UK says lower oestrogen can lead to:

thinner tissues around the bladder
weaker pelvic floor muscles
a bladder that's less stretchy

It adds that these changes may start in perimenopause, while you're still having periods.

The same drop in oestrogen causes vaginal dryness. Our page on vaginal dryness and GSM explains more.

Other things that play a part

Menopause isn't the only possible reason. The NHS lists other causes and risk factors:

Having babies, especially vaginal births, which can weaken or damage the pelvic floor
Extra pressure on your tummy, for example from being overweight
Age. Incontinence becomes more common in middle age
Family history. There may be a genetic link
Drinks. Too much alcohol or caffeine, or not drinking enough
Constipation
Urine infections, which can bring on urgency and leaks. See our page on urine infections in menopause
Some medicines, including water tablets (diuretics) and HRT

What about HRT?

The NHS lists HRT among the medicines that can affect your bladder. A 2012 Cochrane review looked at this. In its trials, HRT taken as tablets may have made leaks worse. Oestrogen used inside the vagina, though, may have made them better. The evidence wasn't strong, and the tablet finding came mostly from one large trial.

If you take HRT and your bladder is playing up, tell your GP. Please don't stop or change HRT on your own.

What can help: things you can start today

Pelvic floor exercises

Your pelvic floor muscles help keep the tube you pee through closed. When they're weak, the NHS explains, it may not stay shut. The NHS also says pelvic floor exercises can be effective at reducing leaks.

Here's how the NHS describes them:

Find the muscles. Imagine stopping yourself peeing and passing wind at the same time. Those are the muscles.
Squeeze quickly. Try not to pull your tummy in.
Hold for 2 seconds, then let go.
Repeat 10 times.
Build up slowly until you can hold each squeeze for 10 seconds.

Breathe normally while you do them. Do them every day. The NHS says you may need to keep going for a few months before you notice a difference.

A specialist plan, the NHS says, should include at least 8 squeezes at least 3 times a day, for at least 3 months.

Small changes that can make a difference

These come from the NHS's 10 ways to stop leaks and its main incontinence page.

Cut down on caffeine. It irritates the bladder. Coffee has the biggest effect, so try decaf. Tea, fizzy drinks and energy drinks count too.
Cut down on alcohol. It makes you pee more.
Don't cut back on water. It's tempting, but drinking too little can make leaks worse. The NHS suggests about 6 to 8 glasses of fluid a day, unless your doctor says otherwise.
If you're up at night, drink a bit less in the hours before bed. Keep drinking well during the day.
Deal with constipation. Straining on the toilet weakens your pelvic floor.
Stop smoking. Coughing strains your pelvic floor.
Swap high-impact exercise and sit-ups for gentler ones like Pilates, which strengthens the core muscles.
Squeeze before you lift. If you have to lift something, tighten your pelvic floor before and during the lift.
Go easy on spicy and acidic foods, such as curries and citrus fruits, which can irritate the bladder.
Aim for a healthy weight. The NHS says leaks may improve, and could go away completely, if you lose any extra weight.

The NHS says that for many people, self-help changes like these are enough. Pads and pants can be useful while you wait for help, the NHS adds, but they don't deal with the cause.

What your GP can offer

A chat and some simple checks. The NHS says your GP will ask about your symptoms. They may offer to examine you. They may also ask you to keep a bladder diary for a few days: what you drink, and how often you pee.

Here are the main options to talk through with your GP. The NHS says the non-medicine ones are tried first.

Referral to a specialist physio. NHS continence services include specialist nurses and physiotherapists (often called pelvic health physios). They can check you're doing pelvic floor exercises the right way and set you a plan. Your GP can refer you, and in some areas you can refer yourself.
Bladder training. This is usually offered first for urge incontinence. It teaches you to slowly stretch the time between feeling the urge and going to the toilet. The NHS says a course usually lasts at least 6 weeks.
Vaginal oestrogen. This is a low dose of oestrogen you put inside the vagina, as a cream, ring or tablet. The Menopause Charity says it works locally, and very little gets into your bloodstream. The Cochrane review found it may help with leaks. Bladder & Bowel UK says recent research has found no raised risk of breast cancer with low-dose vaginal oestrogen.
Medicines for urge incontinence and overactive bladder. The NHS lists several tablets for these. Your GP can talk you through them.
A medicine for stress incontinence. The NHS says this may be an option if surgery isn't suitable or you'd rather avoid it.
Surgery. If other things haven't helped, the NHS describes operations for both stress and urge incontinence.

Bladder & Bowel UK puts it simply: "There is treatment available."

When to see a GP about bladder leaks

The NHS says it's a good idea to see a GP if you have any kind of urinary incontinence. It says you shouldn't feel embarrassed, and that seeing a GP can be the first step towards managing it. In particular, see your GP if:

leaks are getting in the way of work, exercise, sleep or sex
you're often up more than once a night to pee
you feel your bladder never fully empties, or you pass small trickles often
it stings when you pee, or urine infections keep coming back
you've done pelvic floor exercises for a few months and they haven't helped

Use the box near the top of this page for anything urgent. Our symptoms checklist lets you tick off everything you've noticed and print a list to take with you.

Bladder changes often come with urine infections in menopause, vaginal dryness (GSM) and painful sex after menopause. You can see them all in our list of perimenopause symptoms.

This page is general information, not medical advice. If you're worried about any symptom, please talk to your GP or pharmacist.

See all perimenopause symptoms

Menopause incontinence: bladder leaks, needing to pee more, and what can help