Urinary Discomfort for Post Menopausal Women: Understanding the Causes and Finding Practical Solutions

Urinary discomfort is a common issue that many postmenopausal women face. The changes that occur in the body during menopause can lead to symptoms such as vaginal dryness, frequent urinary tract infections (UTIs), and urinary incontinence. Understanding the causes of these discomforts and finding effective solutions is crucial for improving the quality of life for women in this stage of life. (1)

During menopause, there is a decline in estrogen production in the ovaries. The decline leads the body to rely on other tissues for the production the sufficient levels of estrogen. Some of those tissues include the adrenals and even adipose (fat) tissues. Though the body will naturally require less estrogen after menopause, sometimes, adrenal fatigue may make it so that even this small need is not covered by the body. Such conditions can have a significant impact on the urinary tract. (2)

The lack of estrogen can cause thinning of the bladder and urethral linings, leading to chronic dysuria (painful urination) and an increased risk of UTIs. Those changes are collectively referred to as urogenital atrophy, also known as Genitourinary Syndrome of Menopause (GSM).  Additionally, hormonal changes can result in atrophic vaginitis, which is characterized by the thinning and inflammation of the vaginal walls. (3)

The consequences of low estrogen can be both structural and metabolic. Metabolic changes include alterations in energy regulation and hormone profile. Structural changes affect the integrity of the body's tissues, particularly the skeleton, muscles, and pelvic tissues. These changes can result in decreased bone density, muscle mass, and pelvic organ support, potentially leading to various health issues. (2, 3, 4)

During menopause, hormonal changes affect both the vaginal lining and urethral tissues. Structural changes cause the vaginal walls to become thinner and less elastic, resulting in dryness, itching, irritation, and discomfort or pain during intercourse (dyspareunia).

The weakening of the pelvic tissues and reduced natural defences make women more susceptible to irritation, dysbiosis and urinary tract infections (UTIs). Moreover, the decreased lubrication during sexual activity may cause microtrauma, providing entry points for bacteria and further increasing the risk of UTIs. (2, 3)

While lubricants and local estrogen are commonly used for managing vaginal dryness and discomfort, internal hormone regulation offers a more effective approach to address these issues in postmenopausal women. Certain herbs, such as chaste tree, hops, and maca, have shown potential as gentle and safe hormone regulators. However, discussing these specific herbs is beyond the scope of this article. (5)

For effective hormone regulation, it is advised to work with a healthcare provider and obtain a detailed salivary or urinary hormone panel to accurately understand hormone distribution. Additionally, evaluating and healing the adrenals can be beneficial in achieving hormone balance and helping tissues heal properly. (5,6)

White antibiotics are great at getting rid of bacterial urinary infections, the consistent use of antibiotics to treat UTIs can increase susceptibility to recurrent infections and may contribute to the development of antibiotic resistance.

Antibiotics can allow the yeast to thrive as it kills the good bacteria that usually compete with disease-causing strains. For many women, this creates a cycle where they feel better on the antibiotics and end up suffering more severe discomfort when they are off of them. Therefore, for women with long-term urinary irritation, it is important to explore natural solutions for urinary tract health. (7, 8)

Preventing urinary tract infections is crucial for maintaining urinary health in postmenopausal women. We need to start with the understanding that postmenopausal women have a more delicate lining in the vaginal canal and the urethra. Knowing that injury is quite common, it is important to follow a gentle approach. (2, 3)

When seeking suitable support for urinary health in postmenopausal women, several crucial criteria should be considered to ensure the utmost effectiveness and well-being. Firstly, prioritize long-term safety by opting for products or therapies with a well-established track record of safety and minimal adverse effects. Postmenopausal women may require those supportive factors for a long time, so anything employed should be safe for long-term use.

Gentleness is another key factor to take into account. Choose interventions that are gentle on the body and avoid harsh chemicals or treatments that could potentially exacerbate existing issues. A gentle approach is vital for promoting overall comfort and minimizing any potential discomfort during the healing process.

Moreover, it is essential to consider the impact of the chosen support on overall health. Postmenopausal women are usually older, so it is important to ensure that any therapy used for them does not lead to accelerated aging or tissue-quality deterioration. Thus, a holistic approach ensures that the chosen intervention supports multiple aspects of health, enhancing the overall quality of life for postmenopausal women.

Vitamin C, selenium, omega-3 fatty acids, and zinc have been found to play a role in preventing urinary tract infections (UTIs). Here's why they are not likely to be effective at treating an infection:
 

• Vitamin C makes urine more acidic, which can help prevent the growth of bacteria in the urinary tract (may lead to discomfort). It also aids in supporting the immune system, which can help fight off infections. Additionally, on a structural level, it can help to support collagen building which, in turn, can help heal tissues faster after infection (9)
   
• Selenium is an essential mineral that plays a role in immune function. It helps support the body's defence against infections, including UTIs (10, 11)
   
• Omega-3 fatty acids, found in cold-water fish like salmon, have anti-inflammatory properties that can help reduce inflammation caused by a UTI. This may lead to less tissue damage and faster healing from a UTI (12)
   
• Zinc is a mineral that plays a crucial role in both immune function and wound healing. It helps support the body's defence against infections, including UTIs (10, 13)

While vitamin C, selenium, omega-3 fatty acids, and zinc have potential benefits in preventing UTIs, they are not likely to be effective at treating an ongoing infection.

Uva ursi (Arctostaphylos uva-ursi), golden seal (Hydrastis canadensis), and juniper (Juniperus communis) are natural herbs that have been used for urinary tract infections (UTIs) and have shown benefits in reducing the symptoms of UTIs and even healing them. Though those herbs are perfectly safe to use in the short term, under the care of a healthcare provider, it is important to use them only in the short term as long-term use may cause undesired side effects:

Natural anti-microbial herbs such as uva ursi, golden seal, and juniper have shown potential benefits in treating and reducing the symptoms of UTIs. However, it is important to use them only in the short term and to work with a knowledgeable healthcare provider to avoid side effects or potential interactions with medications! 

Research suggests that cranberry juice may decrease the number of symptomatic UTIs, especially for women with recurrent UTIs, over 12 months. Clinical research indicates that daily dosages of 240-300 ml of cranberry juice cocktail can prevent 50% of UTI recurrences and reduce bacteriuria. (16-18)

A 2008 study aimed to compare the effectiveness of trimethoprim and cranberry extract in preventing recurrent urinary tract infections (UTIs) in older women. The findings revealed that trimethoprim had only a slight advantage over cranberry extract in UTI prevention, while also exhibiting a higher rate of adverse effects. This suggests that older women with recurrent UTIs may benefit from considering cranberry extract as a cost-effective and safer alternative, given its natural composition and reduced risk of antimicrobial resistance, Clostridium difficile super-infections, and fungal complications. (19)

Hibiscus extract contains beneficial compounds, including flavonoids, sambubiosides, and proanthocyanidins. In a double-blind, placebo-controlled clinical trial, women who took hibiscus extract experienced a remarkable reduction in UTIs. Moreover, laboratory studies and a meta-analysis of 3 clinical studies have shown that hibiscus is effective in treating urinary tract infections. These findings highlight the potential of hibiscus as a natural remedy for UTIs. (20-23) 

• Low Sugar Diet: Reducing sugar intake can be beneficial for pelvic health as it helps prevent inflammation and may reduce the risk of urinary tract infections, which can impact the pelvic region
• Regular Physical Activity: Engaging in regular exercise promotes blood flow to the pelvic area, supports healthy bowel movements, and helps maintain a healthy weight, which can alleviate pressure on the pelvic organs
• Stress Management: Chronic stress can lead to pelvic muscle tension, which may exacerbate pelvic pain or discomfort. Practicing stress-reducing techniques like yoga, meditation, or deep breathing can help promote pelvic health
• Proper Posture: Maintaining good posture supports the alignment of the pelvis and spine, reducing the risk of pelvic floor dysfunction and related symptoms
• Avoiding Prolonged Sitting: Long periods of sitting can put pressure on the pelvic area and weaken pelvic floor muscles. Taking breaks to move around and stretch can be beneficial

Urinary incontinence, or the involuntary leakage of urine, is another common issue that postmenopausal women may face. There are different types of urinary incontinence, including stress incontinence and overactive bladder. Stress incontinence is often caused by weakened pelvic floor muscles and can be managed through pelvic muscle exercises, also known as Kegel exercises. These exercises help strengthen the pelvic floor muscles and improve bladder control.

Overactive bladder, on the other hand, is characterized by sudden urges to urinate and can be managed through lifestyle modifications and medications. Lifestyle modifications may include reducing caffeine intake, maintaining a healthy weight, and practicing bladder training techniques to increase the capacity to hold urine and control the timing of urination.