Are there estrogen alternatives for bladder irritation?

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overactive bladder, incontinence
Bladder irritation is one of the common symptoms associated with menopause. However, you may find it hard to complain about urinary (and vaginal) symptoms out of embarrassment. Unfortunately, many doctors will not ask you about them.

Bladder Overview

The urinary bladder is an elastic, muscular sac which holds the urine excreted by the kidneys before urination. Once it collects 300ml of urine, it starts sending signals for urination, and can hold a maximum of 600ml in normal adults.

One type of bladder disorder is the over-active bladder, also known as urge incontinence. This is the involuntary voiding of urine after a sudden urge to urinate is felt. Over-active bladder is often caused by the abnormal contraction of the detrusor muscle, one of the bladder’s major muscles involved in the normal process of urination.

Cases of over-active bladder are higher in women than in men, and more common as people age. However, it is not a part of the normal ageing process and should be given medical attention.

Causes of Over-active Bladder

The nervous system regulates the contraction and relaxation of the detrusor muscle. The following diseases may affect the detrusor muscle’s normal function, causing inappropriate contractions which force the urine out:

  • Menopause
  • Parkinson’s Disease,
  • Multiple Sclerosis,
  • Spinal Cord Injury,
  • Diabetic Neuropathy,
  • Dementia and
  • Stroke
  • Bladder stones or tumors
    In addition, there can be other factors that may result in symptoms similar to those of an over-active bladder. Therefore, careful assessment is needed to differentiate the disorder from these underlying conditions:

    • Urinary tract infections
    • Poor renal function
    • High fluid intake
    • Excessive consumption of alcohol and caffeine
    • Medications such as diuretics

    Symptoms of Overactive Bladder

    • Urinary urgency and incontinence regardless of the amount of urine
    • Frequency of urination, about 8 or more times per day
    • Nocturia, or waking up three or more times at night to urinate

    Treatment

    Overactive bladder is not a socially- accepted condition, and may cause depression, poor social interaction, and interrupted sleep patterns, thus affecting quality of life. The fear of not making it in time to the toilet may cause disruptions in daily activities. Depending on the severity and the individual’s capability, treatment protocols may be behavioral, medical, and surgical.

    • Kegel exercises: Typically included in the treatment plan, these involve exercises that strengthen the pelvic floor to prevent incontinence, done 30- 80 times daily for at least 8 weeks.
    • Pelvic floor electrical stimulation: Done in conjunction with Kegel, this therapy sends mild electrical impulses to facilitate pelvic muscle contractions.
    • Vaginal weight training: This therapy is performed by tightening vaginal muscles to hold weights placed within the vagina, done twice daily for 15 minutes within a period of 4- 6 weeks.
    • Bladder retraining is a behavioral therapy used to increase voiding intervals and resist urgency.
    • Regular bladder emptying and scheduled toileting can promote routine voiding and prevent leakage.
    • Encourage use of toilets instead of relying on diapers and underpads.
    • Avoiding spicy foods, chocolates, nuts, alcohol, caffeinated beverages, and too much fluid may limit symptoms of overactive bladder. Maintaining a normal weight can also reduce stress on the bladder and lessen feelings of urgency.
    • Anticholinergics are medications that may be used to decrease activity of the Detrusor muscle.
    • Reconstructive bladder surgery is a common surgical procedure to treat overactive bladder, but surgery should be a last option unless patient is unresponsive to other forms of therapy and manifests debilitating symptoms.
    • Estrogen for bladder irritation – Estrogen treatments for bladder irritation are available in various forms:
      1. Oral estrogen – this can improve bladder symptoms like burning and incontinence. However this is not the best option for women who cannot take estrogens for health reasons (e.g. a hitsory of breast cancer). Some women do not get relief from oral estrogen and so may find relief from other forms.
      2. Topical estrogen -
        • estrogen patch – the estrogen in the patch is absorbed through the skin and into the bloodstream. This usually causes fewer side effects compared to oral estrogen. However, the adhesive that sticks the patch to your skin can cause irritation if you are allergic to it.
        • vaginal estrogen – this is available in the form of creams, gels, a vaginal ring e.t.c. This is the best option for you if you are targeting bladder and/or vaginal symptoms in particular.
        • The bladder and vagina are seperated by a few layers of cells. Estrogen applied into the vagina is easily absorbed into the bladder lining to relieve symptoms.

    • As much as possible, try to use natural/bioidentical estrogen as it tends to have fewer symptoms.

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