Urinary complications of menopause.

Stress incontinence: leaking.

1.One nonsurgical intervention is an intravaginal pessary help give support to the bladder neck.

2.Surgical options: Mesh (the size of scotch tape) can form a hammock to keep the urethra upright.  The mesh is the best treatment that urogynecologists have.  The media does not like mesh and attorneys seem to love it

Overactive bladder: urge to urinate. 

1. First steps: voiding diary.  24-hour diary (writing down how much she drinks and how much she urinates at every bathroom trip) as this gives insight as how well the bladder is functioning.
2. 2. Pelvic floor muscle strength.  This is assessed during a pelvic exam. 
3. 3. Common medications are in the family of anticholinergics. The medication limits bladder contractility which is good, but can also cause dry mouth and constipation.
4. Other nonmedication treatments: PTNS percutaneous tibial (which is on the leg) nerve stimulation.  This is a treatment that can be done multiple times in a urology office.
5. Intravesical botox.  Botox is inserted into the bladder at your urology office. This helps relax the bladder.
6. Spinal stimulation with implantable pulse generator can also give long-lasting relief.

Urinary tract infections: UTIs are more frequent after menopause. 

1.The role of estrogen in the urologic system is to help to maintain a beneficial vaginal flora to help decrease infections.  Use of estrogen helps decrease UTIs by half.  Estrogen can be in the vaginal in the form of cream, pill, or ring.