Bladder and urinary symptoms

A group of changes in how your bladder behaves. Needing to go more often, day and night. A sudden urge you cannot hold. Leaking a little when you cough, laugh or lift. Burning when you pee, or urinary infections that keep coming back.

Women's Health Concern says a large proportion of adult women have urinary incontinence, and names two main types. NHS inform, the Scottish health service's site, describes them: stress incontinence, when urine leaks because the bladder is under pressure, as with a cough or a laugh, and urge incontinence, when a sudden, very intense need to pass urine comes and you cannot stop it. Some women have both.

A few drops when you sneeze. Getting up two or three times a night. A rush to the bathroom the moment you get home. The constant low worry of whether it shows. For many women, the worst of it is not the leak itself but planning every outing around it.

The Pakistan Menopause Society groups these symptoms with the genitourinary changes of the years after menopause (Table 1), which it links to falling estrogen and other hormones affecting the vagina, urethra and bladder (section 1.5.2). Doctors call the whole group GSM.

Other things play a part. NHS inform lists pregnancy and vaginal birth, being overweight, a family history and getting older as things that raise the chances of incontinence. The NHS website adds weakened pelvic floor muscles, often after childbirth, and lists caffeine, alcohol, constipation and urinary infections among the possible causes of an overactive bladder.

NHS inform says treatments without medicine or surgery usually come first, and lists ways to cut the chances of leaking:

• pelvic floor exercises, squeezing to strengthen the muscles that hold urine in
• bladder training, learning to wait longer between feeling the need and going
• keeping to a healthy weight
• cutting down on caffeine and alcohol

On caffeine, see chai and caffeine. NHS inform names tea, coffee and some fizzy drinks such as cola. It also says a doctor, nurse or physiotherapist may ask you to keep a bladder diary.

If simple measures are not enough, NHS inform says a doctor may suggest medicine or surgery, depending on the cause and type of incontinence.

For women whose bladder symptoms come with the vaginal changes of menopause, NICE NG23 points doctors to NICE's guidelines on overactive bladder and on recurrent urinary infections, both of which cover vaginal estrogen (1.5.12 and 1.5.13).

The Menopause Society separates the two kinds of estrogen. HRT for the whole body, as tablets, patches or gel, does not help leaks and may make stress leaks more likely, it says, and it rates that evidence as good. Vaginal estrogen may help prevent repeat infections and ease an overactive bladder and urge leaks, on more limited evidence. The European Menopause and Andropause Society (EMAS) also lists vaginal estrogen among the ways to prevent urinary infections, and HRT for the whole body among the things that raise the chances of leaks. Which option suits you is for you and your doctor to decide.

NHS inform says to speak to your GP practice if you have any symptoms of urinary incontinence, and that although it is common, it should not be thought of as normal. The NHS website adds that you should not feel embarrassed to talk about it.

The Pakistan Menopause Society asks doctors to refer women with urinary infections that keep returning despite treatment, blood in the urine, symptoms of prolapse, or incontinence that is affecting their quality of life (Table 4). So if you see blood in your urine, get it checked.

Leaks raise a question that is specific to prayer: what happens to wudu when urine escapes, or keeps escaping, and what about clothes for salah? Women ask this quietly and often feel too embarrassed to ask anyone at all. It belongs with a qualified scholar, and Roshara does not rule on it.

What we can say is that the Pakistan Menopause Society expects doctors to ask about bladder symptoms in private (section 2.2). If yours does not ask, peshaab ki takleef is enough to start.