Periods and Leaking

The recent rainy weather here in Fort Collins (I’m not complaining – my tulips are out in full force) and the onset of my period make it difficult to not want to stay in bed and watch movies all day! That got me thinking about something mentioned to me earlier in the week by a friend… Have you ever noticed that you feel more intense urgency and possibly even more leaking when you are on your period? Well, you are not alone! This is one of the most common symptoms women tell me about in the clinic – they are managing their symptoms well, not leaking with exercise and not peeing every 30 minutes, and then their period comes around and it feels like they have to pee more urgently and more frequently. This is called cyclical incontinence and unfortunately, we do not have much research on the topic (surprise, surprise). We do have two, not-so-recent, studies that have tried to explain this common phenomenon.     According to a 2001 study done by Hextall et al, 

• 24% of females in the study found that their incontinence was worse right before their period, 
• 36% experienced worse incontinence during their period, 
• 15% found that their incontinence was worse in the middle of the month and 
• 7% reported increased incontinence immediately after having their period.

Another (very small) study by Sorenson found that there was no correlation between menstruation and incontinence in healthy, fertile females.    It’s important to understand that research is important, and the findings from such studies can help us to better understand and therefore treat symptoms. However, due to the lack of research, and using an individualized patient approach, YOUR symptoms matter – regardless of if there is a causal relationship or not. So, let’s try to understand the menstrual cycle and why/how it could possibly cause a change in symptoms The menstrual cycle starts when you get your period (bleeding) and lasts anywhere from 24-38 days. if the egg that has been released is not fertilized (i.e. you get your period), your progesterone and estrogen levels drop to begin your cycle. The menstrual cycle occurs in three stages:

• The follicular stage – before the egg is released, estrogen and progesterone levels are low
•  The ovulatory stage – an egg is released, estrogen levels drop, and progesterone levels rise
•  The luteal stage – after the egg is released, estrogen and progesterone levels are high

Progesterone’s role is to prepare your body for pregnancy in the case of an egg being fertilized. These hormone levels rise for around five days.  Estrogen is released before and after ovulation to thicken the uterine lining in preparation for pregnancy.   Progesterone is thought to increase the activity of the detrusor muscle (the bladder). This means that as progesterone levels rise right before and during your cycle, it could be causing your bladder to contract more frequently leading to more urges and possibly incontinence. Estrogen changes the flexibility and stiffness of the pelvic floor muscles and ligaments which can change the position of the cervix. These changes cause decreased muscular pressure around the urethra which can make it more difficult to prevent leaking. Low estrogen levels during menstruation also alter abdominal pressure which can cause leaking. Regardless of whether menstruation influences your symptoms or not, leaking is never optimal. A consult with a pelvic floor PT to assess and address the underlying causes of your symptoms will yield the highest results in the shortest amount of time. Give us a call at Up and Running PT to find out how we can help you!  References

• Hextall A, Bidmead J, Cardozo L, Hooper R. The impact of the menstrual cycle on urinary symptoms and the results of urodynamic investigation. BJOG. 2001 Nov;108(11):1193-6. doi: 10.1111/j.1471-0528.2003.00280.x. PMID: 11762662.
• Sorensen S et al. Urodynamic investigation in healthy fertile females during the menstrual cycle. Europe PMC. 1998 Jan, 114:28-34. PMID: 3201165
• https://aeroflowurology.com/blog/bladder-control-and-period#:~:text=Takeaway%3A%20The%20low%20estrogen%20levels,to%20weaken%2C%20leading%20to%20incontinence.

https://summitwyo.com/what-causes-female-incontinence/#:~:text=Stress%20incontinence%20can%20worsen%20during,urethra%2C%20increasing%20chances%20of%20leakage.  

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