As if the hot flashes and mood swings weren’t enough, many of us going through menopause start to experience more episodes of urinary incontinence. A decrease in estrogen initiates a thinning and weakening of the pelvic muscles and connective tissue — our house just starts to sag a little.

The relationship between bladder control and hormonal balance becomes increasingly important as we get older and transition through menopause. Some of us have been keeping an eye on the bathroom all along the way, but what about those women who never had an awkward leaky moment until their 40’s or 50’s?

We’re now seeing more ads for pharmaceuticals directed at female incontinence (somebody finally noticed!) but as usual, they only address the most obvious symptoms and do nothing to treat the underlying loss of muscle tone. Most of the drugs available act on the muscle spasms related to overactive bladder but do nothing for stress incontinence and can cause other bothersome side effects.

As with any drug or synthetic hormone, you need to weigh the long-term risks against the potential benefits before taking a pill that could do serious long-term damage to your health. Of course, we recommend you try the most natural steps first, and resort to drugs only if necessary to get symptom relief.

After menopause, women are more prone to bladder infection, chronic urinary tract infection (UTI) or cystitis. As the urethral muscle loses strength and elasticity due to loss of estrogen, pockets of bacteria can flourish. Taking an antibiotic — nowadays there’s a one-day massive dose — is usually adequate, but in some cases inflammation takes hold and damages the lining of the bladder.

This condition, called interstitial cystitis (IC), is a growing concern in women’s health that warrants an entire article of its own. It’s an inflammatory condition that manifests with all the symptoms of a urinary tract infection even when no bacteria are present. It would not surprise me to find in the future that estrogen imbalance is somehow implicated in the escalating rates of interstitial cystitis that I’m seeing.

The emotional connection to the bladder

In Chinese medicine, the bladder is related to issues of anger and control — there’s ancient wisdom at work when we say we’re “pissed off”.

In yoga, the root lock — or mula bunda in Sanskrit — is located at the base of the perineum. It is one of the three major body locks that control our inner life force, or kundalini. (Note that this inner life force is considered to be female!). It is closely related to the earth and the force that connects all living things. Lifting the mula bunda creates stability and energy within the body (as you do with a Kegel exercise — discussed below), channels our life force up through the chakras and imbues our bodies with a sense of weightlessness.

Incontinence can sometimes be a physical manifestation of some deep-seated fear or worry that weighs us down. It’s often related to anxiety or anger about losing control. Occasionally, sporadic episodes of incontinence will occur during a particularly stressful — or “out-of-control” — phase of your life. Pay attention to your feelings and see if you notice any patterns.