The penultimate guest blog during Urology Awareness Month comes from Angie Rantell, Lead Nurse Urogynaecology / Nurse Cystoscopist at King’s College Hospital who addresses ageing and menopause symptoms – the ones often openly discussed, but more importantly the ones which aren’t – lifting the lid for those feeling alone or unable to seek help.

Ageing is an inevitable fact of life that most women cannot escape and the menopause is often seen as a turning point in the process. As we are living longer women can now spend up to a third of their life in a post-menopausal state. During the climacteric period women are often very vocal with their friends and family about some of the symptoms they may experience, discussing hot sweats (also referred to as ‘my own personal summers’ or ‘granny sweats’) or mood swings (in severe cases nicknamed mood theme parks) or middle age spreads (where difficulty losing those extra few pounds around the tummy and hips are discussed over tea and cake!). But there are still many symptoms associated with the menopause that women remain tight lipped about, mainly the development of urinary symptoms such as incontinence and recurrent urinary tract infections.

Up to 70% of women relate the onset of their urinary incontinence to their final menstrual period. After this time women may also report an increase in urinary urgency which can lead to urgency incontinence and cystitis-like-symptoms including dysuria (burning or discomfort when passing urine). These symptoms can all be related to a depletion of oestrogen in the urinary tract and vagina and can worsen in severity the further post menopause that women become.

Toileting habits change with age. Stereotypically, younger women go to the toilet in pairs (whether this is for support in case the door doesn’t lock or to have a gossip this is not known). Yet this phenomenon is rarely seen with older women (perhaps because you cannot always ensure that your friend can get to the toilet as quickly as you need to or you are too embarrassed for your friend to hear the rustling of the incontinence pad or knickers being changed).

So why aren’t women being more vocal about this problem? Is there still the common misconception that incontinence is a natural consequence of aging? Consumer advertising for continence products has tried to get the issues out into the public domain, for example TV adverts trying to normalise ‘oops moments’ and suggesting products that women can buy. However, there is little education for women about why they may be experiencing these problems or advice on treatment options available to manage and potentially resolve their symptoms.

The big question is – how do we raise awareness and encourage women to open up about these issues and seek help if necessary?

As health care professionals our first responsibility it to make the most of all opportunities to actively enquire about urinary symptoms, whether at routine smear tests, well woman checks or if women seek help for other menopausal symptoms.

We also need to optimise health promotion e.g. advice on good bladder health and how to seek help could be provided when women buy incontinence products. The media should also be encouraged to discuss the issue more openly e.g. in women’s magazines to ensure that credible advice and links for further information are available for all to access.

This Urology Awareness Month let’s try to normalise the discussion and empower women of a certain age to seek help and to encourage those who aren’t there yet to reduce the risks of developing the problems.

Author: Angie Rantell – Lead Nurse Urogynaecology / Nurse Cystoscopist, King’s College Hospital