Menopause bladder and bowel problems: what changes and what helps
Around menopause, many women notice their bladder and bowel change at the same time: leaks on a sneeze, sudden urges, getting up at night, constipation, bloating, trouble holding wind, and sometimes small bowel leaks. The reasons are shared. Falling estrogen thins and weakens the tissue in the pelvis, the pelvic floor muscles lose strength with age, and one problem makes the other worse: a full, straining bowel presses on the bladder and wears down the floor that both rely on.
The good news is that the fixes are shared too. Pelvic floor training, a few bowel habits, bladder training and, for some women, vaginal estrogen help both. This guide explains what changes, why, how common it is, a six-week plan, and the signs that mean see a doctor first.
Why menopause affects the bladder and the bowel
- Estrogen falls. The lining of the vagina, urethra and bladder base, and the support tissue around them, depend on estrogen. As it drops, they get thinner, drier and less springy. Doctors call the bladder and vaginal side of this the genitourinary syndrome of menopause.
- Muscle strength falls with age, including the pelvic floor and the ring of muscle around the back passage (the anal sphincter).
- Old injuries show up. A tear or stretch from childbirth, decades ago, can be covered by strong muscle for years and appear only when that muscle weakens. Continence Foundation of Australia notes some women first notice bowel control problems at menopause for this reason.
- Weight often shifts to the belly, which adds pressure on the pelvic floor every day.
- Lifestyle changes: less sleep, more stress, less movement and new medicines can all slow the bowel or irritate the bladder.
These changes can start in perimenopause, in your 40s, and continue after the last period. They usually build slowly, though they often feel sudden. See perimenopause incontinence for the early years.
How common is it?
Very common, and under-reported. Bladder & Bowel UK states that more than half of women who've been through menopause have some bladder leakage. A US national health survey (NHANES) found about 1 in 12 adults living at home had had accidental bowel leakage in the past month, more often with age. Many women never mention either to a doctor, which is a shame, because both respond to treatment.
Bladder changes you may notice
| Change | What it feels like | Read more |
|---|---|---|
| Stress leaks | A few drops on a cough, sneeze, laugh, lift or jump | Bladder leakage and menopause |
| Urgency and urge leaks | A sudden strong need to go, sometimes not making it | Sudden urge to pee |
| Going more often | More than about 8 times a day | Bladder training schedule |
| Night-time peeing | Waking to pee twice or more | Bladder leakage and menopause |
| More urine infections | Burning, urgency, cloudy urine, coming back | Bladder pressure after menopause |
| Pressure or heaviness | A dragging feeling, worse by evening | Bladder pressure after menopause |
Bowel changes you may notice
Constipation and straining
The most common bowel change women report at midlife. Hard or infrequent stools, straining, and a feeling of not having finished. Less movement, less fiber, less fluid, some medicines (iron, some pain medicines, some antidepressants) and stress all add to it. Some women also notice their gut gets slower or less predictable as hormones change.
Bloating and wind
A swollen belly by evening, more wind, and, as the sphincter weakens, finding wind harder to hold. Slow bowels make bloating worse.
Bowel urgency and leakage
Needing to rush for a bowel movement, leaking a little stool or mucus, or finding marks on your underwear. Doctors call it accidental bowel leakage or fecal incontinence. It's more common in women who had a tear during a vaginal birth, and in women with loose stools. It is not a normal part of getting older, and it's very treatable.
Not emptying, or pressing to empty
If you need to press on the skin between the vagina and back passage, or inside the vagina, to finish a bowel movement (called splinting), the back wall of the vagina may be bulging into it. That's a type of prolapse called a rectocele. It's common, it's not dangerous, but it's worth a doctor's exam; see the prolapse section below.
Why bladder and bowel problems come together
They share one floor. The pelvic floor is a hammock of muscle that holds up the bladder, the womb and the bowel, and closes the urethra and the back passage. Weakness or tightness affects both openings. They also affect each other:
- A full bowel presses on the bladder. Constipation can make urgency and frequency worse, and some bladders improve when constipation is treated.
- Straining pushes the floor down, hard, many times a week. Over years it stretches the support, which feeds leaks and prolapse.
- A tight floor blocks both. A pelvic floor that won't relax can make it hard to start peeing and hard to empty the bowel. Pushing harder then makes it tighter. See tight pelvic floor symptoms.
- Drinking less to avoid leaks makes stools harder and urine stronger, which irritates the bladder: two problems from one fix.
That's why working on only one side often stalls. Treat the bowel, and the bladder often gets easier; train the floor, and both benefit.
Prolapse: when the walls sag
When the support weakens, the front wall of the vagina (with the bladder behind it) or the back wall (with the bowel behind it) can sag down. Signs: heaviness or dragging, a bulge you can feel or see, feeling you haven't emptied, splinting to empty the bowel, or a slow stream. Symptoms are often worse at the end of the day or after standing and lifting. Pelvic floor training helps mild prolapse; a pessary fitted by a doctor or nurse supports it; surgery is an option when symptoms are bothersome. See pelvic floor exercises for prolapse.
What you can do: bowel habits
- Fiber, built up slowly. The US Dietary Guidelines suggest about 25 grams a day for women 31 to 50 and about 22 grams from 51. Most of us eat far less. Add one food at a time over 2 to 3 weeks: oats, beans and lentils, fruit with skins, vegetables, whole grains, ground flaxseed. Going fast causes gas and bloating.
- Fluid. About 6 to 8 cups a day, spread out. Fiber needs water to soften stools. Don't cut fluids to control leaks; cut caffeine instead.
- Move every day. A brisk walk helps the gut move.
- Use the morning. The gut is most active after waking and after a meal. Give yourself 10 unhurried minutes after breakfast.
- Go when you feel the urge. Putting it off lets the stool dry and harden.
- Sit right. Feet on a low stool so your knees are above your hips, lean forward with your elbows on your knees, back straight.
- Breathe, don't strain. Breathe into your belly and let it bulge, let the floor drop, and push gently with a long out-breath, as if blowing out a candle slowly. Don't hold your breath and bear down.
- Aim for soft, formed stools, types 3 to 4 on the Bristol stool chart. Too hard is constipation; too loose makes leakage more likely.
What you can do: the pelvic floor, front and back
Pelvic floor training is the first treatment for stress leaks in women in the NICE guideline, and the same muscles control wind and stool. Train both openings:
- Back squeeze: tighten as if stopping wind, without clenching your buttocks. This works the anal sphincter.
- Front squeeze: tighten as if stopping the flow of urine (practise it, don't do it while peeing).
- Together, lifting: squeeze both and draw them up inside you. Breathe. This is the full pelvic floor lift.
- Slow holds: 8 to 12 holds, up to 10 seconds each, with a full let-go between. Quick squeezes: 10 one-second lifts. Three times a day.
- The let-go matters as much as the squeeze. If you're unsure, see how to know if you are doing Kegels correctly.
In a 2018 Cochrane review, women with stress leaks who did pelvic floor training were far more likely to report a cure (56%) than women who didn't (6%). Training also helps bowel leakage, often with biofeedback from a physical therapist. For the moves and counts, see menopause pelvic floor exercises.
What you can do: the bladder
- Bladder training for urgency: stretch the time between toilet trips by 15 minutes every week or so, using the urge steps (stop, squeeze, breathe) to wait out each wave.
- Less caffeine, which NICE recommends trying for overactive bladder; many women find alcohol and fizzy drinks matter too.
- Fewer drinks in the 2 hours before bed if you're up at night.
- The squeeze before a push: lift your floor just before a cough, sneeze or lift.
Treatments a doctor can offer
| Problem | Options |
|---|---|
| Dryness, urgency, repeat UTIs after menopause | Vaginal estrogen (cream, tablet or ring); vaginal moisturisers |
| Stress leaks | Supervised pelvic floor training; vaginal devices or a pessary; surgery if needed |
| Overactive bladder | Bladder training, then medicines, then specialist procedures |
| Constipation | Fiber supplements, gentle laxatives, a medicine review; therapy if the floor doesn't relax |
| Bowel leakage | Firming loose stools (fiber, sometimes loperamide), sphincter training with biofeedback, specialist options |
| Prolapse | Training, a pessary, surgery |
What about hormone therapy? Vaginal estrogen treats the local tissue and is the option guidelines name for bladder symptoms after menopause. NICE advises against hormone tablets or patches as a treatment for leaks. HRT has other good reasons (hot flushes, bones); discuss those with your doctor separately.
A six-week plan for both
| Week | Bowel | Bladder and floor |
|---|---|---|
| 1 | 3-day diary: stools (type, straining), food, fluid. Footstool in the bathroom. | 3-day bladder diary. Find the front, back and full lift lying down. |
| 2 | Add one fiber food a day. 6–8 cups of fluid. 10 minutes after breakfast. | 3 sets a day: 8 holds (as long as you can) + 10 quick. Swap one coffee. |
| 3 | Add a second fiber food. Daily walk. Breathe, don't strain. | Holds to 5–6 seconds. Squeeze before every cough and lift. |
| 4 | Check your diary: stools softer? Less straining? | Sets sitting. Start bladder training: +15 minutes between trips. |
| 5 | Keep fiber steady; add ground flaxseed or oats if needed. | Holds 7–8 seconds, sets standing. Fewer drinks after 8 pm if up at night. |
| 6 | Repeat the 3-day diary and compare. | Repeat the bladder diary. Keep going: training needs 3 months to judge. |
Not sure where your floor stands? Our free 1-minute check asks when your symptoms happen and shows why Kegels alone often don't help.
When to see a doctor
See a doctor soon if you have blood in your stool or black stools, a change in your bowel habit that lasts more than 3 weeks, weight loss you can't explain, belly pain that doesn't go away, blood in your urine, or a bulge in the vagina. Bowel changes in midlife deserve a check because colorectal screening matters at this age: the US Preventive Services Task Force recommends screening from age 45. Book a visit too if leaks of urine or stool affect your day, if you splint to empty, or if 3 months of training hasn't helped.
How to bring it up
Many women wait years because it's embarrassing. A doctor hears it every week. It helps to say it in one line, and bring your diary: "Since menopause I've been leaking urine when I sneeze and I struggle with constipation; I'd like help with both." Ask whether a pelvic floor physical therapist is an option; in the US, many women can book one directly, depending on their state and insurance.
Frequently asked questions
Can menopause cause bowel problems?
It can play a part. Weaker pelvic floor muscles and tissue changes can make constipation, wind control and bowel leakage more likely, and old birth injuries can show up. Other causes need ruling out.
Why do I have bladder and bowel problems at the same time?
They share the pelvic floor, and constipation and straining make bladder problems worse. Treating both together usually works better than one at a time.
Can pelvic floor exercises help bowel leakage?
Yes, training the back part of the floor helps many women, often with a therapist's biofeedback. Firm, regular stools help too.
Is it normal to leak after menopause?
It's common, but you don't have to live with it. Training, bladder habits and vaginal estrogen help many women.
Does HRT help bladder and bowel problems?
Vaginal estrogen can help bladder symptoms and repeat infections after menopause. Hormone tablets or patches aren't a treatment for leaks.
Where to start today
Put a low stool by the toilet and start a 3-day diary for both bladder and bowel. Then find your back squeeze: tighten as if stopping wind, hold for a few seconds, let go. To see in one minute why Kegels often don't help on their own, take the free 1-minute check. For more on menopause, leaks and the pelvic floor, see all our pelvic floor guides.
Sources: NICE NG123, Urinary incontinence and pelvic organ prolapse in women: management, 2019. Bladder & Bowel UK, How may menopause affect my bladder and bowel? (bbuk.org.uk). Continence Foundation of Australia, Menopause and incontinence (continence.org.au). University Hospitals, Urinary and bowel changes at midlife (uhhospitals.org). Portman D.J., Gass M.L., Genitourinary syndrome of menopause: new terminology, Menopause, 2014. Ditah I. et al., Prevalence, trends, and risk factors for fecal incontinence in United States adults, 2005–2010, Clin Gastroenterol Hepatol, 2014. Dumoulin C., Cacciari L., Hay-Smith J., Pelvic floor muscle training versus no treatment for urinary incontinence in women, Cochrane, 2018. Dietary Guidelines for Americans 2020–2025. US Preventive Services Task Force, Colorectal cancer screening, 2021. Training and education, not medical advice.