--- title: 'Urinary Symptoms in Perimenopause: Why Leakage and Urgency Happen and What Helps' slug: bladder-symptoms-perimenopause-urinary-leakage lifeStage: perimenopause category: Wellbeing medicalReviewer: 'Dr Clare Bourne, Consultant Pelvic and Digestive Health Physiotherapist' reviewerId: 'https://blog.bloume.com/perimenopause/medical-board.md#clare-bourne' lastUpdated: '2026-08-08' primarySource: 'Genitourinary Syndrome of Menopause (GSM)' wordCount: 1330 readTimeInSeconds: 332.5 --- # Urinary Symptoms in Perimenopause: Why Leakage and Urgency Happen and What Helps Urinary symptoms in perimenopause, including leakage, urgency and going more often, are common, and they line up with falling oestrogen. Your bladder, urethra and pelvic floor all respond to that hormonal shift. Pelvic floor exercises, bladder training and a few simple fluid changes can make a real difference. If your symptoms do not improve, your GP can refer you to a pelvic health physiotherapist for a tailored assessment and programme. **Q: Is bladder leakage a normal part of perimenopause?** A: Leakage, urgency and going more often are common in perimenopause, and they line up with falling oestrogen. They are not something you have to accept as permanent, and they often respond well to pelvic floor exercises, bladder training and small fluid changes. If they are affecting your daily life, speak to your GP. > **INFO**: This article is for informational purposes only and does not constitute medical advice. Always speak with your GP or a qualified healthcare professional about your symptoms. You may have noticed the sudden urge to reach the toilet before you are quite ready, or the small leak that comes when you cough or laugh. Maybe you are waking in the night to go more often than you used to, or the need to go arrives fast and is hard to ignore. These urinary symptoms in perimenopause, and the leakage that can come with them, are common. They often turn up without warning and can feel disruptive and embarrassing. In most cases, they respond well to a few practical changes. ## Why urinary symptoms emerge as oestrogen fluctuates Much of what you are feeling comes back to oestrogen. The bladder, the urethra (the tube that carries urine out of your body) and the pelvic floor muscles all respond to it. As oestrogen falls through perimenopause, these tissues can get thinner, less stretchy and weaker, which affects both the support around the bladder and the muscles that control when urine is released. If you have come across the term Genitourinary Syndrome of Menopause, or GSM, this is what it describes, the bladder, urethral and vaginal symptoms that come with lower oestrogen. Two main types of leakage come with these changes. Stress incontinence is the leak that happens under physical pressure, like coughing, sneezing or exercising. Urge incontinence, or overactive bladder, is the sudden, intense need to go that can be followed by a leak before you reach the toilet. You may have both at once, which is called mixed incontinence. ## What helps: practical steps you can start now ### Pelvic floor exercises and what doing them correctly feels like Pelvic floor muscle training, often shortened to PFMT, is usually the first thing suggested for leakage under pressure and for the mixed type, and it is worth sticking with for at least three months. What makes the difference is doing the exercises correctly, and it is common to be unsure whether you are. To find the right muscles, imagine you are trying to stop both wind from your back passage and the flow of urine at the same time. You should feel a squeezing and lifting inside your vagina, without clenching your buttocks or holding your breath. If you feel the effort mostly in your bottom or thighs, adjust until the sensation is internal and upward. A full routine uses two kinds of squeeze. Slow holds mean squeezing and holding for up to 10 seconds, then letting go completely. Fast squeezes are quick, strong contractions and releases. A common starting point is 10 slow holds and 10 fast squeezes, three times a day. A healthcare professional can set you a programme matched to your own level. It can take a few months of steady daily practice before you notice a clear improvement in bladder control. Consistency matters more than intensity. ### Why cutting back on fluids isn't advised It is tempting to drink less to cut down on toilet trips, but that often makes things worse. When urine gets concentrated it irritates the bladder lining, and the urgency can sharpen. Aim for around 1.5 to 2 litres a day unless your GP has told you otherwise. A simple check is the colour: pale straw is about right, and darker than that means drink a little more. Some drinks irritate the bladder and are worth easing off rather than cutting out completely. Caffeine in tea, coffee and cola, along with alcohol and fizzy or sugary drinks, can all push urgency up. Swapping one or two of them for water or a herbal alternative is an easy place to start. ### Bladder habits that help rather than worsen urgency Bladder training is usually the first approach for urge incontinence. The idea is to slowly stretch the gap between feeling the urge and going, so the bladder learns to hold a little more and the urgency eases over time. When a strong urge arrives, resist the instinct to rush to the toilet. Instead, stop still, sit on a firm surface if you can, and shift your attention by counting backwards from 100 or focusing on something nearby. At the same time, do several quick pelvic floor squeezes. This combination can calm the bladder signal and give you more control over when you go. Keeping a bladder diary for at least three days can help you spot patterns and triggers. Note what you drink and when, how often and how much you wee, and any leakage or urgency. This is also useful information if you later see a GP or physiotherapist. > **WARNING**: Some GSM symptoms, like a burning feeling when you wee or needing to go very often including through the night, can look a lot like a urinary tract infection (UTI). If you notice these, see your GP to rule out an infection before putting them down to perimenopause. ## When to consider physiotherapy and what to expect If exercises and bladder training have not shifted your symptoms after a few months, or you are not sure you are doing the pelvic floor exercises correctly, the next step is usually a referral to a pelvic health physiotherapist. Your GP is the usual starting point for that. A pelvic health physiotherapist usually starts with a detailed history, asking about bladder, bowel and sexual function, followed by a physical examination. That often includes an internal vaginal exam, done only with your full consent, to check your pelvic floor muscles function, how long they can hold and how well they relax. It lets them confirm you are squeezing the right muscles and build a programme around you. Beyond the exercises, a physiotherapist can guide you on bladder training and day-to-day adjustments. They may also use biofeedback, which uses sensors to show you in real time how your pelvic floor muscles are working, so you can connect with the right ones and control them more easily. Urinary symptoms in perimenopause, including leakage and urgency, are common, and they often respond well to treatment. If they are getting in the way of your day, raise them with your GP, who can work out what is going on, rule out other causes like infection, and refer you on for specialist support if you need it. --- **Q: Is bladder leakage a normal part of perimenopause?** Leakage, urgency and going more often are common in perimenopause, and they line up with falling oestrogen. They are not something you have to accept as permanent, and they often respond well to pelvic floor exercises, bladder training and small fluid changes. If they are affecting your daily life, speak to your GP. **Q: How long do pelvic floor exercises take to work for bladder symptoms?** It can take a few months of steady daily practice before you notice a clear improvement. A common starting point is 10 slow holds, up to 10 seconds each, and 10 fast squeezes, three times a day. A pelvic health physiotherapist can adjust the programme to your level and check you are doing the exercises correctly. **Q: Should you drink less water to reduce urgency and leakage?** Drinking less tends to make urgency worse. When urine gets concentrated it irritates the bladder, and the urge can sharpen. Aim for around 1.5 to 2 litres a day unless your GP has told you otherwise. Easing off caffeine, alcohol and fizzy drinks may also help reduce the irritation. **Q: When should you see a GP about bladder symptoms in perimenopause?** See your GP if you have any burning or pain when you wee, or anything that looks like a urinary tract infection, so an active infection can be ruled out. It is also worth going if symptoms have not improved after a few months of trying things yourself, if they are affecting your daily life, or if you would like a referral to a pelvic health physiotherapist. ### Clinical Sources - [Genitourinary Syndrome of Menopause (GSM)](https://thebms.org.uk/publications/consensus-statements/genitourinary-syndrome-of-menopause-gsm/) - [Recommendations | Urinary incontinence and pelvic organ prolapse in women: management | Guidance | NICE](https://www.nice.org.uk/guidance/ng210/chapter/recommendations) - [POGP — Pelvic Floor Muscles Patient Information](https://thepogp.co.uk/patients/pelvic_health_advice/pelvic_floor_%20muscles.aspx) - [POGP Pelvic Floor Patient Information Leaflet](https://thepogp.co.uk/_userfiles/pages/files/POGP-PelvicFloor%20(UL).pdf) - [POGP Pelvic Floor Patient Information Leaflet](https://thepogp.co.uk/_userfiles/pages/files/POGP-PelvicFloor%20(UL).pdf) - [Pelvic Health: Overactive Bladder (OAB)](https://thepogp.co.uk/_userfiles/pages/files/21918pogpea_signed_off.pdf) - [Pelvic Health: Overactive Bladder (OAB)](https://thepogp.co.uk/_userfiles/pages/files/21918pogpea_signed_off.pdf) - [Recommendations | Urinary incontinence and pelvic organ prolapse in women: management | Guidance | NICE](https://www.nice.org.uk/guidance/ng210/chapter/recommendations) - [Pelvic Health: Overactive Bladder (OAB)](https://thepogp.co.uk/_userfiles/pages/files/21918pogpea_signed_off.pdf) - [Recommendations | Urinary incontinence and pelvic organ prolapse in women: management | Guidance | NICE](https://www.nice.org.uk/guidance/ng210/chapter/recommendations) - [Genitourinary Syndrome of Menopause (GSM)](https://thebms.org.uk/publications/consensus-statements/genitourinary-syndrome-of-menopause-gsm/) - [Urinary Incontinence in Menopause: Are You Ignoring the Symptoms?](https://www.drlouisenewson.co.uk/knowledge/urinary-incontinence-in-menopause-are-you-ignoring-the-symptoms) - [POGP Pelvic Floor Patient Information Leaflet](https://thepogp.co.uk/_userfiles/pages/files/POGP-PelvicFloor%20(UL).pdf) - [Genitourinary Syndrome of Menopause (GSM)](https://thebms.org.uk/publications/consensus-statements/genitourinary-syndrome-of-menopause-gsm/) - [POGP — Pelvic Floor Muscles Patient Information](https://thepogp.co.uk/patients/pelvic_health_advice/pelvic_floor_%20muscles.aspx) - [POGP Pelvic Floor Patient Information Leaflet](https://thepogp.co.uk/_userfiles/pages/files/POGP-PelvicFloor%20(UL).pdf) - [Quality statement 4: Supervised pelvic floor muscle training](https://www.nice.org.uk/guidance/qs77/chapter/quality-statement-4-supervised-pelvic-floor-muscle-training) --- Reviewed by Dr Clare Bourne, Consultant Pelvic and Digestive Health Physiotherapist | [Medical Board](https://blog.bloume.com/perimenopause/medical-board.md) | August 2026