Women’s Pelvic Health at Mid-Life and Beyond

Almost overnight, there appear to be more frequent trips to the bathroom, waking us from sleep and driving women to map out their days based on the proximity of clean bathrooms.

Then, there’s the worry about coughing, sneezing or laughing and the possibility of a little leaking urine and needing to wear pads for protection. Leaking and incontinence describe the same thing.

In addition, many women also start noticing a slight discomfort and dryness around the genitals and in the vagina, and a new need for lubricant when intimate.

If these are some of the changes you’re noticing, you’re not alone. Millions of women at mid-life find that their bodies are changing in ways that few people talk about.
 

Types of Incontinence

• Stress Incontinence – Occurs when the pelvic muscles become weaker and more stretched after pregnancies.
• Urge Incontinence – Also called overactive bladder. A woman may leak when she senses the need to urinate without warning. She may have the urge to urinate every hour, especially at night. Nerve damage from illnesses or deliveries may cause this.
• Mixed Incontinence – As if one type wasn’t enough. This is usually a combination of urge and stress incontinence.

Shrouded in Shame

These issues may be beyond embarrassing, which leads to women dealing with these issues on their own. The fact is, very few women feel comfortable bringing up embarrassing topics with their health care providers. And, sadly, many providers are so busy discussing blood pressure, weight, lab tests and all the other health concerns, that they don’t talk about leaking, vaginal dryness or changes in sex either.

What happens, is that women adapt, by buying more pads or what’s worse, limiting their lives and their activities for fear of the odor of urine. Many women are surprised that as many as 1 in 3 women their age are also dealing with some leaking urine and that the old adage “Just do your Kegels” has been replaced by the new field of Pelvic Floor Physical Therapy.

The Women’s Health Foundation has developed a Total Control Program®
 

This is the description of how to perform Kegel Exercises from the Women’s Health Foundation:

• First, it’s important to take pressure off of your pelvic floor muscles, so they can “lift” more easily.
• Lie on your side with your hips and knees flexed to about 90 degrees (like you are sitting in a straight-backed chair, rather than curled up in a fetal position).
• Relax your rear end muscles – The muscles you want to concentrate on are deeper. Relax those very deep “personal” muscles, too – these are your pelvic floor muscles.
• Now, imagine you are trying to stop the flow of urine and gas, feel the openings in your pelvic floor begin to squeeze, slowly and gently if you can. Make sure you are not squeezing your rear end or inner thighs.
• Once you are confident that you can feel the openings begin to squeeze without squeezing your rear end muscles, try to increase the strength of the squeeze around your pelvic floor muscles.
• Don’t worry about squeezing as hard as you can – this often causes too much tension. Feel the muscles relax completely between squeezes. Practice this gentle squeezing 5 to 10 times.
• Now that you have the hang of squeezing your pelvic floor, focus on feeling a squeeze which builds to a lifting sensation. “Squeeze and Lift” is the Kegel Mantra!
• Practice squeezing and lifting for a count of 5, then relaxing for a count of 5, repeat 10 times. You may also try what we call a “Pelvic Floor Waltz”, because of the rhythm: Squeeze, Relax, Relax…Squeeze, Relax, Relax….
• This trains the quick-response muscles. Repeat this 10 times, depending on how fatigued the muscles feel. With consistent practice, you should feel an increase in your endurance.

There’s Hope

Pelvic floor physical therapy can help not only with leaking, but also for women with pelvic pain and pain with intercourse. Some women will benefit from a few classes and others may need a complete private evaluation by a certified physical therapist and then have a treatment plan designed specifically for them.

Learn about pelvic floor physical therapy classes, part of a comprehensive pelvic health program at El Camino Hospital.

Total Control® Program

Health care providers and urologists now routinely recommend pelvic floor physical therapy to help women regain pelvic muscle strength and tone. I’ve been referring my patients to the Total Control® Program at El Camino Hospital, which is the only one available in Santa Clara County. This program helps women achieve:

• Stronger pelvic core and flatter abdominal muscles
• Improved bladder control
• Better sexual health

These improvements can be life-changing and give hope to the many women living in pain, discomfort and embarrassment.

For more information, visit the Services section, Pelvic Health program.

Disclosure: I am working with El Camino Hospital to provide information on the programs and services that are available here.

This article first appeared in the Autumn 2015 blog and some programs may no longer be offered.