Coming Out Of The Closet About Pelvic Organ Prolapse

This is a guest post from Betty Heath, of The Rejoicing Soul.

During the past twelve years I have shared much of my life’s journey with you. Well, today I am coming out of the closet.  Stunning isn’t it? I was recently diagnosed with Pelvic Organ Prolapse. How many of you can identify with me? The current estimate of the number of women in the U.S. with this condition is approximately 4.3 million. According to a recent study by the World Health Organization guestimates indicate that there are 36 million women world-wide with this condition. The reality is that it is difficult to know what the real numbers are because women are reluctant to be talk about it or be treated for it.

Pelvic Organ Prolapse (POP) is quite common among today’s female population. Many women have the symptoms but because they are embarrassed to discuss them with anyone they suffer in silence.  POP can occur when the pelvic floor muscles weaken and one or more organs shift out into the vaginal canal and even bulge outside of the body.

My journey with POP began sometime in the spring of 2016. I began having symptoms of POP which include pressure, pain and/or fullness in vagina or rectum or both; sensation of ‘your insides falling out’; bulging in the vagina; severe back pain and incontinence. Every time I went for a walk or even sneezed I thought my insides were going to fall right out onto the ground. I began staying home more often and said little about it to my friends. At first I attributed these symptoms to old age and laughed them off. After all, I am approaching the ripe old age of 80. We hear and see so many TV ads regarding incontinence and because the causes are never addressed we become oblivious to what they might be.

This past fall I finally decided I didn’t want to spend the rest of my life worrying about my insides falling out and was tired of dealing with this issue so I made an appointment with a gynecologist. After the initial exam I was referred to Dr. Alexander Shapiro who is a specialist gyn/urologist in Denver. That exam took place in early December and was one hour and thirty minutes.

After the exam I told him I never dreamed I would be sitting in a gyn/urologist office at the age of 79. He smiled and replied, “We do have ways to keep popping up in your lives, don’t we.”  I then told him this was the most disgusting, gross thing that has ever happened to me. He said, “Right now your insides are a total mess. This is a very intimate surgery and is a major surgery. This is who you are right now and you can’t allow this to define your life. I promise you I can repair the damage and relieve the pain and discomfort”.

The four-hour surgery took place on Monday, January 30. I told my physician that most women my age are having face lifts and here I was having a butt-lift. I went home Tuesday and Wednesday as I was having breakfast I suddenly realized that the fullness/pressure feeling and the back pain I had prior to surgery were totally gone. Oh, what a relief it is. I cried tears of joy. I’ve experienced minimal pain with this surgery.

Today, if you are a woman reading this (or a man who has a woman in your life with this condition) I urge you to make an appointment to at least talk with your physician about your problem. There is help and hope for women with POP. New treatment options evolve daily to control, improve and repair this cryptic health condition.

Join with me in taking Pelvic Organ Prolapse out of the closet and make it common knowledge for women of all ages. Don’t allow this condition to define who you are or how you live your life.  Don’t wait! Call for your appointment today.

Betty Heath
Betty Heath

About The Author:  Betty Heath lives in Colorado with her husband. She is “retired from work, but not from living”, and has a weekly column called “As I See It”, which appears each Sunday in the Longmont Times-Call, owned by the Denver Post. She enjoys writing, cooking, gardening, and quilting. Betty also volunteers in the St. Vrain Valley School District, helping students learn how to write from their heart. For the past six years, she and her husband have volunteered as Santa and Mrs. Claus for the Holiday Festival in the Carbon Valley. You can read more from Betty at her blog, The Rejoicing Soul.

What To Expect Post Menopause

What To Expect Post Menopause - common ailments

So, you’ve made it through menopause – now what? While many of the symptoms that came along with menopause will go away, because of some of the changes that happened during menopause, you still need to be on your A-game to remain healthy.

Here are some of the common things to watch out for

Vaginal Bleeding

As your estrogen levels drop during menopause, the vaginal lining becomes very thin and, as a result, may be easily irritated, resulting in bleeding. Polyps (usually non-cancerous growths) can also occur. Bleeding after menopause is not normal, so if you experience this, be sure to see your doctor right away to get checked out to ensure it’s nothing serious.

Risk of Osteoporosis

After menopause, a woman’s bone breakdown overtakes bone buildup, resulting in a loss of bone mass. Overtime, this can develop into osteoporosis. Prevention is key here – be sure to exercise on a regular basis (weight bearing exercises done regularly are great at making bones stronger). Eat high calcium foods, such as low-fat milk and dairy products, canned fish, dark leafy greens, and calcium fortified foods. Vitamin D is also essential, as it helps the body better absorb the calcium you’ll be taking in. You can get Vitamin D naturally by exposing your skin to sun for about 20 minutes daily, but you may also get it from foods like eggs, fatty fish, cereal and milk. If you feel you are at a risk for not getting the calcium or vitamin D you need, talk to your doctor about taking supplements.

Risk of Heart Disease

While menopause doesn’t cause heart disease, women are at an increased risk for heart disease after menopause has occurred. Some believe that lack of estrogen may again be to blame, but other changes are in effect too – increased blood pressure, increased LDL cholesterol (this is the “bad” one) and higher levels of fat in the blood can also increase after menopause.  Diet and exercise are as important as ever (to keep your heart healthy and prevent other conditions). Just 30 minutes of physical activity - walking, dancing, and swimming are all great options – 5 days per week can give you a good aerobic workout. And be sure to eat a healthy diet while avoiding too much red meat, or high sugar foods and drinks.

Vaginal Dryness

Because of low estrogen levels, you may still experience some vaginal dryness. Over the counter vaginal lubricants and moisturizers can help ease these symptoms, but if that doesn’t work, talk with your doctor about using some type of estrogen treatment – there are many available, and in different forms (tablets, rings, creams).

Life after menopause can be a wonderful time provided you take the time for self care and work to maintain a healthy lifestyle.

The Pelvic Floor As We Age. A look at how it changes through the different phases of life (pregnancy, menopause, etc.).

The Pelvic Floor As We Age, Pregnancy, Menopause.

A Guest Post By Michelle Herbst, PT

As women age, their birthing history and overall muscle weakness may catch up with them.  A healthy pelvic floor can be achieved as we age but often little attention is paid to the pelvic floor until it starts to fail. It can be difficult for women to seek medical attention due to feelings of embarrassment and despair. But, advances in health care and knowledge of the aging process allows today’s women to seek effective treatments.

Let’s step back and take a closer look at the pelvic floor as we age.

The pelvic floor is a sling supporting our abdominal and pelvic organs. It is made up of our muscles and connective tissues which I like to think of as our active and passive pelvic support structures. The pelvic floor muscles, or active pelvic support structures, create a muscular sling whereas our passive pelvic support structures are made of connective tissue called fascia. Fascia is a spider-web like material traveling through and covering the pelvic floor.

The active and passive pelvic support system are one in the same. They are knitted together interlacing creating a dynamic basin of support. Healthy pelvic support system work together controlling our sphincters, limit the downward descent of the pelvic organs and aide in sexual appreciation. Damage or weakness to the pelvic support system may result in symptoms of pelvic floor dysfunctions resulting in leakage and pelvic organ prolapse.

The pelvic floor over time.     

Pregnancy, child birth and the post-partum period is a time of great change. The interlacing nature of the active and passive pelvic floor support systems protect the mother and baby as they both grown. Child birth calls on the pelvic support system to push and slide the baby out into the world. The pelvic floor muscles can heal in as quickly as 6 weeks after delivery. But, the physical strain of living and creating new life can be taxing on the pelvic support system leaving it overstretched and weak.

The prescription is often kegels and post-partum kegels can be hard to do. The muscles are lengthened, very weak and trying to ‘reconnect’ to their nerve supply. In an attempt to ‘get it all done’, the post-partum mom is often multi-tasking while doing kegels. Their brain is preoccupied, sleep deprived and foggy. Despite good intentions, many new mothers ‘muscle their way through’ relying on other muscle groups to assist or do the job of the pelvic floor. Overtime with due diligence and a sleeping baby – the brain fog lifts, kegels are consistent and pelvic floor muscles recover allowing the new mom to return to and enjoy life’s pleasures and adventures.

Life continues to click at a fast pace.  The biological process of aging ticks away. The passage of time can be bittersweet. In the 3rd through 5th decades of a woman’s life, she will begin to experience a gradual loss in overall muscle strength and tensile strength of their connective tissue. In their 4th and 5th decades, peri-menopause ushers in a decrease in circulating estrogen and progesterone. The conclusion of these gradual changes are marked by menopause which is typically complete during the 5th decade. Life starts to catch up with you. The birthing of children, past injuries, the development of chronic health conditions and your family history may predispose the active and passive support system to overall weakening and loss of integrity resulting in leakage, organ prolapse and decline in sexual function.

What Can you do To Strengthen The Pelvic Floor?

1.     Protect and strengthen your active pelvic support system by engaging in a strength program and doing your kegels. Peak muscle strength occurs in twenties or thirties. And, unless a woman is engaging in a strength program she will begin lose muscle mass and strength.

2.     Protect the passive pelvic support system by avoiding straining during bowel movements and avoid holding your breath while lifting, pushing and pulling. The passive pelvic support system can not ‘fix itself’ and will need to rely strength of the active pelvic support system. So, revisit number 1 again and again and again …

3.     Stay healthy and seek out your doctor’s advice when you are sick or notice your first sign of leakage or prolapse. The treatment often times isn’t as bad as you think it will be.

 
Michelle Herbst, PT

Michelle Herbst, PT

 

Staying Strong And Preventing Bladder Leakage During Menopause

preventing #bladderleakage during menopause

It’s estimated that a whopping 6,000 women reach menopause each day in the US. Menopause happens to every woman, and is the shift in hormonal changes that result in the cessation of menstruation.

While many women know about the common symptoms of menopause (Hot flashes! Insomnia!), there are certain changes that come about in menopause that are often surprising to women. One of these is loss of bladder or bowel control

A number of things occur during menopause that can contribute to you suddenly experiencing a bit of leakage

Weakening Of Pelvic Floor Muscles

Your pelvic floor muscles play a huge role in controlling your bladder and bowel. As the muscles weaken, it can lead to more urgent needs to use the restroom, and more leaks. Weakened muscles can also lead to an increased risk for pelvic organ prolapse.

A Less Elastic Bladder

Changes that occur during menopause can cause the bladder to lose it’s elasticity and the ability to stretch. This can cause increased irritation in the bladder when it fills with urine, and can impact the nerves that regulate bladder function, which can sometimes cause overactive bladder (OAB).

Vaginal Dryness

During and after menopause, the body produces much less estrogen, which results in an increase of vaginal dryness. This dryness has a number of consequences, which can include an increase in the amount of urinary tract infections.

Anal Trauma

While anal trauma is usually the result of childbirth, many women may not see the results of it until menopause, when that, combined with a weakened pelvic floor can increase the risk of fecal incontinence.

It’s important to know that while these changes can lead to bladder or bowel leakage, the symptoms can also be avoided or eliminated by taking proper care of the pelvic floor. It’s never too late to start strengthening things up.

Here are some ways to increase the strength of your pelvic floor as you go through this period

Get Active

As simple as it sounds, simply staying active is great to keep your weight, and overall health in check.  Gentle exercises, like walking, that don’t place too much pressure on the pelvic floor are best.

Try Squats

Squats are a great way to build up your glute and core muscles. To perform one, stand with feet shoulder with apart. Keeping your knees over your feet (don’t let them move past your toes), lower your bottom down as if you are sitting in a chair, being careful not to lean too far forward. Raise back up to starting position.  Aim for 10 reps per day. (Note, if these feel too difficult for you, try wall squats, which use the same movement, but are performed with your back to the wall for extra support.)

Kegel

When done correctly, kegels can do wonders for helping women with incontinence.  They help strengthen the muscles that prevent bladder leakage and also help to avoid or reduce the symptoms of pelvic organ prolapse.  Remember that when performing a kegal, learning how to relax the pelvic floor is just as important as learning how to tighten it. In some cases, women have pelvic floors that are too tight and cannot relax, and if this is the case, kegels can end up aggravating your condition. If you’re concerned about your pelvic floor, or just can’t get the hang of how to do a kegel, visit a pelvic floor physical therapist for help.

Hormones! They Are A Changin'. Top 3 Myths About Menopause - Debunked!

Top 3 myths about menopause - Debunked!

Menopause will affect every woman at some point in her life. Menopause occurs when hormonal changes cause the menstrual cycle to stop. Whether you are on the verge of this life change or right in the middle of it, there are things you can do to manage the side-effects. But first, it helps to know what is and isn’t true.

Here are some common myths about menopause and the reality behind them

MYTH #1: MENOPAUSE BEGINS AT A CERTAIN AGE.

Fact: While the average age for menopause to start is 52, this is not a steadfast rule.

Women can begin menopause as early as their 30s and as late as their 60s! Technically, menopause begins when you have stopped having a menstrual cycle for 12 months. But symptoms can start even before this begins – perimenopausal symptoms can last anywhere from a few months to several years before actual menopause starts.

MYTH #2: HOT FLASHES ARE THE BIGGEST SYMPTOM I NEED TO WORRY ABOUT.

Fact: While hot flashes are a commonly talked about symptom of perimenopause and menopause, there are many symptoms that can occur (although not all women experience all symptoms). Irritability, fatigue, anxiety, mood swings, low libido, forgetfulness, weight gain and vaginal dryness are just a few of the symptoms that women may experience during this stage of life.

MYTH #3: INCONTINENCE THAT COMES AS WE AGE IS JUST A RESULT OF GETTING OLDER AND THERE’S NOTHING I CAN DO ABOUT IT.

Fact: It’s true that menopause can increase the risk of urinary incontinence. During menopause, estrogen levels decline, causing a number of changes to the body. Without proper care, pelvic floor muscles can become weaker, increasing the possibility of leakage, or even pelvic organ prolapse. Vaginal dryness can occur as the lining of the vagina produces less mucus. And a decline in bladder elasticity can increase bladder irritation and impact bladder function, which can cause overactive bladder (OAB). But while hormonal changes that come with age can influence symptoms, there are many things that can be done to prevent or manage incontinence, starting with taking proper care of your pelvic floor. If you are experiencing any of the above symptoms, talk with a licensed physical therapist who specializes in women’s health as soon as possible so that they can evaluate your symptoms and set you up on a proper treatment plan.

The Mama Body: Physical Therapy During And After Pregnancy

Physical Therapy During And After Pregnancy

A Guest Blog by Lizanne Pastore PT, MA, COMT

Eighty percent of the bodily changes occurring during pregnancy happen in the first trimester!  Isn’t that astounding?  A woman’s body must adjust quickly to a 40% increase in fluid volume, increased heart and respiratory rates and myriad other changes that may affect us in different ways.  The fluid volume increase, for example, can make our connective tissues weaker—our tendons can get a little mushy and our nerves and blood vessels a bit softer.  This extra fluid and tissue weakening makes us more prone to things like leg swelling, varicosities, tendonitis, carpal tunnel syndrome, or sciatica.  

The hormonal changes in pregnancy play a big role in our metabolism, mood, memory and, of course, ligamentous laxity.  Some pregnant women experience instability not only in the pelvis and hips, but also in the joints of the spine, elbows, and wrists.  Our musculoskeletal system is taxed by these changes even before the baby gets very big.  Then, as baby grows, we might begin seeing rectus abdominis separation (“diastasis recti,”) spinal problems from posture and center of gravity changes, even rib dysfunction as the ribs are forced out and up to make room for belly.  Foot pain from falling arches from the sudden weight gain can occur, and on and on. 

In the pelvic girdle, there is a list of other maladies that can be downright scary to a pregnant or postpartum mama.  And most women are not warned about these potential problems.   Pelvic girdle pain manifesting as coccyx, pubic or sacroiliac joint pain; groin or hip pain; pelvic muscle or nerve pain; plus urinary or fecal incontinence or pelvic organ prolapse are some of the more common things occurring during or after pregnancy. 

After birth, as Mom is busy caring for her newborn and any other children at home—schlepping heavy car seats, strollers, laundry baskets, breastfeeding through the day and night, lifting ever-heavier babies into and out of cribs—she wonders why everything hurts, or why she feels a clicking in her pelvic bones when she lifts her leg!  Well, she is busy performing exceedingly challenging tasks with a sub-optimal musculo-skeletal-neural system (not to mention sleep deprivation!) 

It is well documented that both pregnancy and vaginal birth increases a woman’s risk of developing pelvic organ prolapse or becoming incontinent later in life.  And many women think that leaking during or after birth is “normal” because their friends, moms, aunts, and sisters leaked, plus there are 20 different brands of incontinence pads to choose from in the drugstore, so it “must” be normal.   

But this is wrong; leaking and pelvic organ prolapse is common, but not normal or OK.   The same holds true for back or pelvic pain.  Sure pregnancy puts demands on our bodies, but there is no reason to “put up” with pain, leaking, prolapse, numb hands or legs!  There is a health professional who knows all about this—a physical therapist specially trained in women’s health issues and the pelvic floor.  These PT’s are special – they understand the pregnant and postpartum body and are experts in negotiating a path to health and strength for women with special concerns.

After an initial assessment, which often includes a thorough pelvic muscle exam and possibly even a biofeedback analysis, the woman is prescribed a home program.  This program may include a combination of postural or corrective exercises, motor training or strengthening exercises, bladder and bowel re-training, special instruction to change movement strategies to limit stressors on the body, and even self-care techniques for pain or prolapse, such as self massage for constipation, or gentle inversions for prolapse. 

Wouldn’t it be amazing if every pregnant woman and new mama could have a visit with a PT like this?  Guess what – they can!  If you are reading this article and are pregnant talk about this option with your doctor.  And if you have friends, sisters, aunts and co-workers who might be pregnant or new moms, talk to them about it.  Tell them to ask their doctors for a referral to woman’s health physical therapist!  

Need help finding a qualified PT? Visit the NAFC Specialist Locator to find one in your area.

About the author:  A physical therapist for 29 years, Lizanne has specialized in treating women and men with complex pelvic floor and pelvic girdle issues since 2005.  She has worked primarily in San Francisco and the Bay Area, running a successful private practice for the past 18 years. She writes, lectures, and teaches about pelvic health at the professional and community levels and is currently a board member of the NAFC.  

How a 'Birth Plan' Can Help Protect Your Pelvic Floor

How A Birth Plan Can Help Protect Your Pelvic Floor

The relationship between urinary incontinence (UI), pelvic floor disorders, and vaginal birth is a hot topic. Popular magazines and some scientific journals claim that vaginal birth is a cause of urinary incontinence, which has fueled the debate about another equally hot topic: cesarean delivery by maternal request! The presumed logic is this: if vaginal birth leads to UI, then cesarean delivery should be done to prevent it. In fact, questions surrounding causes and prevention of UI, as it relates to vaginal birth, are far more complex. Scientific studies done to date have shown no conclusive evidence that vaginal birth causes UI or pelvic floor disorders. Until we have more answers, cesarean deliveries done to protect the pelvic floor are unwarranted.

What is a “Birth Plan”?

It is never too early to learn what you can do during childbearing years to protect your pelvic floor and bladder health. A Birth Plan is a paper document you develop that serves as a communication tool between you and your healthcare provider. It describes how you would like to be cared for during your pregnancy, labor, and birth.  A Birth Plan helps you and your provider focus on practices and procedures you believe are important to include or avoid. Everyone wants a healthy mother and baby – that is a given. However, there are many pathways to achieving a safe, normal vaginal birth, a healthy infant and a healthy, satisfied mother and family. A Birth Plan simply places these thoughts in writing. During the course of your prenatal visits, a Birth Plan encourages conversation with your provider about the processes and procedures that occur in the hospital during labor and birth that may affect your bladder and pelvic floor.

Tips For Determining a Birth Plan

During your pregnancy, ask your provider to teach you the correct method for doing Kegel exercises. When done correctly, Kegels help strengthen your pelvic floor during pregnancy and after birth.

The obesity epidemic in the United States has led to changes in recommendations about weight gain in pregnancy. Ask your provider about the optimal weight gain for you. The old adage, “eating for two” no longer applies. Obese mothers who give birth to excessively large infants are more likely to experience postpartum bladder troubles whether having a vaginal or operative birth.

Pregnancy provides the ideal time for women to quit smoking. Cigarette smoking is a risk factor for urinary incontinence. Your healthcare provider has many suggestions to help you quit once and for all.

Once in labor, being upright allows gravity to assist with your baby’s descent instead of working against it while lying on your back.

New evidence shows that “gentle pushing” or delayed, non-directed pushing techniques can minimize pelvic trauma and are more protective than “forced pushing.”

To protect pelvic floor muscles, nerves, and connective tissue, express your desire to avoid the use of episiotomy, forceps and/or vacuum extraction. There is more than a decade of research that an episiotomy need not be performed unless there are indications for such intervention (e.g., fetal distress). Episiotomy, especially midline, has been shown to increase a woman’s risk of anal sphincter injury and not to reduce the risk of other pelvic floor disorders. Patients should discuss whether or not to have an episiotomy and be certain that their doctor will not use one, other than in extreme situations. Sometimes however, these maneuvers may be necessary for you or your baby’s health.

For help in writing a Birth Plan that works for you, consult your library, pregnancy resources, your healthcare  provider, and the Internet. Your healthcare provider can guide you about trusted web sites.

3 Common Infections That Affect Young Women And How To Treat Them.

3 Common Infections That Affect Young Women And How To Treat Them: UTI, Yeast Infection, HPV

You’re young, healthy and probably think you’re invincible. However there are some infections that are common in young women. Read below to learn about three you are likely to experience at some point, and what to do about them.

Urinary Tract Infections

Urinary tract infections can occur in men and women of any age. They can be very uncomfortable and most symptoms include a burning feeling when urinating, urinating frequently, feeling tired or shaky, or feeling a pain or pressure in your back or lower stomach. They occur when foreign bacteria enter into the urethra and travel up to the bladder where they can cause an infection.  The most common causes of UTIs are improper wiping after using the toilet (always wipe from front to back to avoid spreading bacteria from the anus to the urethra) and sexual intercourse, which can present larger numbers of bacteria into the bladder. (Tip: Always urinate after having sex – it helps to flush away any bacteria that may be present). UTIs typically clear up quickly with antibiotics, but drinking plenty of water, removing any bladder irritants from your diet (caffeine, alcohol, spicy foods), and emptying your bladder regularly can help treat UTIs too.

Yeast Infections

Yeast infections are caused by the presence of extra yeast in the vagina. When the normal ratio of yeast to healthy bacteria is off, yeast can grow too much and cause an infection. This imbalance can be caused by fluctuating hormones, certain antibiotics, or other conditions like diabetes. Many women experience itching in the vagina, in addition to painful urination and a thick white discharge. Yeast infections are typically diagnosed by a physician, and can be treated with OTC anti-fungal cream, suppositories, or anti-fungal tablets.

HPV

Younger women tend to have more sexual partners than older women.  Great for your sex life – not so great when trying to prevent STDs.  The human papilloma virus is the most common sexually transmitted disease, and one that you should be regularly checked for. Be sure to ask your doctor to check for HPV at each Pap smear.  It’s a good idea to also get tested for chlamydia and gonorrhea while you’re at it. 

Learn more about women’s conditions here. 

4 Moves To Help You Strengthen Your Pelvic Floor Before You Get Pregnant.

How to firm up your pelvic floor before you become pregnant.

Thinking of trying for a baby soon? Now is the perfect time to start strengthening your body in preparation for pregnancy and childbirth. And even if you’re not quite at that stage yet, the moves listed here are great for anyone to improve pelvic floor and core strength.

The pelvic floor acts as a basket of muscles that help support the pelvic organs (your uterus, bladder and bowels).  Keeping them toned can not only help ease pregnancy discomforts (like urine leakage and hemorrhoids), but it can also help you later on in life as your body naturally changes due to hormones, and age. The moves below work not only the pelvic floor, but also other important muscles connected to it to ensure overall core strength.

Four Moves To Firm Up Your Pelvic Floor Before Pregnancy

Kegels 

There’s a reason that you’ve heard again and again that kegels are important.  This exercise has long been touted by professionals as one of the most vital exercises in increasing your pelvic floor strength.   Follow the instructions below to be sure you’re performing them correctly.

  1. Identify your pelvic floor muscles by attempting to stop your urine flow mid-stream. If you can do this, you’ve found the muscles! (Note – don’t practice your kegels in this way on a regular basis – it should only be done to identify the correct muscles.)

  2. Performing with an empty bladder, your first goal should be to tighten your pelvic floor muscles for 5 seconds. Then relax them for 5 seconds. Try to do 5 reps on your first day. As you gain confidence from your new routine, aim for 10 seconds at a time, relaxing for 10 seconds between contractions.

  3. Be careful not to flex the muscles in your abdomen, thighs, or buttocks. Also, avoid holding your breath. Breathe freely during the exercises to keep from stressing the rest of your body.

  4. Aim for at least 3 sets of 10 repetitions per day. The beauty of kegels is that they can be done anywhere, anytime. Try performing them during your downtime, such as waiting in line, or sitting at a stoplight.

  5. Give yourself encouragement. These exercises will feel foreign in the beginning. But the longer you stay with this, the better your bladder health will become. As a bonus, Kegels have been reported to increase sexual pleasure as well.

To learn more about kegels and the variations of kegel exercises that you can perform, review the information on our website found here, or check out one of our most visited blogs here.

Squats

Strong glutes and hamstrings are very important to the overall health of your pelvic floor.  And one of the best exercises to develop these muscles is the deep squat.  Squatting is actually one of the most natural forms of movement there is, however our modern-day lifestyle, characterized by long hours of sitting at a desk or on a couch, has made the squat virtually extinct.  By strengthening your glutes and hamstrings, you’ll be adding additional support to your pelvic floor.  Follow the instructions below to make sure you are performing squats safely and correctly.

  1. Stand with feet slightly wider than your hips, toes pointed slightly outward.

  2. Keep your spine in a neutral position – don’t round your back, and don’t over accentuate the natural arch of your back.

  3. Extend your arms out straight so they are parallel with the ground, palms facing down.

  4. Balance your weight on the heels and the balls of your feet.

  5. Taking a deep breath, begin sending your hips backwards as your knees begin to bend.

  6. Keep your back straight, and your chest and shoulders up.

  7. Be sure to keep your knees directly in line with your feet as you squat.

  8. Continue lowering your hips until they are slightly lower than your knees to perform a deep squat.

  9. Use your core to push yourself back up, keeping your bodyweight in your heels.

  10. Congratulations! You have just completed 1 rep!

It may help to watch yourself in a mirror as you first perform this exercise, as it is easy to perform squats incorrectly.  Some things to watch for are not dropping low enough, leaning your body too far forward, allowing your knees to drift inward, and performing the exercise too quickly.   Aim to complete about 2-3 sets of 10 reps daily.

Finding Your TA

Your transverse abdominus, also known as the TA muscle, is the muscle that is located deep within your core, below the six-pack muscles.  This muscle is often overlooked, but it serves a vital role.  The TA muscle helps to stabilize the core, pelvis and lower back, and is recruited almost anytime a movement is made.  Strengthening your TA muscle will ensure that you are protecting your back and spine from extra force or pressure when you move, and will help aid in pelvic floor stabilization.

The following steps provide a very basic way to locate your TA muscle and give it a workout:

  1. Lie on your back, with your knees bent.

  2. Place your hand on your stomach, just over your belly button.

  3. Inhale.

  4. While you exhale, tighten your stomach muscles and pull your belly button inward. You should imagine that you are tightening a corset and flattening your stomach.

  5. Repeat 3 sets of 10 reps each.

Once you have a good feeling for where your TA muscle is and how to activate it, you can begin incorporating the action into your everyday life - while sitting at work, standing in line, etc.  Also try to practice tightening your TA muscle, like a brace, every time you perform a movement such as lifting, sneezing, squatting, etc.  With practice, this action can become automatic and will aid in your core stability.

Multifidus

The multifidus is one of the most important muscles in aiding spinal support.  The muscles are attached to the spinal column and are called upon when bending backwards, turning, and bending side to side.  These muscles work with the rest of your pelvic floor muscles and TA muscle to help you hold good posture, and to stabilize your lower back and pelvis during movement. Try the exercise below to strengthen the multifidus muscle:

  1. Lie on your stomach, with your forehead on your hands, or a towel, looking straight down. (Not to the side)

  2. Very slowly, rotate your pelvis back slightly so that your tailbone lifts toward the ceiling. This should be a very subtle movement.

  3. Hold for one second, then rotate your pelvis back to the floor.

  4. Complete 3 sets of 10 reps each.

Practice activating your multifidus muscle throughout your day by keeping good posture. 

Note: Even before you’ve had children, there may be times when certain pelvic floor exercises are not appropriate. And, it’s important to know that there is no “one” exercise alone that will strengthen your pelvic floor as it is supported by many muscles.  Always check with your doctor before beginning any exercise program.  And, if you have concerns about your pelvic floor, no matter what life-stage you are in, consult a trained physical therapist specialized in women’s health. Your Physical Therapist will also be able to ensure that you are performing the moves correctly so that you are getting the most out of your workout.  Use the NAFC Doctor Finder to find a doctor in your area. 

 

Pre-pregnancy And The Pelvic Floor - It's All About Prevention

Preparing Your Pelvic Floor For Pregnancy

If you’ve never been pregnant, it’s likely you’ve spent little time thinking about your pelvic floor. And yet, now is exactly the time that you should be focused on it.  A healthy pelvic floor can prepare you for a great pregnancy and a safe delivery, and it can prevent a host of problems that may occur after childbirth. The pelvic floor works as a basket of muscles, holding your uterus, bladder, and rectum in place.  When you’re young, and your pelvic floor has not suffered the effects of age or childbirth, you usually see few complications. But sometimes, strain on the pelvic floor (like carrying a growing baby for nine month, giving birth, and the natural effects of gravity over time) can cause problems like bladder leakage. The good news? These effects can be lessened, or even eliminated, if proper care is given to the pelvic floor now.  Here are the steps you need to take to ensure that you’re taking proper care of your pelvic floor, and yourself, prior to becoming pregnant.

How To Prepare Your Pelvic Floor For Pregnancy

Assemble your squad.

Finding the right team of professionals is key to keeping your health in check.  If you haven’t already, do your due diligence and start seeing these health care professionals on a regular basis.

  • Gyno
  • Primary Care physician
  • Dentist
  • Dermatologist

Need help finding a health care professional? Use our Doctor Finder!

Keep a healthy weight and develop a workout routine.

If you’re planning to get pregnant, don’t fall into the trap of thinking that weight doesn’t matter pre-pregnancy – the healthier you are now, the healthier you will be during your pregnancy, and the easier it may be to shed those extra pounds after baby arrives. Not only that, but keeping your core and pelvic floor strong now will help better prepare you for pregnancy and childbirth.

Maintain a healthy diet.  

Eating right is always a good idea, and it can really help you maintain your weight. In addition, keeping your diet in check can help you prevent diabetes (a condition that is on the rise in the US, and that, in some cases lead to neurogenic bladder.)

Routine Exams

Get a well-woman exam every year – be sure to talk with your physician about general health metrics like blood pressure levels, diet, weight, and any stress that you may be experiencing. Have a regular Pap smear every 3 years if you’re between 21 and 30. While you’re at it, be sure to have a yearly breast exam to check for any unusual changes. Do your own monthly exams as well and become familiar with how your breasts normally look and feel.

Quit those bad habits

If you haven’t heard, smoking is really not cool anymore and even if you don’t believe that, consider this – aside from a host of other health problems, smoking can contribute to a leaky bladder

Uncover any risk factors that you may have by learning your health history

Talk with your family to learn about any risks that you may have health-wise. Knowing these now can help you prevent possible health threats down the road.

Even if you only choose to follow a couple of these steps prior to pregnancy, know this: this time is all about prevention – the steps you take now to take care of your body will pay off in folds down the road.  Don’t wait to start taking control of your health. 

Check in with us all month to learn how to stay healthy at every stage of life.

Three Generations Of Incontinence

Talk about incontinence with your family.

Sometimes it's hard to open up with others about what's happening with our health. But doing so can help you gain valuable insights into your background and may help you take preventative action to avoid some conditions. Read this story about the importance of sharing your health history and the impact it can make on the entire family.

Growing up in a very conservative family in the 20’s, my Grandmother learned at an early age how to “act properly”. She was a lady, for sure, always looking immaculate, with great manners and a strong sense of pride. She was a private person – never sharing too much and kept any troubles or personal concerns to herself. She passed these traits along to my own mother and then, by default, on to me.  What none of us knew, until recently, is that while acting ladylike is well and good in many cases, keeping things inside can sometimes cause rippling effects throughout generations, especially as it relates to health concerns.

You see, we all suffer from bladder leakage. My Grandmother gave birth to three children in her younger years, and as she inched toward middle age, she began experiencing the symptoms of stress urinary incontinence, causing her to leak urine when extra “stress” (coughing, laughing, sneezing) is placed on the bladder.

For her, this was simply something that she had to live with. She would never dream of talking to anyone about it, especially her doctor. It just became a part of who she was and she managed as well as she could on her own, in silence.

My mother suffered a similar fate, dealing with her bladder leakage in much the same way as my Grandmother did for all those years. It wasn’t until I started experiencing symptoms a few years after the birth of my second child that I ever knew it was something that had plagued generations of my family. 

I was on the phone with my mom when, after a particularly intense sneezing fit, had to excuse myself to use the restroom. When I got back to the phone, my mother very delicately asked me if everything was ok. And though I had never spoken with her candidly about this before, I suddenly felt a need to know if she had also experienced the problem. I asked her very calmly if she had ever had “issues” holding her bladder, and suddenly it was if the flood gates had opened – she shared her struggles over the years, and also her suspicion that her own mother had experienced the same things. We decided to ask my Grandmother at our next monthly visit and finally, the three of us sat down and spoke frankly about this very common problem.

What I learned shocked me, but also sounded vaguely familiar. My Grandmother had never spoken to anyone about her issue – not even once. She purchased incontinence supplies as discreetly as she could and never even told my Grandfather that she was experiencing problems (although I can’t imagine that he didn’t know).  My mother, at least, did tell her doctor, but after a trying, and failing, on one medication, decided to just try to manage it herself and live with the issue. 

I had only just been experiencing light leaks for the past few months, but after hearing their stories and learning about the years of living with the condition, I was determined to do something. That very day I made an appointment with my doctor to learn my options. I read everything I could find about incontinence and  before my appointment and was armed with a list of questions for my doctor.

At my appointment we talked about my options, and I started out by making several lifestyle changes – including taking a hard look at my diet, and practicing several core and pelvic floor exercises to gain some of the strength back that I lost after having kids.

It’s been about a year since my conversation with my Mom and Grandmother, and I’m so glad that I finally opened up to them and learned their struggle. Too many keep conditions such as incontinence to themselves, instead of speaking up about it – especially to those they love. Knowing that I wasn’t the only one, and in fact, that this problem likely had at least a little bit to do with genetics helped me immensely.

During my research into my own problem, I came across a study that showed incontinence that occurs before you reach middle age is likely determined by your genes. I only wish that I would have had the conversation with my family earlier.

May is Women’s Health Month. And Mother’s Day just happens to be coming up as well. Use this time with your family wisely – make it a point to ask them about their health history. You’ll be able to better arm yourself with information on your background and how to treat your own condition simply by speaking up and starting the conversation. And who knows – you may find that you have someone else who knows exactly what you’re going through who is right under your nose.

Women's Health Month

Women's Health Month

May is Women's Health Month, and we're celebrating at NAFC by walking you through all the ways to keep yourself strong and healthy at every stage. Here's a breakdown of what you can expect from us this month:

Week 1:  We're talking about the early years and prevention! Learn about how to strengthen your pelvic floor before pregnancy.

Week 2: Pregnancy and childbirth can really do a number on your pelvic floor. Learn what you can do during pregnancy to prepare for childbirth, and what you can do after baby's here to regain your body.

Week 3: Peri-Menopause and Menopause are an inevitable part of every woman's life. And while hormones can cause major changes to your body, there are things you can do to make this transition as easy as possible.

Week 4: Life after menopause can be a great time for you if you make an effort to remain healthy and strong. Learn about the steps you can take to enjoy these years.

Plus, all month long we'll be shining the spotlight on OAB and sharing tips, tricks and articles to show you how to manage symptoms of overactive bladder.

Follow along with us on the BHealth Blog, and on Facebook and Twitter!

What I've Learned About IBS And How To Treat It.

IBS, Bowel Health, And How To Treat It

IBS, Bowel Health, And How To Treat It

I was fairly young when I first started having bowel trouble. A consistently nervous young woman, I was constantly in a state of worry – about school, boys, and friendships – pretty much the normal run of the mill high school concerns. My mother always said I had “nervous bowels”, and my family became accustomed to stopping frequently to use the restroom on trips, and always asking me if I had to go before leaving the house.  The pain I felt sometimes with bloating or cramping was attributed to my nerves.  And while my family was fairly sympathetic to my condition, I experienced a lot of eye-rolling growing up when my symptoms would strike (“We have to stop for Annette again?” my brother would say. “She just went!”) It was a normal occurrence that lasted into my college years, and then later as I started a family.  And while it was inconvenient and could definitely be painful at times – it wasn’t until after the birth of my first child that I thought about it as a “condition” that could actually be treated. 

IBS, or irritable bowel syndrome, is when you have an overly sensitive colon or large intestine.  This may result in the contents of your bowel moving too quickly, resulting in diarrhea, or too slowly, resulting in constipation. (Both of which I have experienced, although my symptoms tend to lie more in the former camp, causing me to constantly race to the bathroom for fear of an accident).  Symptoms also can include cramping or abdominal pain, bloating, gas, or mucus in the stool. The condition is more common than you may think. As many as 1 in 5 American adults have IBS, the majority of them being women. And, this is not an old persons disease either – IBS strikes young, commonly in ages younger than 45.

I was finally diagnosed at age 28 – a whopping 13 years after I started experiencing symptoms, and I wish I had thought to seek help earlier.  My doctor told me that there are many things that can contribute to IBS. Things like hormones, certain types of food, and stress (I guess my mother was right) may all impact IBS symptoms.  Since the cause is of IBS is not known, treatments usually focus on relieving symptoms so that you can live as normally as possible. 

Below is a list of treatments my doctor discussed with me.

Behavioral Changes: 

Diet.  Many foods can trigger IBS. And, while they might not be the same for everyone, there are some common triggers that have been identified:

  • Alcohol

  • Caffeine (including coffee, chocolate)

  • Dairy products

  • Sugar-free sweeteners

  • High-gas foods, such as beans, cabbage, cauliflower, broccoli, raw fruits or carbonated beverages)

  • Fatty foods

  • FODMAPs (types of carbohydrates that are found in certain grans, vegetables fruits and dairy products)

  • Gluten

One of the first things I did when starting treatment was to keep a bowel diary, which tracked the foods I ate and how they effected me. This was a huge help in learning my food triggers.  I also learned to eat more frequent, smaller meals, which helped ease my symptoms. (Although those who experience more constipation may see improvement by eating larger amounts of high-fiber foods.)

Stress Management. This was a huge one for me.  It turns out, your brain controls your bowels, so if you’re a hand wringer like me, it may end up making you run to the bathroom more often than you’d like.  Learning ways to control stress was a game changer and I saw a huge improvement with these steps:

  • Meditation – Just taking the time to quite your mind can do wonders in helping you manage stress on a regular basis.

  • Physical Exercise – Regular exercise is a great de-stressor and, if you have constipation, can help keep things moving in that department too. I walk regularly and practice yoga 3 times per week to keep my stress at bay.

  • Deep Breathing Exercises – This is a great trick to practice if you feel yourself starting to get worked up. Practice counting to 10, while breathing in and out slowly until you start feeling relaxed.

  • Counseling – Sometimes you need someone to talk to help you work through your emotions. You may find comfort in talking with a friend or family member, or even a professional counselor, who can help you learn how to deal better with stress.

  • Massage – This one likely doesn’t need much explanation - who doesn’t love a good massage?

Drink Plenty Of Water. Drinking enough water just helps your body function better. And for people with IBS, it will ensure that everything moves more smoothly and minimize pain. This is especially true with those who suffer from constipation. 

Medications 

There are several different medications used to treat symptoms of IBS. Whether you suffer from constipation, or diarrhea, OTCs and prescriptions are available. Antibiotics are also sometimes prescribed for those patients whose symptoms are caused by an overgrowth of bacteria in the intestines. And if you suffer from anxiety or depression, like me, some antidepressants and anti-anxiety agents can actually improve your IBS symptoms too. Talk with your doctor about your symptoms and work with him or her to find a solution that’s best for you.

Other treatment options 

Acupuncture. Despite a lack of data on acupuncture and IBS, many patients turn to this method of treatment for pain and bloating. Acupuncture, which is usually performed by a licensed acupuncturist, targets specific points in the body to help channel energy flow properly.

Probiotics.  As research continues to emerge around the importance of gut bacteria and your overall health, probiotics may become a more common treatment option.  Consuming them can increase the “good” bacteria that live in your intestines and may help ease your symptoms. 

Hypnosis.  Hypnotherapy has been shown to improve symptoms by helping the patient to relax. Patients practicing hypnotherapy have reported improved quality of life, reduced abdominal pain and constipation, and reduced bloating. However, most of the time hypnotherapy is dependent upon a therapist, and is usually not covered by insurance plans, making it a costly form of therapy.

I’m 37 now and have had my IBS pretty much under control for the last several years. Looking back, I can’t believe I lived with it as “normal” for so long. If you suffer from this condition, there is simply no reason to not get it treated. 

Need help finding a doctor?  Use the NAFC Specialist Locator.

About the Author:  Annette Jennings lives in Oklahoma with her husband, 2 children, 2 dogs, and 1 cat. She's happy to be speaking up about her condition and hopes it will inspire more people to do so. 

What To Expect After Pelvic Floor Reconstruction

What to expect after pelvic floor reconstruction surgery for pelvic organ prolapse

The decision to undergo pelvic reconstructive surgery to correct pelvic organ prolapse (POP) can be difficult. Women often wait years dealing with symptoms of POP before they commit to surgery. Aside from decreasing symptoms of prolapse, a desired outcome of pelvic floor reconstruction is for the woman to be able to return to her active life. Likely, the surgeon has provided some information about do’s and don’ts, but this is usually related to immediately post-surgery.  Most pelvic floor surgeries require an initial 6 to 8 week rest period —keeping activity very light—no sexual intercourse, no heavy lifting, no running etc.

But after the initial rest period, then what? Are there activities to avoid or limit? How much is “too much” to lift?  Should anything be avoided altogether? Medical literature tells us that 30% of women may require a second surgery at some point in the future due to failure of the first or because of another pelvic problem.1 Yet, there is little information on improving outcomes in order to prevent another surgery. Most surgeons use a common-sense approach in advising their patients, and if a woman has specific questions or concerns, she is always advised to ask her surgeon. The surgeon has the best understanding of how the procedure went and in what shape the woman’s pelvic tissues are.

The primary cause of POP is trauma to the pelvic floor muscles (PFM,) connective tissue or “fascia” and ligaments. These structures become unable to support the pelvic organs. The majority of women undergoing surgery sustain tissue injury from childbirth trauma.  More rarely, women may develop severe prolapse due to extreme increases in intra-abdominal pressure (IAP) for other reasons.  Examples include illnesses that cause chronic coughing or performing frequent Valsalva maneuvers (straining) such as with chronic constipation.

In attempting to identify risk factors and make post-surgical recommendations, research has determined that indeed, the two things that increase IAP and vaginal pressure (VP) the most are coughing and Valsalva maneuvers. Most of these studies compared pressure measurements during everyday activities like supine lying, standing, lifting, running, coughing and straining. According to the research, many things increase IAP; just getting out of bed will mildly increase IAP, as will lifting moderate weight and running. One study went so far as to say that many post-surgical guidelines are “needlessly restrictive.”5 The researchers found that in subjects without pelvic floor problems tasks such as lifting eight to 20 pounds off a counter, lifting 13 pounds from the floor, walking briskly, performing crunches all produced no more increase in IAP than getting out of a chair. They summarized that “how lifting is done impacts intra-abdominal pressure.” The good news is, that the research, found that unless a woman has a chronic cough condition or habitually performs Valsalva maneuvers, everyday stressors like standing, walking, lifting normal weight, sexual intercourse and running should be okay post pelvic surgery.

Women seen by a specially trained pelvic physical therapist (PT) after surgery are taught strengthening exercises and postural strategies, as well as how to lift correctly. If risk factors are present the woman may need extra help to learn how to care for her pelvic floor during stressful activities, this may include diet counseling and information on sexual positions to limit stress to the PFM.

Here is a list of some things PT’s might teach their patients post surgery:

Posture

PFM works best when the spine, pelvis and hips are in good alignment. If a woman’s back is too rounded, the normal bony structure of the pelvis can’t act to support the pelvic organs as intended. If the back is too arched, the pelvic muscles can become overstretched and strained. Normal spinal posture is a simple and effective way to support the pelvic organs. Learn how to maintain good posture with your normal daily activities, such as sitting at a computer, lifting, squatting etc.

Diet

To avoid constipation and straining (Valsalva) with bowel movements, drink plenty of water, eat a balanced, healthy diet with whole grains and fresh vegetables and learn about soluble and insoluble fiber. If constipation exists, it needs to be assessed to determine the type of constipation, and then be properly treated.Toilet Posture: We know that the vast majority of people evacuate their bowels best when in a squatting position. Most modern toilets don’t accommodate for this. Try placing a phone book or two under the feet to elevate the legs. Or try this device, which allows for a nice squatting position when on the toilet:  spine in neutral, but hips flexed and knees above the hips.

Restful Rescue Poses

There are excellent resting positions that utilize gravity to encourage organs to “reposition” back into the pelvic cavity. Here’s one: lie on your back and place a pillow or small wedge under the pelvis to invert your pelvic region. Place pillows under your knees as well and one pillow (or none) under the head. It’s a lovely position to rest in, and for those doing a strengthening program, it’s a great position for that too. If you want to go all out, place a heating pad over your tummy, turn the lights low, play soothing music and rest for a blissful 20 minutes or so. 

Biomechanical Considerations for Sexual Intercourse

Let’s face it, the majority of women going through POP surgery are sexually active. Sex must be addressed and often it’s the PT who spends the time with the patient and can make the best recommendations. For example, if a woman has pain with vaginal penetration, she may need to perform special stretching exercises to open the vaginal introitus and the PT can advise on intercourse positions that will least stress the PFM. Menopausal women may also need to discuss additional local estrogen and lubricant with your surgeon or physical therapist.

Pelvic Bracing

This is a technique of co-contracting one’s lower abdominal muscles, deep back stabilizing muscles, with the PFM. When done correctly it can limit the stress on the pelvic organs during activities of increased IAP, like lifting or squatting. It sounds complicated but it’s really not. Women should learn to do this in any position. First, attend to your PFM by giving them a gentle squeeze (feel the perineum lift) followed immediately by a relaxation (feel the perineum release down.) Starting from a relaxed place, gently draw the PFM upward as you gently draw the navel inward. Imagine you are trying to lift your vagina like an elevator as you feel your lower tummy gently flatten. Do this gently, not full force. You should be able to breathe normally as you do this. You’ll feel the two muscle groups acting together to tighten the lower belly and “brace” the pelvic floor. The deep back muscles should activate when you do this providing posterior support simultaneously. Hold this co-contraction for a few seconds then release. If you have trouble with this, seek out a pelvic floor PT in your area to help you learn. Learning how to brace during functional activities sometimes requires a bit of training, so again, seeking a specialist may be indicated if you are someone who has risk factors.

Pelvic Floor Muscle (PFM) Strengthening.

Often called “Kegels,” PFM strengthening involves exercising the PFM by contracting them for short or long periods of time—usually from two to four seconds to train the “fast twitch” muscle fibers, and five to 30 seconds to train the “slow twitch” muscle fibers.  Sometimes these exercises are done in conjunction with other muscle groups. The muscle fibers of the pelvic floor are 70% slow twitch and only 30% fast twitch. This means that the PFM are much better at endurance events than brute strength activities. They act more as supportive postural muscles; however we occasionally need a quick strong contraction to avoid leaking with a sneeze. Correct PFM strengthening incorporates exercises for both types of muscle.

Some women actually do too much exercise and develop tight, painful muscles. Sometimes, after a pelvic surgery, a woman might actually feel “tight” or “tense” inside. This is from the surgery, not because the muscles magically strengthened from the procedure. If after surgery you have symptoms of pain (either at rest or with an activity like sex), urinary urgency or frequency, then tell your doctor. Kegels would not be appropriate for you. If this is the case be sure to talk to your doctor for other options, such as biofeedback.

Other women need to exercise to develop more muscle tone and strength. The trick is to ensure there is balance between strength and flexibility. If you are still leaking or feel weak, then strengthening may be helpful.

Physical therapists with a pelvic floor specialization are trained to assess the whole person to determine an appropriate exercise routine, and women are advised to be evaluated before undertaking a rigorous strength program.

Gender Neutral Pelvic Floor Tips

Gender Neutral Pelvic Floor Tips

Simply stated - the pelvic floor isn’t just a female thing - it is a muscular sling supporting the pelvic and abdominal organs of men and women.  The pelvic floor helps keep us dry.  More than 50 percent of men over the age of 60 experience bladder control issues due to an enlarged prostate.  

Before I share my best pelvic floor tips for both sexes, we need to agree on the following three truths: strengthening a weak pelvic floor may improve bladder control and confidence, utilizing my tips in conjunction with seeing your healthcare provider will create the most optimal effect, and it’s important to allow yourself to have a bad day here and there.  

Here are my best pelvic floor tips.

Start a Bladder or Bowel Diary

For a week, keep track of your trips to the bathroom, your leaks and how much and what you are drinking. Note any trends with fluid intake, time of day and activity level in relation to using the bathroom and your leaks. Your documentation may help your health care provider order tests, make a more accurate diagnosis or prompt a referral to a specialist.But, please consider what you can do with the information. Are there any trends you are seeing? Do you have more problems in the morning, afternoon or evening? Do you need to space out your fluid intake?  ou may be able to cue into changes that may positively impact your bladder control and confidence.  

Drink more water and consider cutting down on alcohol and caffeine

Many newly incontinent persons incorrectly assume if there is less water in the system there will be less water to pass. Cutting out water, or significantly decreasing water consumption, while continuing to consume alcohol and caffeine at normal previous levels may aggravate the bladder and make the leakage problems worse.  Hydration with plain, old water is one of the keys to improved bladder function.  And, revisit your diary – it may be possible that alcohol or caffeine may be a trigger to your leakage pattern.  Do you need notice you have more problems with bladder control after a glass or two of coffee or your favorite cocktail?  

Kegels

Yes – we need to talk about this.  Men can do Kegels and should do Kegels to improve bladder control.  Kegels are not just meant for women.  Repetitively performing Kegels will improve pelvic floor muscle function, strength and endurance.  Kegels should be a habit like brushing your teeth. The truth of the matter is - if your pelvic floor muscles are in better space they will be better able to support you and keep you dry.  Here are some cues that may help you or your loved one perform a Kegel.   

 Return to the idea that pelvic floor is a muscular sling.  It supports your abdominal and pelvic organs kind of like a hammock running along the base of pelvis – front to back and side to side.

  • Gently pull the pelvic floor up and in towards your navel as if trying to protect yourself from a blow to the belly. When you do this – you may feel a gentle tightening of the muscles underneath your navel. Your tailbone may gently rises up and in. Continue your normal breath. Keep in mind, the Kegel, I am recommending is not 100% effort but a gentle tightening of the muscular sling.

  • Continue breathing and hold the Kegel for a few seconds. Then gradually relax. Repeat until you’re fatigued or have completed your goal.

That concludes my list of my best pelvic floor tips. What are your best practices?

About the Author, Michelle Herbst: I am a wife and mother with a passion of helping women live to their fullest potential. I am a women’s health physical therapist and for nearly decade have helped women with musculoskeletal conditions during their pregnancies, postpartum period and into their golden years.

About the Author, Michelle Herbst: I am a wife and mother with a passion of helping women live to their fullest potential. I am a women’s health physical therapist and for nearly decade have helped women with musculoskeletal conditions during their pregnancies, postpartum period and into their golden years.

The Importance Of Being Social

The Importance Of Being Social

When most people think of incontinence, they usually think of the physical problems that go along with it. However, in addition to leakage, there are also emotional and psychological issues that can be just as impactful. Emotional symptoms of incontinence may include the following:

  1. Feeling humiliated and degraded.

  2. Experiencing a poor self-esteem.

  3. Withdrawing from society and becoming more isolated.

  4. Feeling anxious about being incontinent in public.

  5. Reduced intimacy and affection.

But just because you have incontinence doesn’t mean that you should limit your social life.

In fact, being social may help you avoid many of the above symptoms.

Social connections not only give pleasure and enjoyment but they also have been shown to improve the health of individuals. Studies have shown that individuals who have healthy and affectionate relationships with their family and friends benefit in a host of different ways, such as getting fewer colds, avoiding depression, keeping a sharp mind, and living a longer life. 

Don’t believe us? Check out this list of ways that being social can improve your health and mood. And then get out there and start reconnecting with friends and family. Trust us - you, and your health, will thank us.

Why Didn't Anyone Tell Me About Pelvic Organ Prolapse?

A Guest Blog By Sally Connor

I am a 38-year old woman, and I am angry. Angry that my body has changed so much since I’ve had children, angry that I developed a prolapsed bladder after the birth of my first son, angry that I can no longer run the way I used to without making several trips to the bathroom, or worse, wetting myself. I am angry with my doctors for not telling me that this may be a side effect of pregnancy and that there were steps I could have taken to prevent it. I’m angry with other women for not telling me that it has happened to them. I am angry for my sheer ignorance of the situation until it happened to me. But more than anything, I am angry that no one knows any of this because in our society, it feels too embarrassing to really talk about.

When we are young, we don’t think about these things. Before I had children, I don’t think that I ever even gave the pelvic floor much thought. Quite frankly, I didn’t even know what it was.  Here is what I didn’t know:  That the pelvic floor muscles act as a basket, supporting your bladder, uterus, and rectum. It is also connected to and supported by your deepest core muscles – your transverse abdominus (below the ‘six pack’ abs) and your multifidus (the tiny muscles that support the spine), and is affected by almost every movement you make.  The pelvic floor, what I now refer to as the epicenter of my body, is called upon every time you sit, stand, squat, walk, and even breathe. 

So I ask, why is it that we don’t hear more about this vital web of muscles? Why are we kept in the dark until it is too late? Because, really, much of this can usually be prevented. The pelvic floor, just like any other muscle in the body, can be strengthened and trained. With regular exercise, the pelvic floor and the supporting muscles around it can provide a strong foundation for continence for your entire life. But, like any other muscle, if it is already in a weakened state, and then becomes traumatized by something like childbirth, well, the damage is done. 

That is the case with prolapse. You can try to repair it, and may see marked improvement through physical therapy, or even surgery, but once the damage is done, it is done. 

It doesn’t mean that there is no hope though. I know this. I have seen great improvement in my symptoms and am grateful to have had access to a very skilled physical therapist who was able to show me how to strengthen things up ‘down there’. But, I still do experience some symptoms and I can’t help wonder if things would be the same had I been more aware of this muscle and what I should have been doing to keep it strong prior to and during pregnancy. 

With over 25 million Americans experiencing incontinence, I am baffled that the issue is not publically talked about more often. It is estimated that about 40% of women will experience prolapse at some point in their life. When will we decide that these conditions deserve attention? Talking about them would encourage more people to get help, and, maybe even more importantly, take steps to prevent it. 

Instead, the silence only encourages the shame, embarrassment, and isolation that many people with incontinence experience.  It does nothing to help those who are experiencing the issue to know there are ways to treat it.  Nor does it educate those who have not experienced it to know that this is something that should be considered. Until we can all be more open and recognize that this is a problem worth talking about (shouting about!), we will be a society that continues to allow it’s people to ‘quietly manage their symptoms’ instead of really preventing or treating them. 

So please, speak up about your incontinence, your prolapse, or any other pelvic floor issue you may have. While it may be common, it’s not normal, and is nothing that anyone should have to suffer with in silence.

About the author:  Sally Connor is a mother, wife, entrepreneur, and homemaker who suffered a prolapse after giving birth to her son. She has refused to let this symptom rule her life and strives to increase awareness of pelvic floor issues and what women can do about them by simply talking more about the issue.  She hopes that one day pelvic floor issues and incontinence will be a less taboo subject.

How To Prepare For Your OAB Doctor Appointment

How to prepare for your oab doctor appointment

NAFC encourages you to make an appointment with your doctor so you can get on a path to treatment.

These 6 steps will help prepare you for a discussion with your doctor about OAB:

  1. Fill out the Overactive Bladder Awareness Tool and NAFC’s bladder diary to take with you to your appointment. Download the Overactive Bladder - Validated 8-question Awareness Tool PDF, answer the questions, and give it to your doctor at the first appointment. Additionally, you can download and fill out NAFC's bladder diary for about 2 days before your appointment in order to record your symptoms.
  2. Make a list of all of your doctors and medical conditions.Take a list of all your doctors, medical conditions (e.g., diabetes, sleep disorders, heart conditions, etc.) to your appointment.
  3. Complete a list of any operations or medical procedures you have had in your lifetime. Women should list their number of pregnancies, number of deliveries, weight of their babies, and whether they were delivered vaginally or by Caesarean section.
  4. Provide the doctor with all your medications. Include all prescription medicines you are taking that have been prescribed or refilled during the last 30 days. Also include all the prescriptions that you keep in the house but that you don't take regularly. As well as, all the over-the-counter medicines, vitamins, and other supplements that you take.
  5. Be prepared to describe how incontinence affects your daily life. Make a list of the most bothersome aspects related to your incontinence.
  6. Be prepared for your appointment. On the day of your appointment, expect to be asked for a urine specimen. Talk with the doctor's receptionist when you make the appointment and when you arrive to see if there are tests, or preparations for tests, that you should know about (eg. fasting after midnight).

NAFC's Response to the Milwaukee Journal Sentinel article, "With Overactive Bladder, Drug Firms Helped Create A $3 Billion Market"

Recently, the Milwaukee Journal Sentinel published an article titled "With overactive bladder, drug companies helped create a $3 billion market."  In the article, the authors insinuate that OAB, as a condition, is mostly made up by drug companies to create a market need.  As an organization that has helped countless people find treatment as they struggle with Overactive Bladder, and has seen first hand the debilitating effects that OAB has had on so many lives, NAFC vehemently objects to this article. Below is our response, sent as an open letter to the editor, from NAFC's Executive Director, Steve Gregg, Ph.D.

 "To Whom it May Concern:

We recently read your article in the October 16th, 2016 Sunday edition of the Milwaukee Journal Sentinel entitled “With overactive bladder, drug companies helped create a $3 billion market”.  As a patient advocacy organization we take exception to the article.  We can categorically state that OAB is a condition that does in fact affect millions of patients in the US. 

OAB is a term created to help patients understand the condition of urge urinary incontinence (UUI).  UUI is not just about the need to go to the bathroom but is most often association with an increase in urinary frequency and accidents.  This condition has been shown to increase feeling of isolation, depression and a general loss in quality of life.  And based on the number of individuals contacting NAFC each day we know this is a real condition with real consequences.

Our organization is dedicated to helping individuals and their families facing the challenges of incontinence overcoming the stigma associated with bladder and bowel conditions.  Your article reinforces the misguided idea that bladder conditions such as OAB are simply the effect of aging, or childbearing and poor toileting habits or worse just a made up condition to allow pharma companies to generate revenue.  Currently, women wait on average 7 years from the onset of symptoms to seeking medical treatment.  The reasons for this lengthy wait time are well documented, but embarrassment and lack of awareness of treatment options are sited most frequently. 

We implore you to consider patients and their need for access to medical care and effective treatment options when writing about conditions that are hard to treat, especially when patients feel embarrassed to discuss their conditions with healthcare providers.  It may help you to talk to actual patients about their frustrations and what it is like to live with a condition that is often dismissed.  At NAFC we feel strongly that these patients need our support and assistance to find the care they need and the treatment options they deserve. 

We are disappointed in tone and tenor of your article regarding patients and their need to find medically appropriate treatment options for OAB.  We hope that you will address this obvious misrepresentation in the near future.

Respectively, 

Steven G. Gregg, Ph.D.

Executive Director

The National Association For Continence"

How do you feel about the Milwaukee Journal Sentinel's article? Share your thoughts in the comments below.  And, if you object to the article, please share our response on Facebook.

UTIs - What Causes Them And How To Avoid Them

UTIs - What Causes Them And How To Avoid Them

UTIs, or Urinary Tract Infections, will affect most women at some point in their lifetime.  UTI’s are recognized by the burning sensation they cause in the bladder or urethra (the tube that empties urine from the body) during urination, and the intense urge to urinate frequently – even if it is just a little amount.  Some women may also leak urine during a UTI, even if that isn’t something they normally experience.  Urine may also smell differently and appear cloudy or dark. 

UTI’s are not pleasant, but there are things you can do to prevent them.

The first thing you need to know is why UTIs happen.  UTIs are caused by the presence of bacteria in the urinary tract, which can then travel up to the bladder.  And, while the urinary tract does have several safe guards, which naturally help it to flush bacteria out, infections can still occur.  Infections are more common in women primarily due to their anatomy.  Bacteria from the bowel can easily sneak into the urethra because it is so close to the anus (This is why we wipe front to back people!), and women have much shorter urethras than men, which means bacteria can more easily get into the bladder.   Certain conditions can make people more prone to UTIs – those who wear catheters may be at an increased risk since it is harder to flush bacteria out of the urinary tract. And anyone who has trouble emptying his or her bladder completely can also be at risk.  Sex can also contribute to UTIs since it can introduce new bacteria to the urethral opening.

The good news is that most UTIs don’t last long once treated.  Since the main cause of a UTI is often the presence of bacteria, antibiotics are usually used to treat them, and take roughly 2-3 days to work.  Drinking lots of water and fluids can also quicken your recovery time, because it helps you to flush out the bacteria out of your system. 

Here are some tips to avoid UTIs altogether:

Wipe front to back.

Keeping the Urethra clean and avoiding contact with bacteria from the anus or bowel can help prevent bacteria from entering the urinary tract in the first place.

Drink lots of fluids. 

Staying hydrated and drinking lots of water each day will help flush out any bacteria that may be present.

Urinate when you need to.

Holding urine in the bladder for longer than necessary only increases the chance that bacteria will multiply and cause an infection.

Urinate after having sex.

This helps get rid of any bacteria that may be lingering from intercourse.

If you do get a UTI, see a doctor right away for treatment. If left untreated, the bacteria can sometimes make its way to the kidneys and cause a more serious infection.