I was halfway through my annual gyn exam, making conversation with my doctor, when I decided to tell her about the newest addition to my workout wardrobe: pee-proof undies. “They’re like period underwear, but for pee!” I explained, adding that even if I used the washroom immediately before my favorite yoga sculpt class, I still ended up dribbling during high-impact moves. “I feel like I’m the only one in there who needs pee pee undies,” I lamented, to which she responded, “No way. I’m sure half the women in there are leaking.”
Besides giving me a fun new mental game to play while I grunted my way through 60-second planks, my doctor’s words comforted me. And she was totally correct — urinary incontinence is rampant among women, especially those of us in our 40s and older who have carried a baby or three and have the sagging, jaded pelvic floor to prove it.
Peeing when you laugh during The White Lotus is suggestive of a pelvic floor disorder (PFD). Your pelvic floor is a web of muscles, tissues and ligaments that acts like a hammock to support the uterus, vagina, bladder, urethra and rectum. It also controls the sphincters that regulate your bladder and bowels (so you only pee and poop when you intend to).
When we’re young, most of us have a pelvic floor that’s strong-like-bull. But with age, our pelvic floors start to conk out. “The muscles and tissues become weakened and injured,” explains Karen Stander, vice president of Physical Therapy and Women’s Health at Hinge Health, a digital clinic for treating musculoskeletal pain. As a result, women can experience urinary incontinence; bowel dysfunction (trouble pooping or holding in your poop); chronic pelvic pain or painful sex; or pelvic organ prolapse, in which the bladder or uterus may bulge into the vagina. (My friend Steph was in the bathroom one day, minding her own business, when she felt a strange … something when she wiped. Because her phone was in her hands — oh come on, you know yours is, too — she positioned it between her legs and snapped a pic. The resulting selfie forced her mouth open in a voiceless Edvard Munchian scream: There was a “lychee-size blob” of tissue protruding from her vagina.)
Stander says 1 in 4 women will experience a pelvic floor disorder in their lifetime. The disorders tend to present around periods of hormonal transition, such as during pregnancy, postpartum, perimenopause or menopause. This makes sense considering we’re asking our pelvic floor to carry up to 10 pounds — or more! — of baby while pregnant (not including amniotic fluid, placenta and more), and then “the estrogen drop that occurs during menopause can cause the pelvic floor to thin out, making prolapse even more likely,” Stander adds. It doesn’t matter if you’ve given birth vaginally or via C-section. Weight gain at any point is another PFD risk factor.
Your odds of developing symptoms increases with age. An often-quoted JAMA study found that about 10 percent of women between ages 20 and 39 have a PFD, increasing to 26.5 percent in women between 40 and 59, 37 percent between 60 and 70, and nearly half in those 80 and older. “For better or worse, it’s become normalized,” Stander says. “We all say, ‘Yeah, I pee a little bit when I’m on the trampoline with my kids.’ It’s common. But common is not normal.”
This willingness to accept dribbling in the bounce house or pain during sex means most women wait more than six years before receiving care for their PFD. Other reasons women tend to avoid treatment include embarrassment and stigma, a lack of awareness that these symptoms are treatable, and inadequate access to pelvic floor physical therapists.
Yep, there are PTs for your V. They’re called women’s health physical therapists (WHPTs) or pelvic health physical therapists. They’ve seen it all, and they know how to help. I’ve used one. Stander used one. Many of my girlfriends have them. In France, all new moms get a prescription for a series of WHPT sessions. It’s just that unlike general physical therapists, whom we often humblebrag about needing to rehab our marathon injury, U.S. women don’t often talk about it.
During these sessions, your PT will assess the health of your pelvic floor and design a plan to help you strengthen weak tissue, loosen too-tight tissue, and ease pain. This often involves manual therapy, during which they use external and internal pressure and massage to treat the muscles and tissues, as well as Kegel reeducation.
Yes, despite the love shown to Kegels, they’re often the exact opposite of what women with PFD need, says my former WHPT Lesli Lo, an instructor of obstetrics and gynecology at Chicago’s Northwestern University Feinberg School of Medicine. “When pelvic muscles and connective tissues are strained and weak, they can tighten and become stuck in a contracted position, unable to control the flow of urine or to fully relax and contract in a pleasurable way during intercourse,” Lo says. For these women, Kegels can worsen things because they don’t need to strengthen their pelvic floor muscles; they need to relax them. Lo often teaches reverse Kegels, during which patients “imagine they’re controlling an elevator with their vagina and send it down to the basement, relaxing their muscles as they do when they’ve just sat down on the toilet and are about to pee or poop.”
After relaxing for 10 seconds, they send the elevator back up and hold 10 seconds before repeating the sequence.
WHPTs have other tricks up their sleeves, too, including:
Biofeedback
A sensor inserted into the vagina sends information to a computer as you squeeze and release. That data is transformed into visual feedback in real time, often in the form of an expanding and contracting circle or a line that rises and falls. This helps teach proper muscle recruitment.
Yoga
Certain poses, like Happy Baby, can relax pelvic floor muscles, decrease the urge to urinate, and improve constipation, Stander says.
Diaphragmatic breathing
This form of deep breathing helps relax and coordinate the entire core, pelvic floor included, to lessen pain and improve muscle function.
Find a WHPT by going to the American Physical Therapy Association’s section on Pelvic Health website at aptapelvichealth.org/ptlocator — or request a referral from your ob-gyn.
Have you ever suffered from the above? Let us know in the comments below.
Marta Monteiro
Follow Article Topics: Health
