Menopause symptoms such as hot flashes and night sweats are popular topics of conversation these days. But there is another side to this part of aging that women are not so quick to discuss: bladder control due to weak pelvic muscles.
Pelvic floor disorders such as incontinence occur when the pelvic floor muscles don’t properly support the pelvic organs. This weakening, often due to childbirth, menopause or illness, can lead to disorders ranging from incontinence and pelvic pain to vaginal bulge (when the vagina has fallen due to weak muscles).
According to the National Institutes of Health, an estimated one-third of all U.S. women will be affected by one type of pelvic floor disorder in her lifetime.
Sounds scary? Yup — but according to Dr. Shameem Abbasy, a urogynecologist at Swedish Covenant Hospital, exercise, diet and even hypnosis can prevent or decrease symptoms.
Abbasy spoke this week at the hospital’s Anderson Pavilion auditorium as part of the "Aging Well" event series.
While some 226,000 women have pelvic floor surgery each year, said Dr. Abbasy, there are plenty of non-surgical techniques to try first for the following issues:
Urine leakage / incontinence
For stress incontinence (due to sneezing, coughing or laughing) and urge incontinence (an urgent need to urinate), or a combination of the two, there are numerous solutions.
• Go to the bathroom on a schedule to train your bladder to hold more urine
• Pelvic floor exercises are extremely important. These muscles hold up the bladder, vagina and other organs, and aid urination and defecation. Learn to do them with a physical therapist or through a class
• Diet is important. Constipating foods should be avoided because they put more pressure on the bladder. Add fiber to the diet
• Take classes like Total Control (offered through Galter LifeCenter) to strengthen pelvic floor and stomach muscles
• Learn “urgency strategies” (what to do if you feel an urgent need to urinate)
• Biofeedback can help you contract and relax muscles in an urge/panic situation
• Dr. Abbasy uses hypnotherapy to help control incontinence
You can also try these exercises at home:
• Pelvic-strengthening Kegels (contract your pelvic floor muscles), working up to three sets of 10, twice each day, holding five seconds each
• Pull your belly button in toward spine, holding five seconds, and working up to sets of 10
• Do knee bends. Every time you sit down or stand, repeat it three more times
In addition, don’t hold your breath when you exercise. It puts more pressure on your bladder and internal organs.
Besides incontinence, a typical patient Dr. Abbasy sees may have other menopausal symptoms, including vaginal dryness, urinary tract infection and/or pelvic organ prolapse (vaginal bulge). She suggests the following:
For vaginal dryness
• Natural lubricants (olive, mineral or sesame oil). Not compatible with condoms
• Silicon-based lubricants: Have good staying power
• Water-based lubricants
• Vaginal moisturizers, such as Replens
If still dry or painful after using moisturizers, try local vaginal estrogen therapy (applied directly to vagina), vaginal cream, suppository or ring
For Urinary Tract Infections
UTIs are typically due to changes in vaginal pH levels as we age. Try:
• Lubricants, estrogen cream or low-dose antibiotics can help
For vaginal bulge
This is when muscles in the vagina give way and the vagina falls through its opening. It is common in women who’ve given birth because pelvic floor muscles have stretched 3.5 times their normal size during pregnancy.
Treatment includes: ongoing observation, pessary (a small plastic, silicon or rubber ring that holds pelvic organs in place) or surgery.
Surgery can bring the vagina back to its anatomically correct position, or, in women who aren’t sexually active, can be used to close the vagina, leaving an opening only large enough to urinate.
If you’re suffering from menopause and/or pelvic floor issues, talk to your doctor, see a physical therapist who specializes in pelvic exercise or consider taking a class, such a Galter LifeCenter’s Total Control, to strengthen the area.