Women’s bodies go through many changes as they age. One area of the body women may not focus on is the pelvis. The pelvic floor can undergo changes over time that increase the risk of many kinds of urine leaks, also known as urinary incontinence. The good news is there are steps women can take to address these changes and maintain a healthy pelvic floor, according to Elizabeth Timbrook Brown, MD, MPH, Associate Professor of Urology at Georgetown University School of Medicine.

Pelvic Floor Problems

Pelvic floor muscles hold up your bladder. They also support the uterus and bowel (small and large intestine). “The pelvic floor can change for many reasons,” said Dr. Brown. “The muscles can get weaker or tense up.” The bladder muscle should be relaxed when the bladder is filling and the pelvic floor muscles should be tight. The pelvic floor muscles surround the urethra (the tube that urine passes through). When they tighten, they help prevent urine leakage.

The pelvic muscles can get weak from pregnancy and childbirth. Being overweight and having low estrogen levels can also weaken pelvic floor muscles. Women with a weak pelvic floor may develop stress urinary incontinence (SUI). This happens when the pelvic floor muscles have stretched or weakened. Physical activity puts pressure on the bladder and can cause the bladder to leak. Leaking may happen with workouts, walking, bending, lifting or even sneezing, coughing and laughing. It can be a few drops of urine to a tablespoon or more. SUI can be mild, moderate or severe. For women with SUI, strengthening the pelvic floor muscles can help prevent leakage.

Other women have tension in the pelvic floor. This can lead to overactive bladder (OAB). With OAB, your brain tells your bladder to empty - even when it isn't full. Or the bladder muscles are too active. They contract to pass urine before your bladder is full. The main symptom of OAB is the sudden urge to pass urine. You can't control or ignore this “got to go” feeling. Another symptom is having to pass urine many times during the day and night. Learning to relax the pelvic floor muscles may help reduce these problems.

Tension in the pelvic floor can also lead to pain during sex. “If you have any of these symptoms, it’s best to seek medical attention from your doctor to point you in the right direction for treatment,” said Dr. Brown. “In many cases, women can benefit from working with a physical therapist (PT) who is specially trained in treating the pelvic floor. The PT can tailor a program that is designed to treat your particular issue.”

“In many cases, women can benefit from working with a physical therapist (PT) who is specially trained in treating the pelvic floor. The PT can tailor a program that is designed to treat your particular issue.”

Elizabeth Timbrook Brown, MD, MPH, FACS

Associate Professor of Urology at Georgetown University School of Medicine

Treating a Weak Pelvic Floor with Kegels

“Kegel” exercises can strengthen your pelvic floor muscles. They will help keep your pelvic floor muscles firm, reducing problems with leakage.

To make your pelvic floor muscles stronger, alternate between squeezing and relaxing them. Follow the below steps to help practice this technique.

  1. Squeeze your muscles for one second and hold.
  2. Relax your muscles for two seconds.
  3. Each time you squeeze and relax, it counts as one set.
  4. Complete five sets.

When you can do the exercises easily, increase to doing them 10 times per day. When that gets easy, try to squeeze and hold the muscles for three seconds. Then relax the muscles for three seconds. As your pelvic floor muscles get stronger, try holding squeezes for about 10 seconds. Relax between squeezes so your muscles can rest before squeezing again.

You should do these exercises in three different positions. Do 10 sets lying down, 10 sitting and 10 standing. You may want to do one set of 30 in the morning when you get up and another set of 30 at night. However, the exact time of day does not matter. What matters is that you get in the habit of doing the exercises every day.

Don’t overdo these exercises. Too many of them could strain your pelvic floor muscles, which can lead to bad results. Working with a pelvic floor physical therapist can help you do these exercises the right way.

Relaxing the Pelvic Floor

Working with a pelvic floor physical therapist can also be helpful for women who need to relax their pelvic floor. The PT can teach you deep breathing exercises and exercises to relax the pelvic floor muscles. “This can help with urinary urgency, frequency and feelings of incomplete bladder emptying,” said Dr. Brown.

A special exercise called “quick flicks” can help women who need to relax their pelvic floor. This exercise uses the same pelvic floor muscles used in Kegels to relax the bladder. To do “quick flicks,” you quickly squeeze and relax your pelvic floor muscles over and over. When you feel the urge to go, try a number of “quick flicks” instead. These exercises can help control that “got to go” feeling. It helps to be still, relax and focus on just the exercise. Your doctor or a physical therapist can help you learn these exercises. A physical therapist can also offer other techniques, like biofeedback. Biofeedback uses computer graphs and sounds to monitor muscle movement. It can help teach you how your pelvic floor muscles move and how strong they are.

Other Steps You Can Take

“For all women, maintaining a healthy body weight and improving core strength will help keep the pelvic floor healthy,” said Dr. Brown. Women can also counter the effects of dropping estrogen levels with vaginal estrogen cream. The cream can help with common menopausal symptoms such as vaginal dryness, urinary urgency and frequency, painful urination, painful sex and recurrent urinary tract infections.

“Not all cases of urinary incontinence can be treated successfully with pelvic floor exercises,” said Dr. Brown. “If exercises aren’t working, a woman should see a urologist to be evaluated for other types of treatment. There are other minimally invasive treatment options available. These include dietary and behavioral modifications, medications and procedures. Stress urinary incontinence and overactive bladder are not conditions that a woman needs to live with.”

More Information

Listen to our Urology Care Podcast: Women’s Urology with Dr. Elizabeth Timbrook Brown. This podcast episode includes an important discussion on women’s health and urology with Dr. Elizabeth Timbrook Brown.

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UrologyHealth.org  |  FALL 2021  |  UROLOGYHEALTH extra