Empowering women: To pee or not to pee – Is that your question?

By Sari Uretsky

Vagina.

Now that most of the men have left, those interested can have a conversation. An important conversation about Women’s Health. When was the last time you talked about your vagina?  Or labia or perineum? Do you even know what these things are and where they are located?  What about a prolapse?  What is that and where does it happen?  Why do some women have pain “down there” when they pee or have sex? Is that normal after childbirth? What about those leaks when you cough, laugh or jump up and down? What about urges to void constantly throughout the day? Women very rarely talk about these things. I think we need to.  We should be more open and speak about the concerns we have, instead of trying to just live with them. 54% of incontinent women report the loss of confidence and 45% report the loss of intimacy. 5 out of 10 women do not seek help. There are things women can do to address the issues mentioned above and many of these are non-invasive, non-surgical options.

Have you ever been pregnant? Do you have children? If so, you likely have a weakened pelvic floor. Research shows that pregnancy, not just delivery, can disrupt the pelvic floor. The pelvic floor consists of muscles that act like a sling making up the bottom part of your core. It is responsible for keeping our bladder and bowel from leaking, holding in the pelvic organs, supporting the low back and pelvis and maintaining optimal sexual function. During a vaginal delivery, the pelvic floor muscles are stretched up to 4X their normal length! These muscles may be torn or cut during the delivery as well, which repairs with scar tissue. This scar tissue can be hypersensitive or painful and extremely tight causing a great deal of discomfort.  Unfortunately, you are not in the clear if you have had a C-section. Due to the weight of the growing uterus directly down on the muscles and due to hormonal changes, pelvic floor muscle dysfunction will likely occur. There is also an incision made through the lower abdomen during a C-section and therefore scar tissue forms here too.

Many women experience bladder and/or bowel dysfunction after pregnancy and many women will experience it later in life, even if they have never had a biological pregnancy.  A weak pelvic floor can lead to stress incontinence. This is when you leak urine during an activity that increases your inter-abdominal pressure, like coughing, sneezing, laughing, jumping or lifting.   How many times have you heard people say “Oh, I can’t do that because I’ll pee my pants!” It is NOT NORMAL to lose control of your bladder regularly or on occasion, but it is COMMON.   Thankfully, there are strengthening and endurance exercises to help you get better control of your pelvic floor.

Sometimes an over-active bladder is the issue. You might have urgency with or without incontinence. This is when you have a strong urge to void often or all the time. It is normal to go to the washroom every 3-4 hours and once at night. If you are going more often than this, there is likely a problem with either urge or frequency or both. A physiotherapist trained in pelvic health can teach you strategies to increase the time between bathroom visits and calm urgency.

Pain can be associated with the pelvic floor in many different ways. It may be painful to urinate, have a bowel movement, insert a tampon or some experience pain prior to, during or after sexual intercourse. Some people cannot relax their pelvic floor and thus feel discomfort all the time. Being able to control your pelvic floor muscles also means being able to relax them.  Stretches, scar massage, exercises, positions of relief and even IMS (intramuscular stimulation) can be very helpful in reducing tightness and learning how to relax.

Now if there happen to be any men left reading, men’s pelvic health is also extremely important. Men can have pain, urgency, frequency and incontinence too. These are not strictly female issues. In fact, most men require pelvic physiotherapy after prostate surgery. Exercises, education and pelvic training are all effective means to improve and resolve issues in both male and female patients.

I could go on and on about the different issues people face with their pelvic floor but the two most important things to understand is that you are not alone and there is help! Start talking to your friends about the things you are experiencing. Speak to your family doctor or better yet, gynecologist. Find a pelvic health trained physiotherapist you trust, to work with you to help resolve these issues. There are so many things you can do to make your life better and to feel more confident. Feel Better. Move Better. Be Better.

Sari Uretsky, BSCPT, CAFCI, IMS is a Physiotherapist – Women’s Health Specialist. Contact her at uretskyphysiotherapy.com.