Trouble Down Below

Pelvic-floor problems like incontinence and prolapse are common but not often discussed. Here are some nonsurgical solutions.

Trouble Down Below
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My grandma Honey had but one criterion for choosing a movie at a multiplex: It had to be playing in the theater closest to the bathroom. Grandma had to pee so often and so urgently that she didn’t mind sitting through graphic sex and violence and head-exploding special effects—as long as she could make a beeline to the toilet.

I thought of Grandma often when I was pregnant and sprinting to restrooms myself. But within six weeks of delivering my twin boys, the urgency and occasional leakage stopped, and so did my bladder-related concerns.

It seems I let down my guard too soon. The decades between pregnancy and grandmahood are actually the most important time to attend to your bladder and adjacent organs, muscles and ligaments because at some point, you’re likely to leak, bulge, sag or otherwise experience pelvic trouble. “Women are shocked when it happens. They hit 50 and say, ‘Oh my gosh, I survived pregnancy, but now this,’ ” says Missy Lavender, founder of the Women’s Health Foundation, a Chicago-based nonprofit that educates women about pelvic health.

Leaking and sagging and bulging, oh my!
About 28 percent of women age 50 and younger experience urinary leakage, increasing to 34 percent for women older than 50, according to a review of 22 studies. And 20 percent to 30 percent of all women suffer from some degree of pelvic organ prolapse—slippage of the uterus, vagina, bladder or rectum—because the surrounding muscles and ligaments no longer provide enough support. (Likelihood increases with age.) Urinary incontinence can be a symptom of prolapse, though you can have leakage without prolapse and vice versa. Other prolapse symptoms include a feeling of pressure or discomfort in the vagina or pelvis, back pain or painful intercourse.

“Women who have had kids get a double whammy,” says Diana Quinn, N.D., a naturopathic physician with Beaumont Health System Integrative Medicine in Royal Oak, Mich. “First are the mechanical and structural changes that happen during labor and delivery, then the diminishing estrogen levels after menopause cause thinning and irritation of the bladder wall.” But even women who have not delivered babies can develop incontinence as well as prolapse, due to gravity, age and hormonal changes. There are surgical options for both problems, including mesh “sling surgery,” but complications are common and results do not always last.

Now for the good news: Natural approaches— Kegels, physical therapy, acupuncture, dietary changes and herbal remedies—work well both to prevent and treat incontinence. And a pelvic-floor workout also can slow or even improve symptoms of both incontinence and prolapse while making sex more pleasurable to boot, Lavender says.