Trouble Down Below

Trouble Down Below

Stress incontinence solutions
If you leak when you sneeze, cough, run, jump or lift weights, you have stress incontinence, caused by pressure—“stress”—on the bladder. You’re especially prone if you had a long or difficult vaginal delivery, such as one involving forceps or other interventions that can injure pelvic nerves and muscles.

Being overweight doubles the risk of stress incontinence because the extra poundage puts pressure on the bladder. Losing weight appears to help. In a 2010 Journal of Urology study of women with daily leakage episodes, those who lost 7.5 percent of their body weight after one year reported a 65 percent reduction in episodes of stress incontinence.

If stress incontinence interferes with your daily life and you are not a candidate for, or interested in, surgery, what then? First: Kegels. Then, more Kegels. (And by the way, Kegel rhymes with “bagel,” not “legal.”) These exercises work both to prevent and treat stress and urge incontinence by strengthening the pelvic floor, a thick, wide band of muscle that stretches across your pelvis and acts as a hammock, supporting the bladder and uterus.

You can, and should, do Kegels on your own. However, if you have persistent, bothersome leakage when you laugh, cough or sneeze, or if you are experiencing urinary urgency, you may want to see a specially trained physical therapist, who may use exercises and/or biofeedback to improve your pelvic-floor muscle strength and endurance. These techniques may also help reverse symptoms of pelvic organ prolapse, according to a 2010 article published in the American Journal of Obstetrics and Gynecology.

Do Kegels correctly
Most women squeeze the wrong muscles or fail to contract them long enough, says Melissa Nassaney, M.S., D.P.T., a pelvic-floor physical therapist at Women & Infants Hospital in Providence, R.I. Here’s how to do them right: Lie down in a quiet place so you can focus. Try to imagine that the muscles of your vagina are like the doors of an elevator. Gently close the doors and lift the elevator up to the next floor, then bring the elevator back down and open the doors. Do not lift your hips. If you have difficulty finding your pelvic- floor muscles, place a finger or two inside your vagina, squeeze the surrounding muscles and make sure you feel a tightening. You also can locate these muscles by stopping the flow of urine as you pee, but only try that once: Doing it regularly can damage your urinary system. Once you get comfortable with contracting and relaxing these muscles, you can try doing Kegels in other positions. Don’t hold your breath or squeeze other muscles, such as your buttocks or inner thighs. Do 10 to 15 repetitions three times a day. Work up to holding each contraction for 10 seconds. Do Kegels daily for 6 weeks, and then two or three times a week—forever.