Spirit of Women magazine is a national publication presented to women by hospitals and their physicians. The magazine provides up-to-date, evidence-based healthcare information and promotes our hospitals as leaders in women's health excellence.
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2 7 w w w. s p i r i t o f w o m e n . c o m | S U M M E R 2 0 1 7 | S P I R I T O F W O M E N Pelvic organ tissues, such as those of the vagina and bladder, need estrogen to stay healthy and supple. But estrogen levels decline after menopause, causing these delicate tissues to thin and become easily irritated. Your bladder can't hold as much urine, and your vagina produces less lubrication, which can make sexual intercourse difficult or even painful. Even for pre-menopausal women, pregnancy, childbirth and repeated heavy lifting or exertion can put stress and pressure on the pelvic floor muscles, as can being obese or overweight. "Obesity is a huge risk factor for pelvic floor problems," says Dr. Koszczuk. "Having a BMI [body mass index, a measure of body fat] of 30 or higher significantly increases your risk." Illnesses such as diabetes, multiple sclerosis, Alzheimer's disease and vascular disease can also put you at greater risk for pelvic floor problems. Urinary incontinence A weakened pelvic floor can easily lead to urinary incontinence, or loss of bladder control, which women are twice as likely as men to suffer from. Stress incontinence results from weakness in the bladder muscles. You may leak a small amount of urine when you sneeze or lift something heavy. In severe cases, you may have uncontrolled wetting. On the other hand, if you frequently have a strong urge to urinate, you likely have an overactive bladder, or urgency incontinence. Many women have a combination of stress and urgency incontinence. Underactive bladder muscles, low estrogen or an obstruction in the urethra can cause your bladder to become too full (overflow incontinence), which can also lead to leaking. The good news is that Kegel exercises [see related story above right], bladder training and medications can successfully fix most urinary incontinence problems. Fecal incontinence When trauma, nerve injury or diseases such as irritable bowel syndrome (IBS) damage the muscle mechanics around the anus (the opening of the rectum), it can lead to unintentional bowel loss, or fecal incontinence. "Sometimes, simply identifying and avoiding certain foods can alleviate fecal incontinence," says Dr. Koszczuk. Treating any underlying diseases, modifying your diet and adding bulk to your bowels will help resolve most fecal incontinence problems. Pelvic organ prolapse Pelvic organ prolapse occurs when tissue from other organs, such as the bladder or uterus, abnormally protrudes into the vagina. "Pelvic organ prolapse is actually a hernia," says Dr. Koszczuk. Symptoms can include the sensation of vaginal fullness, lower back pain and difficulty going to the bathroom or having sexual intercourse. But often pelvic organ prolapse isn't bothersome and may not require any treatment. Some women use a device called a pessary, which they or their doctor insert into the vagina to support the prolapsed organ. Pelvic protection strategies One of the most important ways to prevent pelvic health problems is completely within your control: Don't smoke. "Smoking reduces tissue integrity, especially as we age and are exposed to other risk factors," says Dr. Koszczuk. Taking charge of your health—and your diet—will also help you avoid pelvic floor problems. "Control your weight before you become obese," says Dr. Koszczuk, "and do Kegel exercises. Don't underestimate the importance of doing these exercises, especially if you are having children. Kegel exercises are always a part of any pelvic floor treatment regimen. "A lot of women live with pelvic floor problems, thinking they are a normal consequence of aging," he adds. "They're not. At least 80 percent of these problems can be treated satisfactorily." KEGEL QUICKIES Strengthen your pelvic floor muscles by regularly performing Kegels: • Squeeze the muscles that you use to stop the flow of urine. This contraction pulls the vagina and rectum up and back. • Hold for up to 10 seconds, then release. • Do 50 contractions a day for at least four to six weeks. Source: American College of Obstetrics and Gynecology "Obesity is a huge risk factor for pelvic floor problems." ~ Dr. Jeffrey Koszczuk, Aspirus Riverview Hospital