As a woman, it’s a safe bet you know what a gynecologist is. You also probably know what a urologist is—a physician specializing in conditions that affect the urinary tract. Urologists may treat UTIs, incontinence, cancer and male infertility problems, among other conditions. What you may not know about yet is the physician who combines the expertise of these two specialists, but with a totally female focus—the urogynecologist.
It’s a relatively new option—and about time! Even though women have been dealing with bladder leaks forever, the American Board of Medical Specialties (ABMS)—the organization that oversees certification standards—didn’t add urogynecology as a subspecialty until 2011, and doctors finally began receiving board certification for it in 2013.
The urogynecologist is an obstetrician-gynecologist with additional training in problems that affect our pelvic floor—the collection of muscles, ligaments, tissue and nerves that supports and controls our bladders, among other things. With specialized training in both women’s health and urology, urogynecologists handle everything from evaluation and diagnosis to treatment and management with a primary focus on quality of life. This makes them ideally suited to help women contending with stress and urge incontinence, prolapse and pelvic floor disorders. They understand why women leak and how to help keep those leaks to a minimum. If you feel like your doctor isn’t quite understanding or empathetic about your bladder health concerns, asking for a urogynecologist referral is a good call.
You can expect a visit similar to the gynecologist, including a pelvic examination. There should also be a candid conversation about the symptoms you are experiencing, any life events (such as pregnancy, childbirth or menopause) that had an impact on your pelvic floor health and how living with bladder leaks is affecting your daily life.
When it comes to helping deal with bladder leaks, your urogynecologist is likely going to start with non-surgical strategies. Of course they can recommend surgery if necessary, but the initial treatments may include easy interventions such as a regimen of Kegels or working with a pelvic floor physical therapist If needed, the urogynecologist also can prescribe medications or injections or recommend the use of a specialized device to address prolapse and improve bladder control.
If you’re reading this, you already suspect that a little bit of leakage may be reason enough to talk to a urogynecologist. Other symptoms that might prompt a conversation and require a referral from your primary care physician could include pain during or after sex, pain when you pee or not being able to fully empty your bladder even when you feel the urge. Any of these circumstances might be nerve-wracking, but set anxiety aside, talk to a specialist who understands and get on a path to feeling better and leaking less!
FitRight Fresh Start isn’t your only source of information and support when it comes to living with bladder leaks. We’ve said it plenty, but it’s worth repeating, that dealing with incontinence is not something you or anyone has to go through alone. The numbers speak for themselves, with nearly two-thirds of U.S. women over twenty dealing with bladder leaks at some point in their lives. That’s almost 80 million women, so you are absolutely not alone!
And while that number might be enlightening, what’s more encouraging is the community of understanding women that has grown up around the issue of bladder leakage. There are chat groups, forums and even podcasts devoted to discussion of the very real issues surrounding incontinence. Together, we are sharing experiences, giving one another empathetic ears and finding ways to stay connected as we live our big, full lives.
Here’s a quick look at some opportunities for you to join—or just listen in on—the conversation.
Content aggregator Reddit has a Subreddit (their name for topic-specific communities) dedicated to incontinence. It’s described as “a support and discussion group for those who deal with all forms of incontinence.” Topics include dealing with relationship stress and selecting incontinence products, as well as personal reflections on dealing with incontinence on a daily basis.
One caveat: This NIH study offers both an introduction to this Subreddit and an assessment of its effectiveness as a health resource. Another relevant read via Urology Times offers some guidance on assessing the information on this forum. Remember that these are people sharing personal stories and offering anecdotal advice, not health care providers or experts.
National Association for Continence
This association, devoted to incontinence education and support, offers a user forum (registration required) that is full of discussions and information concerning everything from bladder leak volume to Kegel effectiveness to consumption of carbonated and caffeinated drinks. Start with the Introductions -New Member’s thread!
The Simon Foundation for Continence Online Support Community
The stated mission of this forum is to provide educational information, resources and support to people with incontinence and their caregivers, both professional and family/friends.
Right now, there are about 5 million podcasts offering listeners more than 70 million episodes about incontinence! Within that impressive range are several that focus on issues of incontinence and living with bladder leaks. Here are a few you might want to listen to:
Life Without Leaks: The National Association for Continence Podcast
Frank discussions and patient perspectives on living with leaks, news on new devices, calls for incontinence study participation and more.
The Adult Bedwetting Podcast
Don’t let the name discourage you! A companion to one Subreddit, this podcast deals with everyday incontinence realities, including travel; the effects of drinking alcohol; and contending with the responses of friends, loved ones and even strangers to someone living with bladder leaks.
In addition to specific podcasts on incontinence issues, other podcasts with a broader health focus also feature episodes dedicated to living with leaks. Some worth a listen include:
The Expecting and Empowered Podcast
Urinary Incontinence Doesn’t Have to Be a “Normal” Part of Motherhood
Dr. Sex Fairy—With Dr. Kwanal Bawa
How to Treat Urinary Incontinence
All of these social platforms and podcasts can offer insight, information, community and understanding when it comes to finding ways to manage leaks and make every day a great day. Just remember that their content is often user-driven and not always from a medical professional or specialist. Read, listen and learn—and always remember to consult with your doctor regarding serious decisions around your strategy for living with leaks.
When it comes to living with incontinence, there’s plenty of info available about practical steps you can take to live well even with a little leaking. Throughout the FitRight Fresh Start website, you’ll find articles about everything from managing incontinence stress to helping prevent odor to helping get a better night’s sleep.
Understanding and addressing these factors certainly can help reduce the stress of living with incontinence. What’s also important, however, is to remember the real, feeling person who is in the midst of working to manage it. That person—you—needs to prioritize taking care of your overall wellbeing. There’s a lot more to life than leaks!
We’re not going to pretend that living with leaks doesn’t cause stress. It’s important to recognize that incontinence often puts a strain on our personal relationships and can impact our self-esteem. All the more reason why it’s important to put self-care at the top of your priority list.
So how should you get started on your self-care journey? The specifics are yours to discover, but research has revealed some affirmative changes worth applying to any personal self-care strategy:
Set realistic expectations
You might want to improve your diet by eating foods that benefit bladder health, spend time strengthening your pelvic floor or incorporate some fresh ideas into your daily routine to boost your leak-fighting power. Just remember that change doesn’t happen overnight, and that you have access to plenty of information, support and strategies to help you live your best life, no matter how your bladder is acting day by day.
It’s a challenge, but with some consistent mental practice you can commit to taking a more positive approach to living with bladder leaks. The right mindset is a major factor when it comes to doing well with any lifestyle change. It won’t happen overnight, but the right attitude will absolutely help make good things happen. There are sure to be frustrating days, but don’t let those overshadow your long-term determination to live your best life despite a little leak now and then.
Wherever you decide to start, go easy on yourself, and expect change to take a little time. Challenging yourself to be perfect every day from day one is a surefire path to frustration. Taking satisfaction in slow progress over the long haul and acknowledging steady improvement in how you live means a greater chance of success.
Remember you’re not alone
Plenty of mental health experts remind us that thinking we are alone in facing a challenge is all too common. Looking for validation and inspiration? You don’t need to look any further to realize there are tens of thousands of women just like you determined to live a full and fulfilling life—even if they must manage a little leaking.
Literally! Low-impact exercise, like a morning walk or evening bike ride, is a great way to help shed pounds, reduce stress and encourage better sleep—all factors that can contribute to a more leak-free life. And as you Kegel your way to a stronger pelvic floor, you can consider more energetic pursuits like dancing, resistance weight training or yoga.
Caring for yourself ultimately means never forgetting that you are always going to be worth the effort. To give that real muscle, keep reminding yourself:
Having strong pelvic floor muscles is essential for all genders and all ages. These muscles help control our bladder and bowel movements as well as sexual sensations and functions. They also work with the deep abdominal hip and back muscles and the diaphragm to stabilize and support the spine.
When your pelvic floor muscles don’t relax or contract properly, it can lead to dysfunction, including things like incontinence, urgency, frequency and more. But the good news is, like other muscles in the body, they respond to exercise and can be treated with pelvic floor physical therapy.
For women experiencing urinary incontinence, working with a specially trained pelvic floor physical therapist (PT) is a highly effective option for treating bladder leaks or proactively heading off potential problems that can occur with pregnancy, menopause, surgery, illness and many other issues. It might be a great option for you too.
Being evaluated by a pelvic floor physical therapist can do wonders to help you understand how your body functions. And treatment can be an excellent option for any woman at any age who wants to attain and maintain pelvic floor health. The goals include strengthening voluntary control of pelvic floor muscles, improving bladder function and stopping those leaks.
To give you a brief introduction to what pelvic floor physical therapy entails, we interviewed Amy Friedman, PT, an experienced pelvic floor specialist and passionate women’s health advocate, about her experience, approach and advice. We asked her to provide a basic and broad overview of pelvic floor physical therapy in the hope it will encourage you to explore this option further.
I graduated from the University of Illinois–Chicago with a bachelor’s degree in physical therapy in 1996. At the time there were a handful of pelvic floor PTs working to let people know there were resources to go to for pelvic floor dysfunction. From the start, I knew I was going to go in that direction. After gaining some experience in orthopedics, exploring the biomechanics of the body, I began specializing in pelvic floor dysfunction in 2006. For this interview, I’ll focus primarily on women, but I also treat men and children dealing with pelvic floor dysfunction.
When I opened up the first pelvic floor program in my office, I was the only pelvic floor PT there. And though things were changing, a lot of women still didn’t want to talk about it. It’s very embarrassing, and people believe the myth that it’s just old women who leak. As women age, they think they’re just supposed to have this, right? But actually, it crosses all ages. So, I started calling gynecologists and ob‑gyns to remind their patients that pelvic floor dysfunction may be common among women, but it’s really not normal, and they shouldn’t have to live with it.
In my practice now with Bannockburn Chiropractic & Sports Injury Center near Chicago, I see everything from pregnancy and postpartum incontinence to prolapses and beyond. My hope is that pelvic floor physical therapy can help my urinary incontinence patients not only deal with and eliminate a lot of the reasons they need incontinence products, but also help them use protection in a way that’s healthy for their pelvic floor.
One of the things I emphasize for my patients is that your pelvis is in the middle of your body. And every avenue, every road is going to go there—from your feet up to your head. Every time you take a step, you’re bearing weight, and there’s a lot of shock absorption in your pelvis.
Anytime you exercise or go for a walk, the position of your body can influence what’s happening in your pelvis. Your pelvic bones are attached to your spine. So anything that happens in your spine is going to influence all the nerves and all the muscles that come from your spine into your pelvis. And what about hormones? What about all the organs that are in there? My point is that, because it holds so much and it’s in the middle of the body, it can be impacted by everything you do. It’s profound and complex.
But probably the most important thing I tell my patients from the start is it’s also a very private place, and I’m honored that they are willing to talk about pelvic floor dysfunction with me, even if they’re scared or embarrassed.
Thankfully, yes. With social media, it’s all out there. When you Google incontinence, the recommendation to see a pelvic floor PT is now front and center. That is huge.
So at some level, people are less embarrassed to talk about incontinence. Especially women. We’re all feeling more empowered to focus on self-care. Even the way we talk about menopause is changing. And the really good news is there is available treatment.
Typically, you do not need a prescription for any kind of physical therapy, so you can pursue pelvic floor physical therapy on your own. With that said, if you came in and hadn’t seen your doctor in over a year, I would suggest you go see your ob-gyn, urogynecologist or urologist. Get a thorough exam and checkup. That’s pelvic health, too—making sure everything is medically okay.
One of the things that helps me do that with my patients is I always talk to them ahead of time. I think it’s so comforting for a patient to hear directly from the therapist about what you can expect. I let them know there’s no need to be nervous. The first appointment is going to tell you everything. It’s going to educate you. And that usually calms people down a little bit.
Your first appointment is the most important appointment. It’s not only going to help establish what we’re going to do; it’s going to establish rapport and trust. We talk almost the entire time. It’s about me learning your history. It’s about you understanding some basic anatomy and how the function of the pelvic floor ties in with your body. It’s a lot of education. You’re not just coming in here and immediately lying on the table undergoing an internal exam.
For example, if you’re having leakage, but you’re really embarrassed and trying to deal with it by using period pads, I’ll start by saying, ‘Let’s get you wearing the right protection, so that you’re not anxious about being in public or letting it limit your life.’ Menstrual products don’t absorb urine properly, so it stays on your skin and causes irritation. You need products designed specifically to absorb and wick away the wetness. If I can provide a way to immediately help eliminate that anxiety and embarrassment, it’s a big relief.
During the first visit, I also do a postural screen—sitting and standing. I want to know how you carry yourself. Do the ribs sit over your pelvis? Do you clench your tush? Are you pregnant or did you just have a baby? I look to see how you breathe. How aware are you of your body, in general? And if I put my hands on you, are you skittish or jumping off the table?
I also ask you to complete some questionnaires. Once I have the information, I can share a preliminary idea of what’s going on and make some recommendations. I may also assign some homework, like keeping a bladder log. Finally, I talk about what comes next and what the internal exam will be like.
The second visit includes a through and detailed pelvic floor assessment. Broadly speaking, I usually start with an external visual of the perineum. I look at the tissues. I look to see if there is any prolapse. Are there scars and what is their condition? I observe how you lift and relax your pelvic floor muscles. Do you have to use your body or other muscles to do it?
Then I do a comprehensive internal assessment of the three layers of the pelvic floor muscles by inserting a gloved finger in the vagina and rectum. In brief, I look to see if there are trigger points. Is there tenderness? Is there weakness or tightness? I do a couple of tests for prolapse and many other issues. Depending on what I find, we determine a treatment plan consisting of manual work, neuromuscular reeducation and therapeutic exercise aimed at helping you tone your pelvic floor muscles and coordinate pelvic floor contraction/relaxation with your breathing, with your abdominal muscles and with functional activities in your life. Sometimes treatment also includes coordination with other disciplines and healthcare providers.
Pelvic floor physical therapy is not one size fits all. It must be personalized for every patient—whether man, woman or child. It’s important that you get evaluated to make sure you’re doing what’s best for you and your unique bladder issues.
I’m only making recommendations. It’s still your body. You don’t have to do everything that I suggest, but they’re all recommendations that are going to make your life better.
Most of us love the anticipation of travel. We look forward to new experiences and making memories. For those of us with bladder control issues, however, that anticipation can give way to anxiety about handling leaks on a long flight or road trip. Often, that’s enough for many of us to cancel plans or resign ourselves to staying local. Anecdotal evidence suggests that people with bladder control challenges tend to avoid traveling for more than an hour! But a 60-minute journey, whether in the air or riding in the car, won’t take you very far.
Don’t let bladder leaks derail your travel plans! With a bit of planning, the right products and some patience, you can reach your destination clean, fresh and full of confidence. Here are a few strategies and steps to get you started:
If you’re taking to the skies, for example, remember that time in the plane is only part of the itinerary. There’s getting to the airport, parking, getting through security—all phases that might require you to be aware of your need for a restroom. You should also be prepared to deal with potential delays and disruptions and have what you need on hand to make waits tolerable.
If you’re going about your usual routine, the right protection means you don’t have to map out your day so you’re always near a bathroom. But if you’re traveling to a new destination, you won’t always know your agenda or where public restrooms are located. It might be a good idea to download a bathroom-finding app for your smartphone. Many are free and help you “flush” out the details on restroom locations worldwide.
Travel means adding essentials like absorbent underwear, briefs and protective pads to the packing list. You know best what level of protection you need as you settle in for that flight or drive but think about dialing it up a notch for extra security. If you typically wear liners during the day, a fitted brief might be more practical in case you get stuck in traffic or the captain makes that “please return to your seats” announcement. Bouncing around is no friend to those of us with incontinence issues, so you’ll be happy you’re protected if you find yourself in bumper-to-bumper traffic or flying through turbulent skies. And don’t stash everything in your checked luggage! Keep a good reserve in your carry-on or purse.
Nothing can be as welcome as a personal cleansing wipe or two when you want to freshen up. You’ll be really glad you have a travel pack in your jacket pocket or purse. Add those along with essential toiletries like deodorant and toothpaste, and you’ll always have them with you!
You may think no fluids before you fly makes sense, but that can backfire. It’s easy to get dehydrated on a long flight or drive, and messing with your hydration management may actually increase bladder control concerns. Bring along a small bottle of water—just remember to keep it under 3.4 ounces or fill up after you pass security!
The window seat is scenic, but you don’t want to climb over seat mates should you feel the need to go. That may mean taking care to book a specific seat or making sure you claim an aisle if there’s open seating. If no seats are available, you can discreetly ask a flight attendant if they wouldn’t mind helping you switch with someone before you settle in. Most people are happy to accommodate a courteous fellow traveler.
Of course, when it comes to fluid intake, we know that caffeine and alcohol have a diuretic effect. Take a pass on coffee, tea or soda, and wait until you’re settled at your destination for that celebratory cocktail.
Part of your pre-travel prep should include a chat with your doctor, who can offer additional advice on how to best be prepared so you can enjoy the journey. Be sure to be open and honest about all your concerns, discuss strategies for helping to ensure an enjoyable trip, and talk about what protective products you should count on to make your travels as comfortable and worry free as possible.