I’ve Never Told This Story: Leaky Bladder, Pelvic Floor, UTIs, & Constipation (#1 Urologist Gives Solutions)

Dr. Rena Malik brings to light the intricate nature and critical functions of the pelvic floor, a component of the core that provides structural and functional support to the pelvic region.

The Pelvic Floor is a Complex Network of Muscles

The pelvic floor is a bowl of muscles residing in the pelvis, holding up vital organs such as the bladder, uterus in women, and rectum. Dr. Malik likens these muscles to a hammock, or to water that buoys a boat—which represents the bladder, vagina, and rectum. She clarifies that when these muscles weaken, akin to the water receding, everything they support can descend.

These muscles also control sphincters, contracting to retain urine and stool. During urination or bowel movements, they relax to facilitate these processes. Beyond holding organs in place, the pelvic floor is instrumental in contributing to the sensations of sexual activity, as it engages during orgasm. Additionally, it has a lesser-known role in aiding the lymphatic system by propelling fluid up toward the heart.

A Healthy, Strong Pelvic Floor

Maintaining a functional, robust pelvic floor is indispensable for a wide range of bodily functions, from bladder and bowel control to organ support and sexual well-being.

Weakness of the pelvic floor may lead to ailments such as prolapse, where the lack of support causes vaginal hernias in women. Dr. Malik points out that various factors contribute to pelvic floor weakness, including the strain of carrying extra weight during pregnancy and the act of vaginal childbirth. Jobs that entail standing for long periods, chronic coughing, neurological conditions, genetic predispositions, and the natural process of aging are additional factors affecting the integrity of the pelvic floor.

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Experts including Dr. Rena Malik and Mel Robbins discuss the commonly faced yet often underreported issue of pelvic health, particularly focusing on urinary incontinence and its implications on quality of life.

Urinary incontinence, including stress incontinence and overactive bladder, is a widespread problem affecting up to 40% of women.

Urinary incontinence and overactive bladder are conditions that Dr. Rena Malik treats and Mel Robbins has personally experienced. Robbins reveals her struggle with bladder issues that began after her first child's birth, progressing from leaking when sneezing to consistent problems due to running, resulting in an overactive bladder. Robbins highlights that these issues are extraordinarily common for both women and men, with 40% of women experiencing them. Malik notes that up to a third of women will have urinary leakage which, while usually not a huge health issue, can significantly affect the quality of life.

Incontinence can result from pelvic floor weakness, often stemming from traumatic childbirth or aging.

Dr. Malik connects urinary incontinence to the weakness often caused by childbirth or a genetically weak pelvic floor. Childbirth can weaken the pelvic floor due to carrying a heavy weight around, followed by a traumatic delivery that may involve forceps or vacuum deliveries. Robbins' own experience with urinary incontinence post-childbirth highlights the chronic issues caused by trauma to the birth canal. Even small actions like taking a step or sneezing would cause leakage, impacting the ability to participate in daily activities.

Constipation and other bowel function issues can also be linked to pelvic floor dysfunction.

Constipation is cited as both a common issue that can lead to urinary problems and as a condition influenced by the pelvic floor. A very tight pelvic floor can contribute to issues such as constipation and feelings akin to urinary tract infections. Increasing fiber intake, fluid consumption, and physical activity ...

Understanding the various signs and symptoms of pelvic floor problems is critical for proper diagnosis and treatment.

Symptoms of pelvic floor problems can include urinary urgency, frequency, leakage, pelvic pain, and difficulty with bowel movements.

Dr. Rena Malik and Mel Robbins discuss the importance of recognizing problems such as constipation, urinary tract infections (UTIs), dribbling, bladder issues, and other signs that indicate dysfunction in the pelvic floor. Problems with the pelvic floor can exhibit through a variety of symptoms, including urgency, frequency, and leakage, which, while common, should not be taken as normal. These issues may be significant indicators of underlying conditions that require medical attention.

These issues, while common, are not necessarily "normal" and may indicate an underlying condition that can be addressed.

Malik highlights that common urinary complaints associated with pelvic floor dysfunction also encompass conditions such as urge incontinence, pain during urination once a UTI is ruled out, and general pelvic floor pain. Painful symptoms can extend to vaginal discomfort, pain during sexual activity or with orgasm, and potential accompanying pains in the hips or back. Bowel-related symptoms can manifest as constipation or issues with emptying the bowel, attributed to tight pelvic floor muscles.

Incontinence can have broader implications on an individual's life, affecting their productivity, social connections, and participation in activities due to the associated embarrassment.

Paying attention to changes in bladder, bowel, and sexual function can help identify potential pelvic floor issues early on.

The condition of one's urinary system, particularly if a man contracts a UTI, might denote other health issues like improper bladder emptying or prostate inflammation. Men experiencing urinary difficulties, frequent visits to the bathroom, or recurrent UTIs should be alert to the possibility of underlying pelvic floor problems. Frequent wake-ups during the night to urinate can present significant risks such as falls and fractur ...

Highlighting various approaches to dealing with pelvic floor disorders, experts underline the efficacy of non-surgical interventions and the potential for advanced procedures when necessary.

Non-surgical interventions, such as pelvic floor physical therapy, medication, and lifestyle changes, can often effectively manage many pelvic floor disorders.

Experts like Dr. Malik advise individuals with pelvic floor troubles to seek medical advice early, hinting at effective non-surgical methods that can prevent the need for surgeries. Such preventative measures could include lifestyle changes like quitting smoking, managing constipation, losing weight, and potentially keeping a diary to track drinking and peeing habits for managing an overactive bladder. Malik also advocates for pelvic floor physical therapy as an important way to strengthen and restore normal function to these muscles. Exercises for pelvic floor muscles start by lying down and progress to sitting and standing as strength improves. Yoga and Pilates are also beneficial, with specific stretches recommended for a tight pelvic floor, such as the happy baby pose or deep squats.

Exercises to strengthen and stabilize the pelvic floor muscles can help restore normal function.

Physical therapy for the pelvic floor is likened to working with a trainer at a gym, with Malik suggesting self-guided exercises, like placing a finger in the vagina to feel muscle movements. Such exercises are pivotal in identifying the correct muscles for Kegel exercises. Before beginning these exercises, particularly for individuals experiencing pain, it is important to be evaluated by an expert, as a tight pelvic floor requires a different approach than a weakened one.

Rena Malik outlines a progression from lying down to standing exercises for pelvic floor strength. Non-surgical intervention options also include products like specialized tampons for incontinence, which can help compensate for weak pelvic floor muscles by activating the necessary muscles to support pelvic organs.

In some cases, minimally invasive surgical procedures like slings or [restricted term] injections may be recommended to treat severe or persistent incontinence or other pelvic floor problems.

For more severe or persistent cases, Malik mentions surgical options such as bulking agents and slings to prevent urine leakage. Bulking agents are water-based gels injected into the urethra, and slings, which can be made from mesh or the patient's own tissue, provide much-needed support. Robbins shares her positive experience with the sling procedure, noting significant improvement in her quality of life after two days of rest.

Additionally, [restricted term] injections in the bladder are ...