You may be wondering. There are certain questions that are hard to ask. You aren’t sure if your mom is up to speed. You are way too embarrassed to ask your spouse and your best bud doesn’t need to know. You probably need to ask your doctor, but even that may cause you to turn three shades of red. So, maybe it would be so much easier if someone just wrote a column about it. This way you don’t have to actually ask, but you get the skinny on the issue.
Well, it’s your lucky day. I am going to answer some of those questions and still try to keep this family friendly article about all things south of the belt line.
Is it normal to have to wear protection for exercise?
No. While one in four regular female exercisers wear some sort of liner or pad, it is not normal and it is correctable without medication in 80% of cases. Typically a combination of pelvic floor exercise, biofeedback, and a few lifestyle changes keep you dry as a bone.
Out of my way! I gotta go! Why do I have to rush to the bathroom like a running back on steriods?
There can be more than one reason for this urgency, but usually it is a combination of an overactive muscle around the bladder combined with a weaker than normal pelvic floor muscle group. It can also be related to going to the bathroom too frequently, which can confuse the bladder reflexes. The good news is that with some behavioral training it can often be corrected in less than two weeks. Of all the things I do related to incontinence and pelvic floor training, this is usually the quickest and easiest. Most of my clients are astonished that they have had to deal with this for years when the answer was so quick and easy. Lots of you may be on medicine for an overactive bladder. While for some of you that may be necessary, most of you could resolve this issue without the medicine. The right training could save you the money, time, and side effects that come with these medications. The most concerning side effect to me is the memory loss. Most of us need all the brain power we can muster. Another side effect of overactive bladder meds is constipation, which puts more pressure on the pelvic floor, making you more likely to leak!
How often should I have to go to the bathroom?
Most of us should be urinating every 3 to 5 hours. If you have a history of frequent urinary tract infections, it will be less. Also, you may need to go shortly after taking a diuretic, but the 3 to 5 hours is a good rule of thumb for most people. If you are going more often, we can teach you how to get your timing to a more normal level and ensure that your urine is nearly clear, odorless, and exits in a steady stream. It is not difficult; it just takes a little education, a watch, and some techniques to correct the pelvic floor to detrusor balance. This process usually takes 2-4 weeks depending on how frequently you go to the bathroom. Patients with benign prostate hypertrophy also get results with treatment though it may take a little longer.
What to do about #2?
Over the years, I have treated all kinds of #2 issues and the good news is that most people get REALLY good results. Some of you swing from diarrhea to constipation, which is uncomfortable and makes it very difficult to make plans to go out. There are others that are very constipated, often going days or weeks between bowel movements. Not only does this increase your risk of colon cancer, it can be painful or at the very least, distracting. Usually, improving your hydration and fiber is helpful. Sometimes it is helpful to work with your doctor on your medicine and dosing, as pain medicines and anti-cholinergics (like for overactive bladder) can cause constipation. Most often, it requires manual therapy to treat the muscles of the pelvic floor. Specialized techniques relax the muscles and allow the sphincter to open with greater ease. Occasionally, visceral mobilization is required for people who have had multiple abdominal surgeries. Depending on the situation, we may use biofeedback to teach relaxation for the pelvic floor muscles or the muscles around the anus. The biofeedback involves about 6 weekly sessions to retrain the muscles. The training for the other treatments usually take 4-6 sessions.
Ok, here’s the big one. What can be done about painful intercourse?
This is more common than you might think. The reasons can be as varied as the patients. Very often it is the result of post-menopausal changes. Post-menopausal women usually respond to a combination of lubrication options, pelvic floor training (most often the person is weak in the pelvic floor, has muscle loss, and changes in sensation), and manual therapy to deal with trigger points, muscle spasms or tenderness. Biofeedback can be used for both strengthening and relaxation. For some patients, your doctor may recommend hormonal replacements in combination with other treatments. Other patients may have solely muscle spasms. This could be from weakness (believe it or not), injury, pregnancy, hormonal changes, or low back problems. The treatments will be very individualized. Every patient will need to be instructed in ways they can improve their symptoms based on the cause. The goal is to get everything working normally. Seventy percent of patients with painful intercourse can return to normal “activities” with proper treatment.
So while you may not be talking about this at your next dinner party or over the water cooler, there are options and treatments that are safe and effective. Ask a lot of questions, do your homework, and get the relief that is available.
Dr. Dawn Muller, PT, DPT, MTC, Cert DN is the owner of Thrive Physical Therapy and Fitness, LLC. She has been practicing 30 years. She has been treating men’s and women’s health dysfunction for 18 years. She is a frequent provider for these issues for Mayo Clinic, as well as many local physicians and surgeons. To make an appointment, call 229-228-9019.