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Incontinence Stories From Experts & Real People | NAFC BHealth Blog

Log in daily to learn tips about #incontinence, #bladder leakage, overcoming symptoms, and first hand accounts from experts and patients.

 

Filtering by Category: Preventative

NAFC's Many Resources For Managing Overactive Bladder

Sarah Jenkins

 NAFC's Resources For Overactive Bladder

Do you have overactive bladder? If you find yourself often running to the bathroom, you might be suffering from OAB – the urgent and frequent need to urinate. And, that urgent need may be difficult to stop, causing you to experience bladder leaks. Overactive bladder affects over 35 million people in the US, and can be a big disrupter to your everyday life. You may be struggling with this condition and wondering how to stop overactive bladder. But knowing more about the condition, what causes it, and how you can manage and treat it can make a big difference.

NAFC has tons of resources for patients living with overactive bladder. Check out the two listed below:

 

OAB Resource Center

The NAFC OAB Resource Center has videos about Overactive Bladder, first hand patient stories, and articles and brochures to help you understand the condition and what to do about it. It also has a collection of downloadable guides that can help you manage your condition. Download our OAB screener to evaluate the severity of your condition, get a tips sheet on bladder retraining, try the NAFC Bladder Diary, and get our tips for how to talk to your doctor about oab.

 

OAB Treatment Tracker

Do you feel like you’ve tried everything to treat your Overactive Bladder? NAFC created the OAB Treatment Tracker to help you determine your next best step in treatment options. Answer a few questions about your symptoms, the treatments you have tried in the past, and new treatments you may be interested in and receive a customized email outlining treatment options that may be a good fit for you. Best of all, you can print out the email and bring it with you to your doctor’s appointment to help facilitate a discussion about treatment options for OAB.

 

 

 

 

 

What Is The Pelvic Floor? (And Why Should I Care?)

Sarah Jenkins

What Is The Pelvic Floor - Facebook.png

If you’ve never thought much about your pelvic floor, you’re not alone. Most people don’t give this section of the body much consideration until it’s too late – they become incontinent, or worse, suffer a pelvic organ prolapse as a result of pregnancy, obesity or chronic constipation. But the pelvic floor is one of the most important muscles in the body, and ignoring it can have potentially great consequences later in life.

Anatomy

Let’s begin with a little bit of anatomy. The pelvic floor is a basket of muscles that supports some pretty major organs – your bladder, rectum and uterus in women, and your bladder, rectum and prostate in men, to be exact.  The muscles stretch across the pubic area from front to back and from side to side. They are typically very firm and thick, but are also flexible and are able to move up and down (kind of like a trampoline).

These muscles are very important in supporting the organs listed above, and are essential in maintaining control over our bladder and bowel. The pelvic floor muscles also play a large role in sexual function for men and women, and provide support for the baby during pregnancy. 

Over the course of our life, many things can compromise the stability of the pelvic floor, leading to things like incontinence, or pelvic organ prolapse. Obesity, childbirth, chronic coughing, chronic constipation, or other things that put strain on the pelvic floor can cause it to weaken. And with age there is often a weakening of the connective tissues of the pelvic floor.

What You Can Do To Protect The Pelvic Floor

The good news is that much like the other muscles in the body, the pelvic floor can be trained and strengthened over time.  By learning to strengthen the pelvic floor, you may be able to prevent or even eliminate symptoms of incontinence or prolapse.

Read: 4 Moves to Help You Strengthen Your Pelvic Floor Before You Get Pregnant

There are many exercises you can do to strengthen the pelvic floor. Kegels are great at isolating the pelvic floor muscles, but because the pelvic floor connects to many of the muscles that create your “core” (your diaphragm, transversus abdonminis, and multifidus), you also need to incorporate workouts that build strength in those areas as well. And remember – it’s not just about tightening. We need to ensure that our muscles are neither too tight, nor too loose. Learning how to relax the pelvic floor is just as important as learning how to strengthen it, since a pelvic floor that is too tight can create weakness and cause problems too. Like any other muscle in the body, we are looking for our muscles to be strong and flexible. 

Symptoms Of Pelvic Floor Tension

  • Constipation
  • Painful intercourse
  • Pelvic Pain
  • Inability to empty your bladder completely
  • Painful urination

If you experience these symptoms, we recommend that you see a pelvic floor physical therapist prior to starting any strengthening program. Performing strengthening exercises on a pelvic floor that is already too tight can create additional problems, or make any existing issues worse.

Symptoms Of Pelvic Floor Weakness

  • Urinary incontinence
  • Urinary urgency/frequency
  • Stool and gas incontinence
  • Pelvic organ prolapse, or the dropping of your organs through your vagina
  • Sexual dysfunction
  • Pelvic girdle pain

Learning how to strengthen, and relax the pelvic muscles can help with pelvic floor weakness.

Want tips on how to improve your pelvic floor strength? Check out these great resources:

Incorporating Pelvic Floor Exercises Into Your General Workout Routine – 3 Best Moves To Add Now.

It’s All About The Base

Ask The Expert: Can Pelvic Floor Exercises Really Help My OAB Symptoms?

Men And Kegels – The Ultimate Guide

Note: If you are experiencing symptoms of either pelvic floor weakness or tension, we strongly advise you to see a physical therapist specialized in pelvic floor therapy. A physical therapist can help provide you with a diagnosis and put you on a custom treatment program specific to your needs.


Dear Readers:  NAFC provides free education and resources to over a million people each year. We are a small non-profit that operates with all the expenses of a large organization - website maintenance and upkeep, servers, staff, and the development of continued educational tools and programs. Please help us continue our mission by making a donation. Even a small gift can make a difference and will help ensure we are able to keep this FREE resource alive and help more people learn to live a Life Without Leaks. PLEASE DONATE TODAY!

A Caregivers Guide To Keeping The Bed Dry

Sarah Jenkins

bed

One of the most challenging things about being a caregiver to someone who has incontinence can be the mornings. Waking up each day to your loved one’s wet bed can be both physically and emotionally draining. No one likes to wash and change sheets each day, and knowing the discomfort (and likely embarrassment) that your loved one feels can be disheartening.  In fact, incontinence is often a big reason that older adults are placed into long-term care facilities.

The key to managing this problem is prevention. Having the right tools at your disposal will do wonders to help keep the bed dry and your loved one comfortable.  And remember, layers are your friend. They will help keep any leaks to a minimum and make clean up so much easier. Here are some of our top tricks for keeping the bed dry and making your life a little easier.

  1. Zippered, Vinyl Waterproof Mattress Cover. This should go on the bed first and will help keep any moisture from getting on the mattress. After all, replacing a mattress is expensive, and getting lingering odors out of them is very hard. If you do nothing else, do this.
  2. Waterproof Mattress Pad. Use this as a second layer – it’s a softer, but still waterproof cover that will go over your vinyl cover.
  3. Waterproof Flat Sheet.  
  4.  Waterproof Underpad. You can use these both under, and on top of a flat sheet if you wish, and they can be disposable or washable. We recommend putting a large, sturdy, washable pad on the flat sheet, then topping that with a disposable pad that you can simply toss in the trash when needed.
  5. Use Layers Of Blankets Instead Of A Thick Comforter. These are easier to wash in the event of an accident.
  6. Disposable Absorbent Products. A good fitting disposable absorbent product is key. Find one for nighttime use (they’re more absorbent) and make sure the fit is good – you don’t want anything too tight or too lose, as it will lead to leaks. For a breakdown on what to look for, see our guide on absorbent products here.
  7. Skincare Protection. While this won’t protect your bedding, it will protect your loved one. Proper skincare protection can help keep skin from getting irritated or chapped due to accidents that happen during the night. 

Try these tips for a drier night, and happier morning. 

What tips do you have for a dry night? Share them with us in the comments below!

Ask The Expert: How Do I Keep Myself Odor Free When I Have Incontinence?

Sarah Jenkins

AskTheExpert-01.jpg

Each month, we ask our expert panel to answer one of our reader's questions. To learn more about the NAFC Expert Panel, and how to submit your own question, see below.

Question:  I live with incontinence and am often concerned about others noticing a certain “smell” about me. How do I ensure that my incontinence problem lead to an odor problem?

Expert Answer: Many people with incontinence often worry about this issue. But, it’s an easy one to solve as long as you’re diligent in following a few simple steps.

1.     Change often. If you wear absorbent pads, make sure you change them often to avoid smell. Fit and type of product is also important – a close fitting product will hold odors better than something that fits too loosely, and some products have odor-reducing materials built in, which can help prevent smells. In addition, stool or urine get onto your bedding or clothing, wash them right away, or place them in an airtight container until you are able to wash them to prevent odors from making their way throughout your house. If you’re on the go, pack a disposable plastic ziplock bag to store any soiled clothing due to leaks.

2.     Drink plenty of fluids. While many people with incontinence may try to limit their fluids, you should never do so to the limit that you become dehydrated. Drinking too little fluid throughout the day makes your urine more concentrated, and more likely to smell. The general guidance is 6-8 glasses a day. You’ll know if you’re drinking enough water by the color of your urine – clear urine with almost no color (and hardly any smell) is a good sign your staying hydrated – if your urine is a concentrated yellow, it could be a sign you need to drink a bit more.

3.     Be diligent about hygiene. It’s essential that you wash daily and clean yourself well after any accidents and after each pad or application change with a gentle cleanser.  If your skin becomes irritated, you can use a moisturizer or a protective ointment. The best line of defense against odor is ensuring that skin is kept clean and absorbent products are frequently changed or washed.

Read about more tips to stay clean and odor free! 

Are you an expert in incontinence care? Would you like to join the NAFC expert panel? Have a question you'd like answered? Contact us!

What Is A Pelvic Floor PT And How Can One Help Me?

Sarah Jenkins

Pelvic Floor physical therapy

Barbara Jennings was 6 weeks postpartum when she realized that something wasn’t right. “I had been feeling some pressure in my vagina for a while, but figured it was just a part of the normal healing process after vaginal delivery.” When she finally got the courage to explore a bit, she found something that surprised her. “I felt a smooth lump protruding slightly from the opening of my vagina. I was horrified, and so scared!” 

What Barbara was experiencing is called a pelvic organ prolapse, and it’s not uncommon. A prolapse happens when the vaginal walls become too week (due to things like childbirth) and the organs that are supported by them fall into the pelvic floor basket, sometimes protruding from the vagina. It’s not a curable condition, but can be improved by behavioral modifications, or surgery if necessary.

“After doing a lot of research, I learned that physical therapy could be done to help strengthen the muscles of the pelvic floor and improve symptoms of prolapse”, said Barbara. “I had never even heard of physical therapy for that part of the body, but because I knew I didn’t want surgery, I signed right up.”

Women’s Health PTs are a thing, and they treat everything from prolapse, like Barbara experienced, to pelvic pain, incontinence, back pain, diastasis recti, and more.  But how do you know if you need one? And at what stage of life do you see them?

The first thing to know is that you can see a Woman’s Health PT at anytime. Whether you’re feeling some back pain during pregnancy, want to get checked out after baby arrives, or have difficulty picking up your grandkids without leaking, physical therapy is an option.  Improvements can be seen at any age, and most physical therapists would agree that it should be a first line of defense against leaks and pelvic floor disorders.  Medications and surgery are often thought of first when it comes to treatment, but when you commit to a physical therapy routine, you’re making the effort to strengthen your body yourself, which can alleviate a lot of pain and/or leakage on it’s own.  If you’re experiencing any kind of pelvic floor, back or hip pain, or if you have bladder leaks, call a physical therapist and get set up an appointment for an examination.

So, what can you expect when you visit? As with most doctor’s visits, you’re PT will ask you lots of questions about your medical history, and the symptoms you’re currently experiencing. You’ll also likely get a musculoskeletal evaluation, and if you are experiencing any pelvic floor dysfunction, an internal exam.

The internal exam sounds scarier than it actually is – rest assured your PT has performed many internal exams and there is nothing to be embarrassed about. It’s a necessary step for them to determine the state of your pelvic floor muscles, and your treatment plan.

Multiple visits are usually required to assess your improvement over time, and to ensure that you are performing your exercises correctly. Treatment is considered complete when your symptoms have improved, although you may need to continue with your treatment plan even after you stop visiting your PT.

If you experience any type of pelvic floor related dysfunction, including pain, bladder leaks, or even if you experience back pain (those muscles are all connected after all!), don’t hesitate to see a PT. It’s often a good first line of defense for these issues and may resolve them better and more naturally than medications or surgery. “Even though my prolapse will never be completely “cured”, I have seen tremendous improvement in my symptoms since I started physical therapy”, says Barbara. “I’m so glad I looked to this option first.”

Men: Let's Talk About Bladder Leakage

Sarah Jenkins

You don’t really hear much about incontinence in men. Let’s face it – it’s not something that anyone ever really wants to talk about, but for men, it can be especially hard. Men are supposed to be tough. Caretakers. Leaders. Defenders. Admitting to something like incontinence can feel like a slap in the face. But it’s something that happens to everyone – not just women – and it isn’t something that anyone should have to live with.  Unfortunately though, many do. As many as 15% of men living at home between the ages of 15-64 may have some type of incontinence.  

Men – if you struggle with bladder leakage, we urge you to speak up about it. This doesn’t mean shouting about it from the rooftops. But a frank discussion with your doctor or a loved one is a good start. Here are 4 good reasons to talk to them about your incontinence:

  1. You’ll get some emotional support. Have you ever had something on your mind that weighed on you? Keeping your incontinence a secret can have big effects on your emotional well-being. Many people who live with incontinence become more reclusive as time goes on and the condition worsens. They avoid social activities, or don’t do the things they once enjoyed because they’re scared of having an embarrassing accident in public. But this can mean isolating themselves from others, and hurting some of their close relationships.  Lean in to those close to you and let them know what’s going on. You’ll likely find that their support motivates you to take the next step in talking to your doctor, where you can finally find some treatment.  Still not ready to talk to someone close? Try our message boards. They're filled with lots of people who struggle with bladder leakage and can be a great resource when you need some tips on how to manage, thoughts on treatment options, or even when you just need a place to vent. Trust us, they know what you’re going through, and are a wonderful and caring community where you can share your concerns without judgment.
  2. You can find out what’s actually causing the bladder leaks. In most cases, incontinence is not the real condition – it’s a symptom of something else.  Talking to a professional about it may help you uncover the true source of what’s going on, which could be something that’s easily treated, or something that’s far more serious than some light bladder leakage. Either way, finding out is better than living in the dark, and will help you get the treatment you need to be on your way to recovery.
  3. You’ll learn about all the treatments options available to you. We’ve come a long way from adult diapers being the only treatment option. While absorbent products are still great management tools, there are many things you can do to actually treat the symptoms and avoid leaks all together. Diet and exercise changes, kegels, medications, minimally invasive procedures, and even surgical options all exist. Learning more about your options will help you find something that works for you and your lifestyle, and can feel very empowering.
  4. There’s no good reason not to. With so many treatment options available to you these days, there’s really not a reason to stay silent. Yes, it will probably be an uncomfortable discussion at first, but it’s not one that your doctor hasn’t had before.  They hear from men who have this problem all the time. Talk with them and begin getting treatment so that you can get back to the activities you once enjoyed, instead of worrying about your bladder.

NAFC has some great resources that can help you as you begin getting treatment. Check them out below:

NAFC Bladder Diary

Talking about Incontinence

OAB Resource Center

Bedwetting Guide

What To Expect Post Menopause

Sarah Jenkins

 What To Expect Post Menopause - common ailments

So, you’ve made it through menopause – now what? While many of the symptoms that came along with menopause will go away, because of some of the changes that happened during menopause, you still need to be on your A-game to remain healthy.

Here are some of the common things to watch out for:

Vaginal Bleeding 

As your estrogen levels drop during menopause, the vaginal lining becomes very thin and, as a result, may be easily irritated, resulting in bleeding. Polyps (usually non-cancerous growths) can also occur. Bleeding after menopause is not normal, so if you experience this, be sure to see your doctor right away to get checked out to ensure it’s nothing serious.

Risk of Osteoporosis

After menopause, a woman’s bone breakdown overtakes bone buildup, resulting in a loss of bone mass. Overtime, this can develop into osteoporosis. Prevention is key here – be sure to exercise on a regular basis (weight bearing exercises done regularly are great at making bones stronger). Eat high calcium foods, such as low-fat milk and dairy products, canned fish, dark leafy greens, and calcium fortified foods. Vitamin D is also essential, as it helps the body better absorb the calcium you’ll be taking in. You can get Vitamin D naturally by exposing your skin to sun for about 20 minutes daily, but you may also get it from foods like eggs, fatty fish, cereal and milk. If you feel you are at a risk for not getting the calcium or vitamin D you need, talk to your doctor about taking supplements.

Risk of Heart Disease

While menopause doesn’t cause heart disease, women are at an increased risk for heart disease after menopause has occurred. Some believe that lack of estrogen may again be to blame, but other changes are in effect too – increased blood pressure, increased LDL cholesterol (this is the “bad” one) and higher levels of fat in the blood can also increase after menopause.  Diet and exercise are as important as ever (to keep your heart healthy and prevent other conditions). Just 30 minutes of physical activity - walking, dancing, and swimming are all great options – 5 days per week can give you a good aerobic workout. And be sure to eat a healthy diet while avoiding too much red meat, or high sugar foods and drinks.

Vaginal Dryness

Because of low estrogen levels, you may still experience some vaginal dryness. Over the counter vaginal lubricants and moisturizers can help ease these symptoms, but if that doesn’t work, talk with your doctor about using some type of estrogen treatment – there are many available, and in different forms (tablets, rings, creams).

Life after menopause can be a wonderful time provided you take the time for self care and work to maintain a healthy lifestyle.

Staying Strong And Preventing Bladder Leakage During Menopause

Sarah Jenkins

 preventing #bladderleakage during menopause

It’s estimated that a whopping 6,000 women reach menopause each day in the US. Menopause happens to every woman, and is the shift in hormonal changes that result in the cessation of menstruation.

While many women know about the common symptoms of menopause (Hot flashes! Insomnia!), there are certain changes that come about in menopause that are often surprising to women. One of these is loss of bladder or bowel control. 

A number of things occur during menopause that can contribute to you suddenly experiencing a bit of leakage:

Weakening Of Pelvic Floor Muscles

Your pelvic floor muscles play a huge role in controlling your bladder and bowel. As the muscles weaken, it can lead to more urgent needs to use the restroom, and more leaks. Weakened muscles can also lead to an increased risk for pelvic organ prolapse.

A Less Elastic Bladder 

Changes that occur during menopause can cause the bladder to lose it’s elasticity and the ability to stretch. This can cause increased irritation in the bladder when it fills with urine, and can impact the nerves that regulate bladder function, which can sometimes cause overactive bladder (OAB).

Vaginal Dryness  

During and after menopause, the body produces much less estrogen, which results in an increase of vaginal dryness. This dryness has a number of consequences, which can include an increase in the amount of urinary tract infections.

Anal Trauma 

While anal trauma is usually the result of childbirth, many women may not see the results of it until menopause, when that, combined with a weakened pelvic floor can increase the risk of fecal incontinence.

It’s important to know that while these changes can lead to bladder or bowel leakage, the symptoms can also be avoided or eliminated by taking proper care of the pelvic floor. It’s never too late to start strengthening things up. Here are some ways to increase the strength of your pelvic floor as you go through this period:

Get Active 

As simple as it sounds, simply staying active is great to keep your weight, and overall health in check.  Gentle exercises, like walking, that don’t place too much pressure on the pelvic floor are best.

Try Squats

Squats are a great way to build up your glute and core muscles. To perform one, stand with feet shoulder with apart. Keeping your knees over your feet (don’t let them move past your toes), lower your bottom down as if you are sitting in a chair, being careful not to lean too far forward. Raise back up to starting position.  Aim for 10 reps per day. (Note, if these feel too difficult for you, try wall squats, which use the same movement, but are performed with your back to the wall for extra support.)

Kegel 

When done correctly, kegels can do wonders for helping women with incontinence.  They help strengthen the muscles that prevent bladder leakage and also help to avoid or reduce the symptoms of pelvic organ prolapse.  Remember that when performing a kegal, learning how to relax the pelvic floor is just as important as learning how to tighten it. In some cases, women have pelvic floors that are too tight and cannot relax, and if this is the case, kegels can end up aggravating your condition. If you’re concerned about your pelvic floor, or just can’t get the hang of how to do a kegel, visit a pelvic floor physical therapist for help.

 

How a 'Birth Plan' Can Help Protect Your Pelvic Floor

Dawn Dingman

The relationship between urinary incontinence (UI), pelvic floor disorders, and vaginal birth is a hot topic. Popular magazines and some scientific journals claim that vaginal birth is a cause of urinary incontinence, which has fueled the debate about another equally hot topic: cesarean delivery by maternal request! The presumed logic is this: if vaginal birth leads to UI, then cesarean delivery should be done to prevent it. In fact, questions surrounding causes and prevention of UI, as it relates to vaginal birth, are far more complex. Scientific studies done to date have shown no conclusive evidence that vaginal birth causes UI or pelvic floor disorders. Until we have more answers, cesarean deliveries done to protect the pelvic floor are unwarranted.

What is a “Birth Plan”?

It is never too early to learn what you can do during childbearing years to protect your pelvic floor and bladder health. A Birth Plan is a paper document you develop that serves as a communication tool between you and your healthcare provider. It describes how you would like to be cared for during your pregnancy, labor, and birth.  A Birth Plan helps you and your provider focus on practices and procedures you believe are important to include or avoid. Everyone wants a healthy mother and baby – that is a given. However, there are many pathways to achieving a safe, normal vaginal birth, a healthy infant and a healthy, satisfied mother and family. A Birth Plan simply places these thoughts in writing. During the course of your prenatal visits, a Birth Plan encourages conversation with your provider about the processes and procedures that occur in the hospital during labor and birth that may affect your bladder and pelvic floor.

Tips For Determining a Birth Plan

During your pregnancy, ask your provider to teach you the correct method for doing Kegel exercises. When done correctly, Kegels help strengthen your pelvic floor during pregnancy and after birth.

The obesity epidemic in the United States has led to changes in recommendations about weight gain in pregnancy. Ask your provider about the optimal weight gain for you. The old adage, “eating for two” no longer applies. Obese mothers who give birth to excessively large infants are more likely to experience postpartum bladder troubles whether having a vaginal or operative birth.

Pregnancy provides the ideal time for women to quit smoking. Cigarette smoking is a risk factor for urinary incontinence. Your healthcare provider has many suggestions to help you quit once and for all.

Once in labor, being upright allows gravity to assist with your baby’s descent instead of working against it while lying on your back.

New evidence shows that “gentle pushing” or delayed, non-directed pushing techniques can minimize pelvic trauma and are more protective than “forced pushing.”

To protect pelvic floor muscles, nerves, and connective tissue, express your desire to avoid the use of episiotomy, forceps and/or vacuum extraction. There is more than a decade of research that an episiotomy need not be performed unless there are indications for such intervention (e.g., fetal distress). Episiotomy, especially midline, has been shown to increase a woman’s risk of anal sphincter injury and not to reduce the risk of other pelvic floor disorders. Patients should discuss whether or not to have an episiotomy and be certain that their doctor will not use one, other than in extreme situations. Sometimes however, these maneuvers may be necessary for you or your baby’s health.

For help in writing a Birth Plan that works for you, consult your library, pregnancy resources, your healthcare  provider, and the Internet. Your healthcare provider can guide you about trusted web sites.

3 Common Infections That Affect Young Women And How To Treat Them.

Sarah Jenkins

 3 Common Infections That Affect Young Women And How To Treat Them: UTI, Yeast Infection, HPV

You’re young, healthy and probably think you’re invincible. However there are some infections that are common in young women. Read below to learn about three you are likely to experience at some point, and what to do about them.

Urinary Tract Infections

Urinary tract infections can occur in men and women of any age. They can be very uncomfortable and most symptoms include a burning feeling when urinating, urinating frequently, feeling tired or shaky, or feeling a pain or pressure in your back or lower stomach. They occur when foreign bacteria enter into the urethra and travel up to the bladder where they can cause an infection.  The most common causes of UTIs are improper wiping after using the toilet (always wipe from front to back to avoid spreading bacteria from the anus to the urethra) and sexual intercourse, which can present larger numbers of bacteria into the bladder. (Tip: Always urinate after having sex – it helps to flush away any bacteria that may be present). UTIs typically clear up quickly with antibiotics, but drinking plenty of water, removing any bladder irritants from your diet (caffeine, alcohol, spicy foods), and emptying your bladder regularly can help treat UTIs too.

Yeast Infections.

Yeast infections are caused by the presence of extra yeast in the vagina. When the normal ratio of yeast to healthy bacteria is off, yeast can grow too much and cause an infection. This imbalance can be caused by fluctuating hormones, certain antibiotics, or other conditions like diabetes. Many women experience itching in the vagina, in addition to painful urination and a thick white discharge. Yeast infections are typically diagnosed by a physician, and can be treated with OTC antifungal cream, suppositories, or antifungal tablets.

HPV.

Younger women tend to have more sexual partners than older women.  Great for your sex life – not so great when trying to prevent STDs.  The human papilloma virus is the most common sexually transmitted disease, and one that you should be regularly checked for. Be sure to ask your doctor to check for HPV at each Pap smear.  It’s a good idea to also get tested for chlamydia and gonorrhea while you’re at it. 

Learn more about women’s conditions here. 

4 Moves To Help You Strengthen Your Pelvic Floor Before You Get Pregnant.

Sarah Jenkins

 How to firm up your pelvic floor before you become pregnant.

Thinking of trying for a baby soon? Now is the perfect time to start strengthening your body in preparation for pregnancy and childbirth. And even if you’re not quite at that stage yet, the moves listed here are great for anyone to improve pelvic floor and core strength.

The pelvic floor acts as a basket of muscles that help support the pelvic organs (your uterus, bladder and bowels).  Keeping them toned can not only help ease pregnancy discomforts (like urine leakage and hemorrhoids), but it can also help you later on in life as your body naturally changes due to hormones, and age. The moves below work not only the pelvic floor, but also other important muscles connected to it to ensure overall core strength.

Kegels 

There’s a reason that you’ve heard again and again that kegels are important.  This exercise has long been touted by professionals as one of the most vital exercises in increasing your pelvic floor strength.   Follow the instructions below to be sure you’re performing them correctly.

  1. Identify your pelvic floor muscles by attempting to stop your urine flow mid-stream. If you can do this, you’ve found the muscles! (Note – don’t practice your kegels in this way on a regular basis – it should only be done to identify the correct muscles.)
  2. Performing with an empty bladder, your first goal should be to tighten your pelvic floor muscles for 5 seconds. Then relax them for 5 seconds. Try to do 5 reps on your first day. As you gain confidence from your new routine, aim for 10 seconds at a time, relaxing for 10 seconds between contractions. 
  3. Be careful not to flex the muscles in your abdomen, thighs, or buttocks. Also, avoid holding your breath. Breathe freely during the exercises to keep from stressing the rest of your body.
  4. Aim for at least 3 sets of 10 repetitions per day.  The beauty of kegels is that they can be done anywhere, anytime.  Try performing them during your downtime, such as waiting in line, or sitting at a stoplight.
  5. Give yourself encouragement. These exercises will feel foreign in the beginning. But the longer you stay with this, the better your bladder health will become. As a bonus, Kegels have been reported to increase sexual pleasure as well. 

To learn more about kegels and the variations of kegel exercises that you can perform, review the information on our website found here, or check out one of our most visited blogs here.

Squats

Strong glutes and hamstrings are very important to the overall health of your pelvic floor.  And one of the best exercises to develop these muscles is the deep squat.  Squatting is actually one of the most natural forms of movement there is, however our modern-day lifestyle, characterized by long hours of sitting at a desk or on a couch, has made the squat virtually extinct.  By strengthening your glutes and hamstrings, you’ll be adding additional support to your pelvic floor.  Follow the instructions below to make sure you are performing squats safely and correctly.

  1. Stand with feet slightly wider than your hips, toes pointed slightly outward. 
  2. Keep your spine in a neutral position – don’t round your back, and don’t over accentuate the natural arch of your back.
  3. Extend your arms out straight so they are parallel with the ground, palms facing down.
  4. Balance your weight on the heels and the balls of your feet.
  5. Taking a deep breath, begin sending your hips backwards as your knees begin to bend.
  6. Keep your back straight, and your chest and shoulders up.
  7. Be sure to keep your knees directly in line with your feet as you squat.
  8. Continue lowering your hips until they are slightly lower than your knees to perform a deep squat.
  9. Use your core to push yourself back up, keeping your bodyweight in your heels. 
  10. Congratulations! You have just completed 1 rep!

It may help to watch yourself in a mirror as you first perform this exercise, as it is easy to perform squats incorrectly.  Some things to watch for are not dropping low enough, leaning your body too far forward, allowing your knees to drift inward, and performing the exercise too quickly.   Aim to complete about 2-3 sets of 10 reps daily.

Finding Your TA

Your transverse abdominus, also known as the TA muscle, is the muscle that is located deep within your core, below the six-pack muscles.  This muscle is often overlooked, but it serves a vital role.  The TA muscle helps to stabilize the core, pelvis and lower back, and is recruited almost anytime a movement is made.  Strengthening your TA muscle will ensure that you are protecting your back and spine from extra force or pressure when you move, and will help aid in pelvic floor stabilization.

The following steps provide a very basic way to locate your TA muscle and give it a workout:

  1. Lie on your back, with your knees bent.
  2. Place your hand on your stomach, just over your belly button.
  3. Inhale.
  4. While you exhale, tighten your stomach muscles and pull your belly button inward.  You should imagine that you are tightening a corset and flattening your stomach.
  5. Repeat 3 sets of 10 reps each.

Once you have a good feeling for where your TA muscle is and how to activate it, you can begin incorporating the action into your everyday life - while sitting at work, standing in line, etc.  Also try to practice tightening your TA muscle, like a brace, every time you perform a movement such as lifting, sneezing, squatting, etc.  With practice, this action can become automatic and will aid in your core stability.

Multifidus

The multifidus is one of the most important muscles in aiding spinal support.  The muscles are attached to the spinal column and are called upon when bending backwards, turning, and bending side to side.  These muscles work with the rest of your pelvic floor muscles and TA muscle to help you hold good posture, and to stabilize your lower back and pelvis during movement.  Try the exercise below to strengthen the multifidus muscle:

  1. Lie on your stomach, with your forehead on your hands, or a towel, looking straight down. (Not to the side)
  2. Very slowly, rotate your pelvis back slightly so that your tailbone lifts toward the ceiling.  This should be a very subtle movement.
  3. Hold for one second, then rotate your pelvis back to the floor.
  4. Complete 3 sets of 10 reps each. 

Practice activating your multifidus muscle throughout your day by keeping good posture. 

Even before you’ve had children, there may be times when certain pelvic floor exercises are not appropriate. And, it’s important to know that there is no “one” exercise alone that will strengthen your pelvic floor as it is supported by many muscles.  Always check with your doctor before beginning any exercise program.  And, if you have concerns about your pelvic floor, no matter what life-stage you are in, consult a trained physical therapist specialized in women’s health. Your Physical Therapist will also be able to ensure that you are performing the moves correctly so that you are getting the most out of your workout.  Use the NAFC Physician Locator to find a doctor in your area. 

Note: Even before you’ve had children, there may be times when certain pelvic floor exercises are not appropriate. Always check with your doctor before beginning any exercise program.  If you have concerns about your pelvic floor, no matter what life-stage you are in, consult a trained physical therapist specialized in women’s health.

Pre-pregnancy And The Pelvic Floor - It's All About Prevention

Sarah Jenkins

Pre-Pregnancy and the Pelvic floor

If you’ve never been pregnant, it’s likely you’ve spent little time thinking about your pelvic floor. And yet, now is exactly the time that you should be focused on it.  A healthy pelvic floor can prepare you for a great pregnancy and a safe delivery, and it can prevent a host of problems that may occur after childbirth. The pelvic floor works as a basket of muscles, holding your uterus, bladder, and rectum in place.  When you’re young, and your pelvic floor has not suffered the effects of age or childbirth, you usually see few complications. But sometimes, strain on the pelvic floor (like carrying a baby for nine month, giving birth, and the natural effects of gravity over time) can cause problems like bladder leakage. The good news? These effects can be lessened, or even eliminated, if proper care is given to the pelvic floor now.  Here are the steps you need to take to ensure that you’re taking proper care of your pelvic floor, and yourself, prior to becoming pregnant.

Assemble your squad. 

Finding the right team of professionals is key to keeping your health in check.  If you haven’t already, do your due diligence and start seeing these health care professionals on a regular basis.

  • Gyno
  • Primary Care physician
  • Dentist
  • Dermatologist

Keep a healthy weight and develop a workout routine.

If you’re planning to get pregnant, don’t fall into the trap of thinking that weight doesn’t matter pre-pregnancy – the healthier you are now, the healthier you will be during your pregnancy, and the easier it may be to shed those extra pounds after baby arrives. Not only that, but keeping your core and pelvic floor strong now will help better prepare you for pregnancy and childbirth.

Maintain a healthy diet.  

Eating right is always a good idea, and it can really help you maintain your weight. In addition, keeping your diet in check can help you prevent diabetes (a condition that is on the rise in the US, and that, in some cases lead to neurogenic bladder.)

Routine Exams

Get a well-woman exam every year – be sure to talk with your physician about general health metrics like blood pressure levels, diet, weight, and any stress that you may be experiencing. Have a regular Pap smear every 3 years if you’re between 21 and 30. While you’re at it, be sure to have a yearly breast exam to check for any unusual changes. Do your own monthly exams as well and become familiar with how your breasts normally look and feel.

Quit those bad habits

If you haven’t heard, smoking is really not cool anymore and even if you don’t believe that, consider this – aside from a host of other health problems, smoking can contribute to a leaky bladder

Uncover any risk factors that you may have by learning your health history.

Talk with your family to learn about any risks that you may have health-wise. Knowing these now can help you prevent possible health threats down the road.

Even if you only choose to follow a couple of these steps prior to pregnancy, know this: this time is all about prevention – the steps you take now to take care of your body will pay off in folds down the road.  Don’t wait to start taking control of your health. 

Check in with us all month to learn how to stay healthy at every stage of life.

 

 

Eating Your Way Through Constipation

Sarah Jenkins

 Diet habits to avoid constipation

Being constipated is a very uncomfortable situation, leaving many people stressed and impatient. For some, constipation further aggravates bladder control issues and for others, the problem is merely uncomfortable. Regardless of how your bladder is affected, the impatience and stress caused by constipation only makes the whole situation worse.

Thankfully, constipation is usually a situation fixed by better eating habits and/or a change in medication. Talk to your doctor about your constipation and consider bringing in a bowel diary of how often you pass a bowel movement.

If medication is the sole catalyst, your doctor should be able to advise a healthy alternative. And if eating a more fibrous diet is in the books for you, consider trying these ten constipation-fighting foods.

      Popcorn
      Nuts
      Beans and Legumes
      Grapes
      Broccoli
      Flax Seeds
      Pineapple Juice
      Bran
      Figs
      Prunes

What foods or drinks do you use to combat constipation?

The Link Between Diabetes And Neurogenic Bladder

Sarah Jenkins

 diabetes and neurogenic bladder

Diabetes is a growing epidemic in our nation. More than 29 million Americans currently suffer from diabetes, and the Centers for Disease Control and Prevention estimates that by 2050, as many as 1 out of every 3 adults in the US could have the condition.

Many of us have heard the common complications associated with diabetes: heart disease and stroke, eye problems, including blindness, kidney disease and amputations due to damaged blood vessels and nerves.  But did you know that diabetes can also lead to neurogenic bladder?

Neurogenic bladder is a condition that occurs when nerve damage has occurred, preventing the bladder from emptying properly. Symptoms can include a frequent and strong urge to urinate (but in small amounts), difficulty emptying the bladder, incontinence, and urinary retention. Many people associate neurogenic bladder with conditions such as spinal cord injuries, MS, Alzheimer’s Disease, or Parkinson’s Disease. But neurogenic bladder can happen in people with diabetes too, as a result of diabetic neuropathy, which causes the bladder to lose the ability to sense when it is full.

The good news is that there are treatment options available for neurogenic bladder. Lifestyle changes, such as scheduled voiding, dietary changes, and keeping a bladder diary are a helpful start and can make a big difference.  Several drugs and procedures can help with symptoms of overactive bladder, and for those who have difficulty urinating, catheters can be a big help as well. Finally, surgery options are available. 

Of course, if you are pre-diabetic, the best course of treatment is prevention. Keeping your A1C levels in check with proper diet and exercise is essential in ensuring that you maintain a healthy weight.  Eating healthy foods at moderate portions, and getting in 30 minutes of physical activity can delay and in some cases prevent the disease.

If you are concerned about diabetes, talk with your doctor. He or she will help you assess your risk factors, and start you on a plan to combat this very prevalent disease.

Ask The Expert: What's The Best Way To Prevent UTI's When You Have A Neurogenic Bladder?

Sarah Jenkins

 UTI's and neurogenic bladder

Question:  What’s the best way to prevent UTI’s when you have a neurogenic bladder?

Answer:  Unfortunately, Urinary Tract Infections are common in patients with neurogenic bladder. Patients with neurogenic bladder often have a harder time completely emptying their bladder. They also are often unable to sense that the bladder is full, resulting in them holding urine for too long.  Some patients also self catheterize, or use indwelling catheters, which can present complications leading to a UTI.

Of course, the best treatment of a UTI is prevention.  Below are 2 simple steps that patients living with neurogenic bladders can take to avoid bladder infections.

  1. Keep things clean. It stands to reason that keeping yourself, and any equipment used to assist with voiding, hygienic can help keep bacteria at bay. Be sure to properly clean your body, and any external catheters after each use. Always wash hands before and after self-catheterizing.  During a short-term infection, change indwelling catheters and be sure that the bladder fully empties to prevent urine from remaining in the bladder for too long.
  2. Develop a voiding schedule. While many things are considered when deciding when to catheterize, including patient and caregiver schedules and urine production, steps should be taken to ensure that the bladder is emptied frequently to prevent infections. Develop a schedule that works for you and stick to it.

UTI’s can cause many complications for people with Neurogenic Bladder, including decreased quality of life and other serious health concerns. If you are experiencing any common signs of a UTI, call your doctor.

Common signs of a UTI:

  • Fever
  • Urinary incontinence/leaking around the catheter
  • Cloudy urine
  • Spasticity
  • Back pain
  • Bladder pain
  • Lethargy
  • Painful or difficult urination
  • Sudden, high blood pressure

Gender Neutral Pelvic Floor Tips

Steve Gregg

Simply stated - the pelvic floor isn’t just a female thing - it is a muscular sling supporting the pelvic and abdominal organs of men and women.  The pelvic floor helps keep us dry.  According to an earlier blog post, more than 50 percent of men over the age of 60 experience bladder control issues due to an enlarged prostate.  

Before I share my best pelvic floor tips for both sexes, we need to agree on the following three truths: strengthening a weak pelvic floor may improve bladder control and confidence, utilizing my tips in conjunction with seeing your healthcare provider will create the most optimal effect, and it’s important to allow yourself to have a bad day here and there.  

My best pelvic floor tips?

  • Start a Bladder or Bowel Diary 

    For a week, keep track of your trips to the bathroom, your leaks and how much and what you are drinking.  Note any trends with fluid intake, time of day and activity level in relation to using the bathroom and your leaks.  Your documentation may help your health care provider order tests, make a more accurate diagnosis or prompt a referral to a specialist.

    But, please consider what you can do with the information.  Are there any trends you are seeing?  Do you have more problems in the morning, afternoon or evening?  Do you need to space out your fluid intake?  You may be able to cue into changes that may positively impact your bladder control and confidence.  

  • Drink more water and consider cutting down on alcohol and caffeine

    Many newly incontinent persons incorrectly assume if there is less water in the system there will be less water to pass.   Cutting out water, or significantly decreasing water consumption, while continuing to consume alcohol and caffeine at normal previous levels may aggravate the bladder and make the leakage problems worse.  Hydration with plain, old water is one of the keys to improved bladder function.  

    And, revisit your diary – it may be possible that alcohol or caffeine may be a trigger to your leakage pattern.  Do you need notice you have more problems with bladder control after a glass or two of coffee or your favorite cocktail?  

  • Kegels

    Yes – we need to talk about this.  Men can do Kegels and should do Kegels to improve bladder control.  Kegels are not just meant for women.  Repetitively performing Kegels will improve pelvic floor muscle function, strength and endurance.  Kegels should be a habit like brushing your teeth. The truth of the matter is - if your pelvic floor muscles are in better space they will be better able to support you and keep you dry.  

    Here are some cues that may help you or your loved one perform a Kegel.   

    • Return to the idea that pelvic floor is a muscular sling.  It supports your abdominal and pelvic organs kind of like a hammock running along the base of pelvis – front to back and side to side.

    • Gently pull the pelvic floor up and in towards your navel as if trying to protect yourself from a blow to the belly.  When you do this – you may feel a gentle tightening of the muscles underneath your navel.  Your tailbone may gently rises up and in.  Continue your normal breath.  Keep in mind, the Kegel, I am recommending is not 100% effort but a gentle tightening of the muscular sling.

    • Continue breathing and hold the Kegel for a few seconds.  Then gradually relax.  Repeat until you’re fatigued or have completed your goal.

That concludes my list of my best pelvic floor tips. What are your best practices?

 About the Author, Michelle Herbst:   I am a wife and mother with a passion of helping women live to their fullest potential.  I am a women’s health physical therapist and for nearly decade have helped women with musculoskeletal conditions during their pregnancies, postpartum period and into their golden years.

About the Author, Michelle Herbst:   I am a wife and mother with a passion of helping women live to their fullest potential.  I am a women’s health physical therapist and for nearly decade have helped women with musculoskeletal conditions during their pregnancies, postpartum period and into their golden years.

Why Do I Feel Like I Need To Pee During Sex? 3 Ways To Overcome It.

Sarah Jenkins

pee during sex

If you’ve ever had the feeling that you’re going to wet yourself during the act, you’re not alone. Many women report feeling this sensation – even those that don’t normally experience incontinence. The main reason this typically occurs is the pressure that is put onto the bladder by the penis. Here are 3 ways to help you eliminate the feeling:

  1. Empty your bladder before you have sex. One of the simplest solutions to ensure you aren’t going to have a leak is to use the bathroom prior to doing the deed. This will ensure that even if you feel pressure, your bladder will be empty, greatly reducing the chance of an accident. (This will probably reduce your fears about it too, so you can actually enjoy yourself!)
  2. Try a change in position.  Sometimes, a simple position change can do the trick to eliminate the sensation. Experiment with your partner to see what sexual position feels best for you.
  3. Experiment on your own to see what works best for you.  Some women feel the sensation to pee before having an orgasm. To know if your fears are really a precursor to pleasure, spend some alone time exploring your body with your fingers or a small vibrator. When you feel the sensation to pee, keep going. If it passes, you know that it is just the way your body reacts to the sensation and you’ll be able to better tell in the future between actually having to pee and being on the verge of experiencing an orgasm.


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Bladder Health and Sex

Steve Gregg

Understanding what is normal during sex and what is unusual can be challenging. After all, sex is a very private experience and differs for every person. Generally speaking, there is no reason for your bladder to empty during sex or for you to feel extreme discomfort or experience pain during sex.

As you can guess, the health of your bladder can directly affect your sex life. 

Two common reasons individuals experience pain or discomfort with their bladder during or after sex are: bladder pain syndrome and stress urinary incontinence.

Interstitial cystitis/bladder pain syndrome (IC/BPS)

Bladder pain syndrome is the continual sensation of pressure or pain on the bladder. This syndrome typically affects women and leaves individuals feeling as if they have to urinate when they don’t have any urine to pass.

Consider making dietary changes and practicing bladder retraining so your bladder begins to hold more urine before experiencing the urge to go.

Relax before engaging in sex to ensure as little stress as possible. Stress can cause flare-ups and trigger discomfort.

Stress Urinary Incontinence

Stress Urinary Incontinence or SUI occurs because of weak pelvic floor muscles and/or a deficient urethral sphincter. This weakness can cause the bladder to leak during exercise, coughing, sneezing, laughing, or any body movement that puts pressure on the bladder. If sex is particular jarring, SUI can be affected.

Consider exercises to strengthen your pelvic floor and limit caffeine intake. Always empty your bladder before sex.

We hope this peek into how your bladder health can impact sex was helpful. If you have experienced any of the symptoms noted above and haven’t talked to your doctor, it’s time to schedule an appointment. Additionally, we feel it’s important to share your health with your partner if you continue to have sex while experiencing some of these bladder health concerns.

Join us on our forum to talk more and learn how others have dealt with issues like these.  

Smoking And Incontinence

Sarah Jenkins

smoking and incontinence

We all know that cigarette smoking  is bad for us. But did you know that it can also lead to incontinence?  Studies have shown that smokers are at an increased risk for incontinence.  Over time, many smokers develop a chronic cough, which can put an enormous amount of pressure on the pelvic muscles, causing them to weaken and increasing the chance of stress incontinence. Additionally, smokers also experience more frequent urges to use the restroom, as smoking is an irritant to the bladder. Even more alarming, it’s been shown that smoking can also lead to bladder cancer.

What’s a smoker to do?

The obvious fix is to quit smoking – not only to alleviate or prevent incontinence, but for a host of other health reasons as well.  While quitting is not easy, there are a few things you can do to help you succeed:

  1. Talk to your doctor. Your doctor can help give you tips to quit, and may suggest medication or programs that can help. 
  2. Get the support of your family and friends. Tell your loved ones what you are trying to do so that they can support you and give you the encouragement you need when you are feeling tempted to smoke.
  3. Avoid your triggers. Many people feel the urge to smoke during certain activities – grabbing drinks with friends, at certain times of the day, etc. Try to avoid these activities for a while or find ways to stay busy during your usual smoking times.
  4. Take up a hobby. With all the time you’ll save by not smoking, you may be able to finally start that project or hobby you’ve been thinking about. Doing something with your hands (knitting, woodworking, etc.)may also help keep you busy and help you avoid the urge to pick up a cigarette.

Smoking is a hard habit to quit for many people. But with determination and perseverance, it can be done. And it’s never too late to see the benefits of quitting – a recent study showed that even smokers who quit in their 60’s saw an increase in their lifespan.

Have any tips for quitting? Please share them with our readers in the comments below!

Why Didn't Anyone Tell Me?

Sarah Jenkins

A Guest Blog By Sally Connor

I am a 38-year old woman, and I am angry. Angry that my body has changed so much since I’ve had children, angry that I developed a prolapsed bladder after the birth of my first son, angry that I can no longer run the way I used to without making several trips to the bathroom, or worse, wetting myself. I am angry with my doctors for not telling me that this may be a side effect of pregnancy and that there were steps I could have taken to prevent it. I’m angry with other women for not telling me that it has happened to them. I am angry for my sheer ignorance of the situation until it happened to me. But more than anything, I am angry that no one knows any of this because in our society, it feels too embarrassing to really talk about.

When we are young, we don’t think about these things. Before I had children, I don’t think that I ever even gave the pelvic floor much thought. Quite frankly, I didn’t even know what it was.  Here is what I didn’t know:  That the pelvic floor muscles act as a basket, supporting your bladder, uterus, and rectum. It is also connected to and supported by your deepest core muscles – your transverse abdominus (below the ‘six pack’ abs) and your multifidus (the tiny muscles that support the spine), and is affected by almost every movement you make.  The pelvic floor, what I now refer to as the epicenter of my body, is called upon every time you sit, stand, squat, walk, and even breathe. So I ask, why is it that we don’t hear more about this vital web of muscles? Why are we kept in the dark until it is too late? Because, really, much of this can usually be prevented. The pelvic floor, just like any other muscle in the body, can be strengthened and trained. With regular exercise, the pelvic floor and the supporting muscles around it can provide a strong foundation for continence for your entire life. But, like any other muscle, if it is already in a weakened state, and then becomes traumatized by something like childbirth, well, the damage is done. That is the case with prolapse. You can try to repair it, and may see marked improvement through physical therapy, or even surgery, but once the damage is done, it is done. 

It doesn’t mean that there is no hope though. I know this. I have seen great improvement in my symptoms and am grateful to have had access to a very skilled physical therapist who was able to show me how to strengthen things up ‘down there’. But, I still do experience some symptoms and I can’t help wonder if things would be the same had I been more aware of this muscle and what I should have been doing to keep it strong prior to and during pregnancy. 

With over 25 million Americans experiencing incontinence, I am baffled that the issue is not publically talked about more often. It is estimated that about 40% of women will experience prolapse at some point in their life. When will we decide that these conditions deserve attention? Talking about them would encourage more people to get help, and, maybe even more importantly, take steps to prevent it. Instead, the silence only encourages the shame, embarrassment, and isolation that many people with incontinence experience.  It does nothing to help those who are experiencing the issue to know there are ways to treat it.  Nor does it educate those who have not experienced it to know that this is something that should be considered. Until we can all be more open and recognize that this is a problem worth talking about (shouting about!), we will be a society that continues to allow it’s people to ‘quietly manage their symptoms’ instead of really preventing or treating them. 

So please, speak up about your incontinence, your prolapse, or any other pelvic floor issue you may have. While it may be common, it’s not normal, and is nothing that anyone should have to suffer with in silence.

About the author:  Sally Connor is a mother, wife, entrepreneur, and homemaker who suffered a prolapse after giving birth to her son. She has refused to let this symptom rule her life and strives to increase awareness of pelvic floor issues and what women can do about them by simply talking more about the issue.  She hopes that one day pelvic floor issues and incontinence will be a less taboo subject.