How to Improve Your Pelvic Health

"Have you tried the leakproof washable underwear yet?" asked one of the four 80-year-old women treading water together in the community pool. Eavesdropping on the conversation, I admired their openness in discussing such personal issues while terrified of heading for the same fate.

With pelvic problems, I wondered whether the litany of disposable pads lining shelves, and now reusable products popping up everywhere, indicated a more common occurrence than I realized.

In fact, according to a recent study, more than 32% of women are plagued by at least one Pelvic Floor Disorder (PFD), with other data showing that number increasing to more than 50% for women 55 and older.

PFDs are weakened or damaged muscles or connective tissues in the pelvic floor, preventing the bladder, bowel or uterus from functioning correctly. The reasons behind these disorders are many, including childbirth, obesity, lifting heavy objects, heredity and more, causing organ prolapse, pelvic pain, or front or back incontinence. 

Bowel incontinence rose to the top as the most frequent ailment among those surveyed. Recent numbers show that a quarter to a third of men and women in the U.S. suffer from urinary incontinence. While PFDs are common, they are not typical. 

Seth Cohen, MD, a urologic surgeon and urogynecologist at the City of Hope in Irvine, California cautions that if you find blood in your urine, notice you need to change positions when peeing or perform gymnastics to poop; it's time to seek the advice of a physician. Some options include an OB/GYN, a nurse practitioner, or a specialist such as a urogynecologist or a urologist.

The good news is that there are several therapeutic methods to prevent or improve your daily life besides surgery or drugs, including modifying your diet, attending physical therapy and using social media to learn about strategies to raise your pelvic floor when appropriate. Read on for several steps to safeguard your pelvic health.

According to Cohen, "maintaining a healthy lifestyle, staying active, and getting a good night's sleep" is a prescription for a healthy pelvis. As part of healthy living, he recommends following the Mediterranean diet for meal planning. 

Well-known for reducing the risks of many chronic illnesses, this diet focus on whole grains, plenty of fruits and vegetables, small portions of animal-based proteins (notably fish and seafood), and plenty of water. It is as good for your pelvis as for other areas of your body.

"When it comes to diet, we know more about nutrition than ever before and the health benefits of anti-inflammatory foods," says Ruth Jenkins, National Director of Pelvic Health and Wellness at FYZICAL in Sarasota, Florida. "Reducing your acidic intake from carbonated drinks, sweeteners and dairy can also improve your pelvic health."

If you like cooking with chiles, MSG, soy sauce or other "hot" seasonings, your mouth may not be the only area of your body on fire; foods in these categories act as bladder irritants. As a result, an unhappy bladder can increase urge, frequency, spasm or pain when urinating.

Other less-known bladder offenders are apples, grapes and strawberries, recognized as great fiber options to help prevent constipation. Why does constipation matter?

Jenkins says many people are not "efficient poopers" and warns that bearing down when having a bowel movement can cause your pelvic core to stretch or weaken over time.

With certain fruits and vegetables good for one thing yet bad for another, keeping a bladder and bowel diary to track your input (food/liquid) and output (urine/bowel movement) for several days can be an eye-opener. 

Doing so will help identify potential triggers and guide you in modifying eating habits accordingly. However, if eliminating a particular item is not palatable, then spreading out the number of irritants consumed throughout the day (versus throwing every fruit into a yogurt smoothie) may reduce bothersome symptoms.

Over the years, research has shown that several factors are critical to maintaining a solid pelvic core and for the pelvis to function correctly: 1) proper relaxation; 2) strength; and 3) good coordination, says Jenkins. Indeed, pelvic floor physical therapy (PFPT) is an excellent way to learn how to practice all three successfully. 

However, often people are reticent to seek the care of a pelvic floor physical therapist due to the intimate nature of these disorders. "We aim to provide as much comfort as possible and explain our evaluation and process in very basic terms," Jenkins says. "Everyone has to pee, poop, sleep and eat, so there is nothing to be intimidated about."

In addition to a comprehensive examination, some things to anticipate during PFPT may include:

• Learning diaphragmatic breathing which allows for improved core stability and relaxes your body in preparation for exercise.
• Determining which strengthening, lengthening and relaxing exercises are best for you and how to perform each accurately.
• Massaging internal or external pelvic, hip or other muscles increases blood flow and reduces pain.

So, what about Kegels? It depends. These simple squeeze exercises are only suitable for some conditions and are often done incorrectly. "Learning how to contract your pelvic floor properly is a game changer," Jenkins says.

Social media will prove otherwise if you worry you are alone with your pelvic conditions. One example is Instagram. With nearly 500,000 followers, "The Vagina Whisperer," aka Sara Reardon, at NOLA Pelvic Health in New Orleans. 

Reardon shares bite-sized tips for individuals seeking guidance on rehabilitating their bodies without pain regarding exercise, sex or work. "My primary objective is to help optimize recovery," she says.

After menopause, many women begin to experience pain with intercourse, fecal leakage and pelvic prolapse; it's the "welcome to a post-partum life," Reardon says. "Doctors want people to reject this; there are treatments that can prevent weakening muscles in the first place or from getting worse."

One of the critical goals of PFPT is to put you back in control of your pelvic health. Meaning, between visits and ultimately after achieving meaningful results, engaging with your pelvic floor daily is a necessary lifetime activity.

Access to credentialed pelvic floor therapists may not be an option for some people. Therefore, the Internet can become your support and community. Equally important, these forums have helped create awareness and reduce the negative bias associated with issues "down there."

Listed below are several ways to manage these very personal concerns in the comfort of your own home.

• Instagram, where you can view video reels and tips by doctors of physical therapy to help relieve pain and discomfort stemming from pelvic floor disorders
• TikTok with medical experts sharing information through short videos
• Facebook public and private support groups
• Reddit forums
• Podcasts dedicated to pelvic health are perfect for listening to while exercising
• Pelvic floor training apps where you can set reminders to practice exercises throughout the day

Before following advice, ensure it comes from credentialed, licensed and experienced practitioners. For other reliable online resources, exercises, and patient information, check out: Voice for PFDs, Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, or APTA Pelvic Health (An Academy of the American Physical Therapy Association).

One of the downsides of a solely virtual solution is not having the benefit of first being seen by a pelvic floor physical therapist. "While you can accomplish a lot on your own, you are missing a piece of the puzzle without the direct examination," Jenkins says. 

Therefore, she recommends an in-person exam to develop a home treatment program based on your individual needs.

Sharing pelvic concerns, like the ladies mentioned earlier, can reassure that others are in the same pool (so to speak). A recent study found many people stopped leaving their houses, traveling and attending family gatherings due to urinary incontinence alone. 

While this and any PFD can be an uncomfortable topic, it must not be. "Don't suffer in silence," Cohen says, "We can make you better."