Leaky Bladder, Pelvic Floor, UTIs, & Constipation: Dr. Rena Malik Gives Solutions To Get Control

KEYPOINTS

• 01

  Bladder leaks and urgency are common, but not normal.

  Urologist and pelvic surgeon Dr. Rena Malik, who trained in female pelvic medicine, defines a normal bladder as one that holds urine until an appropriate time, empties completely, and doesn't leak or cause problematic urgency. She says up to a third of women have urinary leakage and up to 40% have some degree of prolapse, though few need treatment for the prolapse. Being common, she stresses, doesn't mean you have to live with it.

• 02

  The pelvic floor is part of your core.

  Malik describes it as a bowl, or hammock, of layered muscles attached to the tailbone, hips and pelvic bones. It holds up the bladder, uterus and rectum, controls the sphincters for urine and stool, stabilises you with every step, contracts during orgasm, and helps pump lymphatic fluid back toward the heart.

• 03

  Know the symptoms.

  Malik's list: urinary urgency, frequency, leaking when you cough, sneeze, lift or exercise (stress incontinence), leaking because you can't make it in time (urge incontinence), trouble emptying, and pain when urinating with no infection. She also lists pain in the vagina, pain with sex or orgasm, related hip or back pain, and constipation from muscles that won't relax.

• 04

  The muscles can be too weak or too tight.

  Weakness most often comes from pregnancy and childbirth, whether vaginal or C-section, especially with forceps, vacuum or episiotomy. It can also come from standing all day (hairdressers, nurses), a chronic cough, neurological or genetic conditions. Malik compares the organs to a boat floating on water (the muscles) and tied with ropes (ligaments): if the water drops or the ropes stretch, things sag. Young athletes such as gymnasts can leak for the opposite reason. Their pelvic floor is so tense it can't squeeze any further when they need it.

• 05

  Kegels help some people and make others worse.

  If you have pelvic pain, Malik says to get evaluated before exercising, because Kegels make an overly tight pelvic floor worse. Tight muscles respond better to stretches such as happy baby, child's pose and a deep squat. Too much tension can also cause burning that feels like a UTI even when tests come back negative. Yoga and Pilates can help too.

• 06

  Constipation and bladder problems are linked.

  A bowel full of stool presses on the bladder, causing more frequent and urgent urination and night-time trips. It may also raise UTI risk because more stool bacteria are nearby. Malik suggests more fiber with more fluid, walking, dates or kiwis, and less cheese and meat.

• 07

  Night-time urination matters more than you might think.

  Under about 55, Malik says you normally shouldn't need to get up at all; after about 55, once is typical because the body starts producing about a third of its urine at night. Her worry is falls in the dark: for older adults who break a hip, the risk of dying within the following year is about 20%. Going more than eight times a day counts as frequent, but first check whether you're simply drinking a gallon of water.

• 08

  Caffeine, alcohol and smoking irritate the bladder.

  Caffeine and alcohol make the bladder more sensitive and are mild diuretics, and your tolerance can change over your lifetime. Malik won't tell anyone to give up coffee. Instead she suggests experimenting with one caffeinated and one decaf cup, or half-caf, so you know whether it's the cause. Other free steps for overactive bladder: quit smoking, manage constipation, and if you're overweight, lose around 8% of your body weight, which she says significantly improves urinary symptoms.

• 09

  Recurrent UTIs have evidence-based prevention options.

  Recurrent UTI means two within six months or three within a year. Malik cites evidence that drinking two to three litres of fluid a day lowers UTI risk by about 46%. Cranberry is in the American Urological Association's guidelines, but not sugary juice cocktail. She recommends a supplement made from the fruit itself, in soluble form, with 36mg of proanthocyanidins (PACs). If UTIs keep coming back, rule out kidney stones or a stray stitch after surgery. Men shouldn't get UTIs at all, so even one warrants seeing a urologist.

• 10

  There are treatments between pads and major surgery.

  For stress leaks, the options include over-the-counter inserts or a tampon to support the urethra, and a fitted silicone pessary. In-office 'bulking' injections of gel into the urethral wall act as a cushion and don't rule out surgery later. A sling, made of mesh or your own tissue, acts as a backboard under the urethra. For overactive bladder, besides medication, there's tibial nerve stimulation (an acupuncture-style needle at the ankle, 30 minutes weekly for 12 weeks) and bladder Botox, which carries some risk of not being able to urinate afterwards.