Can Urinary Urgency, Pelvic Floor Dysfunction and Vaginal Pain Be Prevented?

You’ve probably been hearing a lot about pelvic floor dysfunction and pelvic pain—because people like me don’t stop talking about it (you’re welcome). You may be wondering, “Okay, Riva, we get that YOU see the world through the lens of PFD, but how common is it really?” … “Can we talk about preventing pelvic pain?” Let me share some stats.

Research shows that at least a minimum, 30% of women have a pelvic floor disorder. So do 16% of men. Meanwhile, up to 25% of women have vestibulodynia (pain in the vestibule—the area around the urethra and vagina). And nearly 10% of women in their forties suffer from urge urinary incontinence.

Surprised? These aren’t always conditions doctors warn patients about. That’s why I’m here!

The good news? Many of these issues may be preventable. And the tips below aren’t just good for your pelvic floor—they’re good for your overall health and well-being.

Curb Constipation

Straining puts unwanted pressure on the pelvic organs. I’ve treated patients who developed prolapse (organ descent) after years of pushing and using faulty toileting mechanics.

Constipation can feel embarrassing, but there’s no room for shame here. It affects about four million people! You might have accepted it as just the consequence of a busy life, but that shouldn’t be the case! Chronic constipation burdens the pelvic floor, especially when you need to strain or push to pass a bowel movement.

Remember: peeing and pooping should be passive. No straining required.

Constipation can be occasional or chronic. Chronic constipation may last more than over 12 weeks. Talk to your doctor for a treatment plan, and also consider more water, more fiber, and regular exercise.

If you have irritable bowel syndrome (IBS), you may hesitate to add fiber since it can upset your stomach. If that’s the case, speak with a nutritionist who knows IBS well. They can help you find safe ways to include fiber.

Stop Smoking

We all know smoking is bad news. The biggest fear is cancer, but smoking also increases your risk for pelvic floor disorders.

A 2020 study in the International Journal of Urology found that urgency and urge incontinence were more common in smokers and ex-smokers than in non-smokers. A study in Neurology and Urodynamics also found a possible link between urinary urgency and smoking.

The Michigan Institute of Urology explains why: frequent coughing (common in smokers) puts downward pressure on pelvic organs. Smoking also irritates the bladder—both big problems for pelvic health.

Run Right

Running is fantastic exercise. It can prevent cancer, protect your heart, and improve sleep. But it’s not without risks. One of them is pelvic floor injury.

As I told Runner’s World, good form and proper shoes are essential to protect your pelvic floor. If you’re unsure, work with a personal trainer who knows running mechanics.

One quick tip? Run with a slight forward lean. This prevents excess strain on the pelvic floor.

Choose the Best Birth Control

Thankfully, we live in a time with many birth control options. But what works for one person may not work for another.

Research in the journal Sexual Medicine shows that combined hormonal contraceptives can increase the risk of hormonally mediated vestibulodynia (pain in the vestibule). Why? Because these contraceptives affect estrogen and testosterone levels.

Many of my patients have seen pain improve with estrogen/testosterone creams prescribed by their doctors. Oral contraceptives can also cause other side effects, such as vaginal bleeding and weight gain—factors that may contribute to pelvic floor dysfunction.

The Takeaway

Pelvic floor dysfunction, urinary urgency, and vestibulodynia can be incredibly tough to live with. And yes, some of these lifestyle changes—like quitting smoking—are difficult. But they are possible.

We work hard to prevent heart attacks or skin cancer because we want to live longer. We should protect our pelvic floor for the same reason: quality of life. Both matter.

You deserve a life full of happiness and health—especially pelvic health.

Wanna learn more? Check out my previous blog – How to Press Fast Forward on Your Pelvic Floor Recovery

Happy late February, dear readers! I’m writing this to you shortly after Valentine’s Day, so maybe you’re basking right now in the glow that comes with having recently had some delicious chocolate, a nice dinner out, and a long, romantic evening with the one you love.

But a lot of you might not love Valentine’s Day because sex causes you pain. And, unfortunately, unlike Valentine’s Day, hardly anyone talks about that.

So maybe you blame yourselves. Maybe you blame your partner. Maybe you stop having sex. Maybe you’re too embarrassed to talk about it, even with a doctor. Maybe you’ve avoided dating because of it. The inability to enjoy one of life’s greatest pleasures could understandably make you feel depressed and hopeless.

But you don’t have to suffer!

First of all, take heart. Sex that hurts, otherwise known as dyspareunia, is common, so you are not alone. It happens to almost three out of four women at some point. It may even affect up to half of postmenopausal women. (Sex can hurt men too, but it’s rarer.)

So what causes it? While you should always see a doctor to get a diagnosis when you are experiencing painful sex, here are just a few possibilities:

Vaginismus happens when your vagina tenses outside of your control. It doesn’t only happen during sex. It can even happen when you’re just putting in a tampon. It may be caused by anything from anxiety to sexual abuse. Pelvic floor physical therapy can help, as can dilator therapy, CBT (cognitive behavior therapy), and sex therapy. (If you come to Revitalize Physical Therapy, we are happy to guide you in how to use dilator therapy to treat this!) Vaginismus can require some patience, but it can ultimately be resolved, as can vulvodynia.

And just what is vulvodynia? Well, it’s chronic pain in your vulva that goes on for a minimum of three months and doesn’t have a definitive cause. (Here is a diagram of the vulva for those who need it!) The Mayo Clinic describes vulvodynia as feeling like “burning,” “stinging,” “rawness,” or even a “sharp or knife-like pain.” Pain can also feel like it is constant or intermittent, be in the whole vulva or just a certain part. And while the medical community doesn’t know what causes it, some theories are previous vaginal infections, inflammation, pelvic floor muscle weakness, or pelvic spasm. Having vulvodynia and dealing with the fear of sex being painful might even lead to vaginismus! This can be a vicious cycle. Pelvic floor physical therapy, CBT and sex therapy can also help with this.

Then there is vaginal atrophy, which can affect middle-aged women: Decreased estrogen results in decreased lubrication, which can result in painful sex. If you haven’t had sex in awhile, that can also lead to atrophy, so again, if you are avoiding sex due to a painful sex condition, you may find yourself with another painful sex condition. (Vaginal atrophy can even be caused by antihistamines!) Treating vaginal atrophy can be as simple as using lubricant (which can help make sex more pleasurable) or you may need vaginal estrogen from your doctor. Dilators may also help.

I know that all this information is overwhelming, but it is worth taking the time to learn more. Proper diagnosis leads to proper treatment, and hopefully, by this time next year, you might be enjoying some sweet new memories of your best Valentine’s Day ever!

Category: Research

Is Pelvic Pain Preventable?