Stress Incontinence and Female Athletes

Posted by Brigham and Women's Hospital March 13, 2014

Nearly one in three young women experiences stress urinary incontinence during exercise.

Author: Joy Shine, MSPT, CLT, a senior women’s health physical therapist in the Department of Rehabilitation at Brigham and Women’s Hospital Joy also works with the Women’s Sports Medicine Program, directed by Elizabeth G. Matzkin, MD.

As a part of your training routine, you may be focused on strengthening a variety of muscle groups in your legs, arms, or abdomen. But there’s an important area you may be missing. Did you know that nearly one in three young women experiences stress urinary incontinence, or urine leakage, during exercise?

During physical activity, especially high-impact sports like running and jumping, there is an increase in intra-abdominal, or belly, pressure,” explains Joy Shine, MSPT, CLT. “The pressure causes the bladder, bladder neck, and urethra to move downward, allowing the involuntary passage of urine.”

A Training Routine for Your Pelvic Floor Muscles

Pelvic floor muscles support pelvic organs and prevent urinary leakage. If these muscles are not coordinated well enough, however, they will not effectively do their job. The good news is that simple exercises can be done to help strengthen the pelvic floor muscles and prevent urinary leakage during exercise, as well as coughing, sneezing, laughing, or heavy lifting – other common causes of stress urinary incontinence.

  • Pelvic floor muscle exercises (commonly known as Kegel exercises) are performed by contracting the pelvic floor muscles, providing closure around the anus, vagina, and urethra. During a pelvic floor muscle contraction, a squeeze and upward lifting sensation can be felt around the vagina and anus when contracting these muscles correctly. Performing three sets of 8-12 slow-velocity repetitions, two to four times a day, are advised for pelvic floor muscle strength training.
  • “The Knack” is a pre-contraction and hold of the pelvic floor muscles before and during activities that increase intra-abdominal (belly) pressure.

“The beauty of these exercises is that they can be done anywhere and at any time,” says Joy. “It’s important, however, to make sure that you are doing these exercises correctly and regularly for maximum effectiveness.”

Seeking Treatment for Urinary Incontinence

Talk with your doctor if you are experiencing symptoms of stress urinary incontinence. In some cases, your primary care physician may recommend that you work with a pelvic floor physical therapist who can guide you in the proper contraction of your pelvic floor muscles and give you tips for properly engaging your pelvic floor muscles. If these exercises don’t provide enough control over symptoms, a urogynecologist can provide additional treatment options.

Related posts and links:



Overactive Bladder: Tired of the Interruptions?

Posted by Brigham and Women's Hospital April 9, 2013

Overactive bladder (OAB) is a common yet frustrating condition that affects women of all ages.

Today’s post is written by  Dr. Vatche Minassian, Chief of Urogynecology at Brigham and Women’s Hospital.  This is the fifth post in a series about common urogynecologic conditions affecting women.

If the first thing you do when you arrive at the mall, a restaurant, or movie theater is locate the bathroom, you may be suffering from an overactive bladder (OAB), a common yet frustrating condition.

OAB affects women of all ages, races, and socio-economic backgrounds. It occurs more often as women get older and may affect as many as one out of six women. OAB is a chronic condition. This means that although we can successfully help women manage their symptoms, there is usually not a cure that will cause the condition to go away permanently.

Recently, I saw several women with symptoms of OAB. My first patient, 61 years old, described the need to go to the bathroom every hour, even waking up several times during the night to go. The same day, another of my patients, who is 45 years old, recounted feeling a strong urgency to urinate, often being unable to hold her urine for long. The following day, a third patient, 72 years old, voiced the following concern, “Doctor, when I feel the need to go, I’ve got to find a bathroom quickly. In fact, I know where all the bathrooms are at the mall or grocery store.”

Read More »

Overcoming the Challenges of Living with Interstitial Cystitis

Posted by Brigham and Women's Hospital March 6, 2013


Interstitial cystitis treatments can help women live more comfortably.

Today’s post on interstitial cystitis, is the fourth post in a series about pelvic floor disorders that impact the quality of life in women.  It was written by physicians in the Brigham and Women’s Hospital Division of Urogynecology, led by Dr. Vatche Minassian.

Occasional burning with urination or treatment for a urinary tract infection is common once women go through puberty. However, if you have chronic and disruptive burning or bladder pain and urine testing does not indicate an infection, you may have a condition called interstitial cystitis (IC). Women with IC have a urethra and/or bladder wall that is tender and easily irritated, leading to uncomfortable symptoms such as pain, a sense of the need to urinate, or the feeling of not emptying the bladder completely. There is no definitive test to diagnose IC, and there is no clear understanding of what causes it. Although IC currently has no cure, there are treatments that can help you manage your symptoms to feel better and live more comfortably.

Women with IC often experience gynecologic problems too, such as a worsening of bladder symptoms during intercourse, and pain or burning at the entrance to the vagina.The combination of symptoms can be very frustrating for patients. Women with this array of issues may need a referral for specialized diagnosis and treatment. Urogynecologists, with specialized training in gynecology as well as expertise in pelvic floor disorders, can manage both the urologic and gynecologic aspects of this condition. They also are comfortable talking to women about sensitive health conditions.

Read More »

No Need to Stress about Stress Urinary Incontinence

Posted by Brigham and Women's Hospital January 29, 2013

Dr. Vatche Minassian says stress urinary incontinence is common and very treatable.

Dr. Vatche Minassian, Chief of Urogynecology at Brigham and Women’s Hospital, is the guest author of today’s post on stress urinary incontinence, the third post in a series about pelvic floor disorders that impact the quality of life in women.

The other day I saw a young woman who had delivered her first baby a few months ago and was complaining of urine loss with laughing and sneezing. Her condition, a common one, is known as stress urinary incontinence. She was worried that she would need surgery to stop her urine loss since her mother and her grandmother both had surgery for incontinence. Her pelvic exam was normal and she had no obvious reason for her incontinence, other than the fact her pelvic floor muscles had weakened due to her pregnancy and delivery.

I reassured her that surgery was not her only option and that, in her case, I would first recommend strengthening her pelvic floor muscles with exercises and physical therapy. We also discussed weight loss and other conservative measures. By the time she left the office, she was less anxious and was eager to start getting in shape as a way to rehabilitate her pelvic floor muscles.

Many of my patients are surprised to learn that urinary incontinence is a very common condition. More than one in three adult women lose urine, making urinary incontinence more common than conditions like diabetes or heart disease. Urinary incontinence affects women of all ages, and its frequency increases with age. Despite these high numbers, very few women talk about their condition, and even fewer women seek care for incontinence. When women with incontinence are asked why they are not seeking help, they commonly say: “I’m too embarrassed,” “I thought this is part of life or part of the aging process,” “My mother has it and my grandmother had it,” “I did not know treatment is available,” “I do not want to have surgery,” or “I have other more important things that I need to take care of.” It is really unfortunate so many women silently suffer and live with incontinence for so long before seeking care.

Read More »

Pelvic Organ Prolapse: Common Yet Misunderstood

Posted by Brigham and Women's Hospital January 10, 2013

Author: Vatche Minassian, MD, MPH, Chief of the Division of Urogynecology at Brigham and Women’s Hospital and Associate Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School.

“I have constant low back pain.” “It feels as if I’m sitting on a ball.” “I have difficulty going to the bathroom.” This is how my patients with pelvic organ prolapse describe their condition. Like other urogynecologic conditions I treat, pelvic organ prolapse is more common than most women believe. One study found that a woman’s lifetime risk of having surgery for pelvic organ prolapse was 11 percent.

What is the Pelvic Floor?

Pelvic organ prolapse develops due to weakening of the connective tissue, muscles, and nerves that form the “pelvic floor.” The pelvic floor holds many of your internal organs in place, such as the intestines, bladder, and uterus. The pelvic floor must be strong enough to support these organs and flexible enough for women to give birth and maintain normal bodily functions such as urination and bowel movements.

Uterine prolapse, cystocele, rectocele, and enterocele each refer to specific areas that become weakened in pelvic organ prolapse. When the pelvic floor is weakened, the bladder, uterus, rectum, or small intestine can descend, creating a bulge in the vagina and resulting in the condition known as pelvic organ prolapse. Vaginal childbirth is the most common risk factor for developing pelvic organ prolapse, but women who have never been pregnant can still develop the condition. You can even develop pelvic organ prolapse after a hysterectomy.

Symptoms such as urinary incontinence, difficulty emptying the bladder, and a sensation of pressure in the vagina can occur with prolapse. Pelvic organ prolapse can also make it difficult for women to have bowel movements as pelvic muscles become weakened. Though pelvic organ prolapse rarely causes an immediate threat to your health, it can cause discomfort and interfere with your ability to do many things, including sexual activity.

How a Urogynecologist Can Help

At Brigham and Women’s Urogynecology Group, we find that women are reluctant to seek help for problems related to pelvic organ prolapse. Often women and their doctors assume that surgery is the only treatment. They may also have concerns about the safety and effectiveness of the surgery. Some women do not seek help because they do not understand what is happening to them, especially since symptoms develop gradually over months or years. Women may also be embarrassed to talk about health concerns related to a sensitive area of their bodies.

As urogynecologists, we have experience dealing with these especially sensitive health issues. We can help our patients evaluate both non-surgical and surgical treatment options. Non-surgical options include the use of pelvic support devices like pessaries and exercises such as Kegels. If surgery is recommended, a urogynecologist can help you understand what’s involved. Surgery for pelvic organ prolapse can be performed either vaginally or through a small incision in the abdomen using an instrument called a laparoscope. Even women who are in their 80s and 90s can get help. Complete recovery can take anywhere from four weeks to three months, and you will need to limit heavy physical activities for four or more weeks. Just as with a knee replacement or back surgery, you will need to protect your surgical repairs while you are healing.

If you think you may be suffering from pelvic organ prolapse, there is no reason to be embarrassed or isolated. A urogynecologist can provide guidance on treatment and help restore your quality of life.

Learn more about common urogynecologic conditions:



Urogynecologists: Offering Women Help and Hope

Posted by Brigham and Women's Hospital December 13, 2012

Urogynecologists can help women with urinary incontinence and other urogynecologic conditions.

As a woman, you might notice it when you laugh, cough or sneeze — a small amount of urine leakage that is more than bothersome, it’s distressing. Urinary incontinence affects 30 to 50 percent of women, yet many are too embarrassed to seek help or believe that nothing can be done. But help is available.

Doctors known as urogynecologists specialize in treating this common yet sensitive condition. They also treat other gynecologic conditions that affect the female pelvic organs and the muscles and tissues supporting these organs. Examples of other conditions they treat include pelvic organ prolapse, frequent and sudden urges to urinate (overactive bladder), recurrent urinary tract infections, and bladder pain (interstitial cystitis).

Pelvic floor conditions can significantly impact a woman’s quality of life, resulting in embarrassment, discomfort, and a disruption to their daily activities. These conditions are experienced often by women who have had children and are in menopause, though they can affect women of all ages. These conditions are also more common than you may realize. The American Urogynecologic Association estimates that one in three women suffers from pelvic floor conditions.

Read More »