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Incontinence & Overactive Bladder Health Center

The Scariest Article You'll Ever Read About Your Ladyparts

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"Why can't I control my bladder?"

If you're like me — and about 18 million other women, according to the National Association for Continence — and lose a little pee whenever you have a sneezing fit, you have stress urinary incontinence (SUI), a condition that causes you to leak small amounts of urine due to physical pressure from coughing, laughing, lifting, running, and the like. Anna Albrecht, 44, of LaGrange, IL, sprung her first leak at the gym. "I started skipping rope, and splash! Suddenly I was all wet," she says. "I was mortified."

Blame it on: A weakened seal between your bladder and urethra (the little tube you pee out of). Typically, women who've stretched their pelvic-floor muscles during childbirth are the most afflicted, especially if they had a large baby or pushed for two or more hours. Weak pelvic-floor muscles can be a trigger too. But just being female is a risk factor, whether or not you ever give birth, Romanzi says. Studies also show that obesity and smoking increase your risk. One third of women with SUI also have overactive bladder (OAB), a debilitating condition in which you suddenly have a strong urge to pee or your bladder muscle spontaneously contracts, sending a wave of urine into your pants.

The fix: The good news about this embarrassing condition is that the treatment is simple and effective. Pelvic-floor exercises such as Kegels, which tone and strengthen the muscles around the bladder and vagina, have been shown to stop leaks. In fact, up to 70 percent of women who do pelvic exercises with a trained physical therapist see significant improvements after three months, Romanzi says. (Note to self: Start doing Kegels!) Anna fixed her problem by regularly doing exercises that target the "pelvic pyramid," a group of deep muscles in the abdomen, back, and pelvis. (Go to totalcontrolprogram.com to find a comprehensive regimen developed by the Women's Health Foundation.) Another alternative is the injection of a filler that temporarily plumps up the urethral seal, making it leak-proof. There are also minimally invasive procedures, such as tension-free vaginal tape and the transobturator sling, that support the urethra and bladder by means of a ribbon or sling threaded through the vaginal wall.

For women with OAB, treatments include pelvic-floor exercises, dietary changes, biofeedback, bladder training (or timed voiding, meaning you go to the bathroom at specific times), Botox injections, and medication. "Look into pelvic-floor exercises and other nonsurgical treatments before committing to an operation or chronic medication," Romanzi says. Talk to your gynecologist to decide which approach is best for you.

Kegels 101: Strength-Train to Hold on Down There
Doing Kegel exercises can help prevent future pelvic-floor disorders by bolstering those muscles. Bonus: It'll also improve your sex life by giving you more control over vaginal contractions, leading to more powerful orgasms and greater sensation for you and your partner, since you'll be better able to grip him during intercourse, says Ilana Addis, M.D., a urogynecologist at the University of Arizona College of Medicine in Tucson. Here's how to get the best workout.

1. Locate your sweet spot. Before you can start strengthening your pelvic floor, you've got to know where it is. You know the muscles you squeeze when you're trying not to pee? Those are your pelvic floor muscles.

2. Learn the right moves. "Kegels, like any other exercise, are most effective when you do them in sets," Addis says. Squeeze for 10 seconds, then relax for a few seconds. Do three sets of 10 contractions a day. Eventually work up to 15 contractions for 15 seconds.

3. Turn them into a habit. To keep your muscles toned, you've got to exercise them every day. Make Kegels a part of your routine by piggybacking them onto another daily habit, such as making your morning coffee, brushing your teeth, or showering.

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