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Too Embarrassed To Tell Your Doc?

Scenario 4

Your urine stream is slow, stops and starts, or doesn't empty your bladder completely. You may also have pain during sex

DIAGNOSIS Pelvic-floor muscle dysfunction

WHAT'S HAPPENING Your pelvic-floor muscles are always tense. "With normal urination, the bladder muscle contracts while the urethra and pelvic-floor muscles relax," Dr. Knight explains. "If these muscles can't relax, you can have urinary problems."

STAT Experts aren't sure how widespread the problem is or what causes it, but they believe it may be what underlies pelvic pain for many women.

BEST FIXES Don't do Kegels on your own — they can further tighten muscles. These techniques can help:

PHYSICAL THERAPY A physical therapist may use biofeedback to teach you to relax these muscles, which helps about 75% of the time. She can also check for weakness or spasms in the muscles of your lower back and hips that can make your pelvic floor tense up. Ask your doctor for names of therapists who specialize in pelvic-floor disorders.

AT-HOME SOOTHING Breathing exercises, whole-body relaxation techniques, soaking in a warm bath, and heating pads or ice packs (as recommended by a doctor or trained physical therapist) can also help.

MEDICATIONS Your doctor may prescribe muscle relaxants and drugs that ease nerve pain, along with physical therapy.

Scenario 5

You have difficulty starting to urinate and/or can't completely empty your bladder. You may feel bulges in the wall of your vagina, as well as pressure, low-back pain, or pain during sex

DIAGNOSIS Pelvic-organ prolapse

WHAT'S HAPPENING Weakened muscles of the pelvic floor and stretched-out connective tissue give way so that your bladder, uterus, and/or rectum presses into the wall of the vagina. Having had pelvic surgeries or several vaginal births, carrying extra weight, and aging all raise risk.

STAT Three out of four women ultimately have at least some degree of pelvic-organ prolapse. Usually it's mild, but 11% will eventually need surgery.

BEST FIXES Kegels may keep mild prolapse from getting worse, Dr. Knight says. If you need more support and want to avoid surgery, a pessary can help. "About 80% of women with prolapse can successfully be fitted with a pessary," she adds.

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