I treat women every day who tell me that they have issues with peeing when they cough, sneeze, and laugh, but that it is because they have had a baby or are in menopause. Just because it is common to have issues with incontinence, prolapse, or pelvic pain does NOT mean that it is normal. Many women struggle with issues that they do not want to talk about to friends or family and are often embarrassed to speak to health care providers about. Because of this, myths that you must live with urine leakage, your bladder or uterus will fall, or just live with painful sex or painful periods are perpetuated. There are options, and they are not all surgical.
Pelvic physical therapy (PT) can help with all these conditions. Stress incontinence, sudden urges to urinate, and getting up frequently at night can all be addressed with hands on treatment and some exercises. Prolapse issues, where the bladder, bowel or uterus are falling into the vagina can also be treated with PT. Once they are at the point where they are outside the vaginal opening, that is a surgical issue. I have helped many women who did not even realize that pain with intercourse was not supposed to happen. I never thought I would have to educate women that sex should be pleasurable from start to finish, but with the lack of discussion on the topic in society, here we are. Painful periods can also be helped with physical therapy with gentle hands-on treatments. In addition to pelvic PT, acupuncture has many ways to help all these conditions.
On the medical side, sometimes hormone replacement (particularly vaginal hormone replacement) can improve lubrication, libido, and help to normalize the pH and vaginal flora. The vaginal flora or normal bacteria, helps to protect the urethra from infection, so when the microbiome of the vagina is in balance, the incidence of urinary tract infections goes down. For women who are unable or do not wish to use hormone replacement, newer technology can now help. Radiofrequency or laser can be used vaginally to promote collagen in the vaginal walls. The new growth helps to support mild prolapse, improves lubrication, and has been shown to normalize the pH.
Many options exist for treatment. Practitioners are willing to listen and help. There are options other than suffering or surgery. I treat people for issues that they often could not share with friends or family and had suffered in silence. The best part of my job is helping people regain bowel, bladder and sexual function knowing that they are no longer suffering in that silence.