Q: From a Doctors Perspective What are some of the most common questions you hear from your patients?
Answer:
Let’s Talk About Bladder Leaks — and Everything Else Nobody Tells You
If you’ve ever sneezed and held your breath hoping for the best, you’re not alone. Bladder leaks, pelvic floor issues, and the constellation of symptoms that go with them are incredibly common — and incredibly under-discussed. We sat down with two of our favorite experts who are changing the bladder leak conversation: Dr. Barbara Frank, Attn: Grace medical advisor and board certified OB/GYN, and Dr. Sara Reardon, pelvic floor physical therapist (and the woman your pelvic floor has been waiting to meet). They took turns asking each other the questions their patients ask most — and answered them with the same candor they bring to the exam room. They cover everything from how to prepare for postpartum, to what question to ask your own pelvic floor PT, to how to manage incontinence during menopause. This is a knowledge drop you don’t want to miss.
First Up, Dr. Sara Reardon Answers Dr. Frank’s Questions
What can pregnant patients do in advance to prepare for postpartum issues with pelvic floor/incontinence?
During pregnancy you can work on strengthening your pelvic floor muscles, along with full body strengthening, to support the physical changes that occur with every trimester. During your third trimester, if you are planning for a vaginal birth, learn different stretches for labor, pushing and breathing techniques, and perineal massage in preparation for birth. In addition, if incontinence or leakage starts during pregnancy, don’t wait until after birth to address them.
How can you work on constipation?
Constipation can be due to a variety of factors like diet, dehydration, side effects of medication, or pelvic floor muscle tension. Initial focus should include eating whole grain, fruits, and vegetables and staying hydrated with adequate water intake throughout the day. These help to keep poop soft and easy to pass. Daily exercise, as simple as walking for 30 minutes, can help promote digestion. From a pelvic floor perspective, knowing the proper way to poop. Don’t delay the urge to poop and go when you have the urge to go. Sit down, ideally with your feet resting on a small stool so that your knees can be higher than your hips, lean forward onto your elbows, and exhale as you bear down to have a bowel movement. Lastly, if you have pelvic floor muscle tension, working on relaxation and coordination of your pelvic floor muscles can also help improve your constipation.
Do the apps to do kegel exercises really work?
Any tool that can help make you more consistent with a home exercise routine can be helpful. Apps that teach you to do pelvic floor muscle training should include more than just kegel exercises, because kegels aren’t the only exercise to strengthen your pelvic floor. But many people have pelvic tension and should not be doing kegels, but instead should be working on pelvic floor muscle relaxation. So more importantly, knowing if you should be doing strengthening with Kegel exercises or not is the first step — and using an app for your personalized needs.
What are some questions to ask your PT to know they specialize in pelvic floor/incontinence?
I would ask your physical therapist if they specialize in pelvic floor health, if they do internal pelvic floor muscle examinations and if they have experience treating your specific symptoms. If they do not, they can refer you to someone else who may. Most pelvic floor therapists will be experienced in treating incontinence, as this is a very common symptom that many of our patients have. But your therapist should also ask about your bowel health, sexual health, childbirth history, surgical history, and medications to gather a picture of your whole pelvic health and not just the incontinence symptoms.
How long can patients expect to need PT, timing of appointments, etc.?
This depends! Often patients come in when symptoms have been going on for quite a while and it can take time to make changes and improvement. If it’s simply building muscle to better support the pelvic floor muscles and the pelvic organs like the bladder or uterus, muscle strength can improve as quickly as 4 weeks after starting a regular exercise program but can take up to 12 weeks to start seeing more significant improvements in your symptoms. More importantly you have to be consistent. Change takes time, consistency and patience in addition to making some lifestyle changes. Appointments are often between 30 to 60 minutes once a week to once a month and then decrease in frequency as your symptoms start to improve and you have additional exercises and changes to make at home.
Sara’s insights make one thing clear: the pelvic floor is connected to everything – and so is the care surrounding it. There is no one size fits all solution, or answer, to what one person may be experiencing. Dr. Frank couldn’t agree more. As an OB/GYN who sees the full picture of women’s health, she brings the same whole-body perspective to the questions Sara’s patients are always asking.
And now, Dr. Barbara Frank Answers Sara’s Questions
How often should I see a gynecologist if I’m done having babies?
The OB/GYN is more than just for babies! I remind my patients that although their primary care provider can do the PAP smear — which is now every 3–5 years depending on your history — we do so much more. The gynecologist can review your menstrual cycle, sex life/libido, pelvic floor health, urinary and bowel health, perimenopause, menopause, the list goes on and on. GYN is more than a PAP smear! We look at the vaginal tissue and pelvic floor muscles. Also, the connection you have with the provider who took care of you during your pregnancies is a wonderful gift!
What skincare recommendations do you have for someone who leaks?
You need to protect your skin similarly to a baby’s bottom! When babies wear diapers we tend to put barrier cream on them or vaseline/aquaphor. Also, we give them time to soak in a tub or warm water. The same care is needed for women who leak and need to wear pads regularly. If you are very irritated or need extra protection overnight, a thicker ointment can be helpful. During the day something thinner. And sitz baths or soaks can also help with protecting the skin as well.
Any suggestions on dietary or beverage changes for someone with incontinence?
Limiting caffeine as this is a diuretic, carbonated beverages, diet sodas and alcohol. Check on your medications and if you take something that is a diuretic take it in the morning to avoid overnight wake ups. Incontinence can worsen with constipation so having a high fiber diet and normal bowel regimen is helpful. Keeping a bladder diary for a few days to see how much you drink and when can help. Many women may drink too much during the day (2L max per day) or at the wrong time of day and lead to leaks. Also, figuring out when you void and making sure you’re on a schedule can be helpful to avoid leaks. Keeping a healthy weight also reduces incontinence.
If a woman starts leaking during pregnancy, should she wait until after birth to seek help or get help during pregnancy?
It is safe to start pelvic floor work during pregnancy. However, it may not fully respond given the pressure on the bladder. If you are going to start pelvic floor work during pregnancy make sure you work on pelvic floor relaxation as well. You don’t want the pelvic floor to be too tight for delivery.
What recommendations do you have for a woman in menopause to prevent or manage incontinence?
Vaginal estrogen for the win! This can help keep the tissue around the urethra healthy. The recommendations above stay consistent — keep a normal weight, avoid constipation, keep a bladder diary, avoid bladder irritants (caffeine, alcohol, carbonation).
The Bottom Line
Between Dr. Frank and Sara, the message is consistent: pelvic floor health is whole-body health, and there is so much that can be done — at any stage of life. Whether you’re pregnant, postpartum, perimenopausal, or somewhere in between, you don’t have to just live with leaks or discomfort. The right provider, the right exercises (yes, it’s not always kegels!), and a few lifestyle tweaks can make a meaningful difference. You deserve care that looks at the full picture — and now you know exactly what questions to ask to get it.
Bios
Dr. Sara Reardon is a pelvic health physical therapist, founder of NOLA Pelvic Health, and creator of The Vagina Whisperer.
Dr. Barbara Frank is a board-certified gynecologist, medical advisor at Attn: Grace, and an expert on sexual health, hormones, perimenopause, and postpartum intimacy.
Attn: Grace is the female-founded, Certified B Corp. changing the way we manage bladder leaks with high-performing, planet-friendlier, plant-based incontinence pads, liners and body care products to support women as we age.
This article was developed in partnership with, and sponsored by Attn: Grace. NAFC collaborates with select partners to bring our community information and resources that support bladder and bowel health.
