Putting Things Back Where They Belong (A post for women)

Stephen and me with our four children.

Psst! This post gets very intimate. If that bothers you, you may want to move on to other stuff. Like this website full of things that make you say "Wow!"

Once upon a time, I had perky breasts, a flat stomach, and flawless skin. And then life happened. Time, aging cells, gravity, childbirth, hormonal changes. The result is that things are no longer quite where they used to be or where they ought to be.


While I can shrug off most of those things, like stretch marks, with a "Meh. It was worth it," the bladder weakness is one that really gets in the way of my enjoying a full life.

When I first saw my current family doctor, she asked how much exercise I got and when I answered "very little" she asked what got in the way of doing more. She was the first doctor to ask that question, rather than simply exhorting me to do more. I told her there were two things:

1. I'm not fond of exercise, having cultivated a couch-potato lifestyle for some decades.
2. I couldn't do any activities that would cause bladder leakage. (You'd be surprised how many activities that removes.)

And thus began a long conversation that has led to some significant changes for me.

"Yeah. So, can we get back to walking?"

I adopted a large, active dog who brings me on long walks, year-round. That motivation kicked me off the couch, but didn't do anything with the second issue: stress incontinence.

Stress incontinence is generally caused by weakness in the pelvic floor muscles. While vaginal childbirth wreaks havoc on these muscles, the hormonal changes of menopause exacerbate this muscle weakening, so even if you've never given birth, you may still experience stress incontinence. 

I can't squat or lift or jump or run or sneeze or cough without leaking. Most of the time, it's very little -- a pantyliner is all I need, but other times it means a change of clothing. Trust me, this only needs to happen once when you're out in public and you will become hypervigilant of keeping your bladder empty and your legs crossed.

There are many options for dealing with stress incontinence in women.

The first, and probably least talked about, is physiotherapy. A physiotherapist works with the woman to teach her how to do a proper Kegel exercise. For many women, this is all the help they need.

The second approach, one which works well in concert with physiotherapy, is a pessary, a plastic or silicone device that is inserted into the vagina.

I told you there was a cube!

While they come in many shapes and sizes (including a cube!), they are typically much like a contraceptive diaphragm. You can probably buy these online, but I wouldn't recommend it. A gynecologist will help size and fit you and will ensure that the urethra is not blocked or pinched.

They can be left in place for months at a time, though most women will insert and remove them much more frequently than that.

My experience has been that the pessary is amazing, but not perfect. I'd say that 90% of the time, it's all I need. But it does involve maintenance and it does sometimes slip out of place a little.

The third is a series of weights that are inserted into the vagina.

The cones range in weight from basically just the plastic shell to a shell filled with lead. The idea is that the woman starts with the lightest one, gradually increasing the amount of time she "wears" it, and then moving on to the next cone.

The Netflix series Weeds had a character, Jill, who used this kind of device and turned her vagina into a powerful constrictor, to her sex partner's delight. I'm not convinced that they could achieve this kind of erotic magic, but they do work for a lot of women.

They didn't work for me.


The final option is surgery.

This is recommended in cases of prolapse, where the pelvic organs like the uterus, bladder, or rectum, have actually dropped into the pelvic floor. There are various degrees of prolapse. (I'm not going to include a picture here because the pictures for "prolapse" all show the worst-case scenario. Most of us get to a doctor long before the cervix pokes its nose out of the vaginal opening!)

There are a number of surgical options, depending on how severe the problem is. The simplest is a mesh sling that is looped under the bladder, to keep things high and dry, if you will. This is done laparoscopically.

The other options involve going through the vagina to put the prolapsed organs back where they belong and repairing the "fascia," the connective tissues that keep things in place. This is pretty major surgery.

This is what I'll be doing next week.

I'm writing about this because I think that there is a lot of undeserved shame around this condition, and there are too many women (like me) who simply endure it and curtail the activities that they might otherwise enjoy. Things that would improve their health.

P.S. Today's Parent has a good article about pelvic prolapse.