Hey, it's your friend Mel, and welcome to the Mel Robbins podcast. It is always such an honor to be able to spend some time with you. And if you're brand new to the Mel Robbins podcast, welcome to the family. I'm Mel Robbins. I'm on a mission to inspire and empower you with the tools and the expert resources that you deserve and that are going to help you create a better life. And, you know, one of the things that you and I haven't talked about yet is something that I really struggled with early in life, and that is, I had a leaky bladder. Now, I never envisioned a life where I would be having problems with my bladder, but it all started in my twenties, after our first child was born. And it was literally like, as soon as the birth was over, I almost immediately started having problems with leaking. I mean, first to happen when I would sneeze, and then it became kind of a more consistent problem, because at the time in my life, I was also doing a lot of running, and then it turned into an overactive bladder. And I just kind of kept thinking, okay, it's going to go away.

It's going to go away. And then I started rationalizing it, thinking, oh, this is something that I'm just going to have to live with. I can live with this. But over the years, it just got worse and worse. And it turns out that bladder issues are extraordinarily common for both women and men. In fact, 40% of the women that you know, will have issues with their bladder. And so today, you and I are going to have a conversation that every single person in your life needs to hear. Because if you've ever had a problem with constipation, with Utis, with dribbling, my message to you is that you do not need to suffer in silence for decades like I did. You do not need to feel ashamed of what's going on. You're going to learn that all these things, Utis, bladder issues, constipation, all kinds of stuff going on down there, it's extremely common. But if happening to you, it indicates that things are not functioning normally, there's a signal that something's wrong. Is it ever normal to leak urine? What are the causes of UtIs? Is there something natural that I can do that will help prevent them or treat them?

What exactly is the pelvic floor, and what role does it play in your health? And why does it have something to do with constipation? And while we're on the topic of constipation, what exactly should normal poop look and feel like the simple fact is this is something that we need to talk about because you can't take control of something that you're not willing to talk about. So let's get into it. Hey, it's your buddy, Mel. Thank you so much for being here with me today. I'm so excited that we are having this conversation because this is an issue that I have dealt with personally, literally, for over a decade. It's something that I wish I would have faced head on sooner in my life. It would have improved my quality of life. And so I am really excited that you and I are going to learn a lot more about improving our pelvic health because doctor Reena Malek is here today. She is a board certified, fellowship trained urologist. She's a pelvic surgeon and a sexual health expert. She specializes in female pelvic medicine and reconstructive surgery and sexual medicine. Now she runs a really busy medical practice that offers patient focused care and bladder health, sexual health and hormone management with a particular expertise in urinary incontinence, which means leakage and accidents and an overactive bladder.

Doctor Reena is a medical powerhouse. She is known for her no shame science back YouTube videos that have over 300 million views. She has also published over 80 peer reviewed research articles and her extraordinary contributions to the field of urology earned her the distinguished title of the 2023 American Urological Association Young Urologist of the Year. Now, this is a topic that I care deeply about and so does doctor Rena. Like 40% of you, I have dealt with bladder issues and I suffered in silence for years about it, and I will not let you do the same. Doctor Rena is here to help you and your loved ones and she's going to tell you exactly what you need to know and what to do about it in a no shame, matter of fact, medically accurate way. So let's jump into it. Doctor Rena, I'm so excited that you are here and that we're going to talk about pelvic floor issues. And I want to start by having you speak directly to the person who's listening. What can they expect to change about their life based on what they're going to learn from you today?

I think what you should know is that your pelvic floor is such an important part of your body that's often ignored. It can create a lot of problems, whether it's urinary issues, constipation issues, pain issues, and these can be corrected. And so you don't have to suffer in silence. You don't have to just live with it. Right. These things that we're going to learn about and talk about today are not necessarily normal. They're very common, but they're not necessarily normal. So they can be fixed and treated and managed appropriately if you want help, but if you don't, that's okay too. But ultimately, learning about your body and knowing what's possible is going to empower you to make better health decisions.

What is the difference between common and normal? That struck me.

Well, so normal physiologic function is for a bladder. Let's talk about is a bladder that can hold urine until an appropriate time, and you're able to delay and go to the bathroom at an appropriate time, empty your bladder completely and not leak or have urgency or frequency at a. At a rate that's problematic. Right. And that's abnormal when those things occur. But again, it's very common for people to have things like bladder leakage or have urge, like, gotta go, gotta go. That doesn't mean that it's normal.

Oh, so it's almost like you're not some weirdo if you're having issues with leaking or with constipation, but your body is designed to function in a better way. And we're gonna talk about the connection between your body functioning in a better way and your pelvic floor health.

Exactly.

Well, this was my story. This is why I wanted to talk to you, because I had a wildly traumatic birth when our daughter, Sawyer, was born, like, over 25 years ago. Just forceps, vacuum delivery, then the placenta tour, I had to have a manual extraction, and, like, lost all this blood. And I didn't realize it at the time, but all of that trauma to the birth canal basically just shredded all the muscles in that region. And from that point forward, I started having chronic issues with leaking urine. Like, I would take a step and I would leak, I would sneeze, I would leak. Forget about jumping on a trampoline. Forget about jumping rope. Like, it started to profoundly impair the quality of my life. I just thought there was this wildly embarrassing thing that was happening to me that made me not want to go on a big hike. That made me stop running something that I really love doing, because I would literally soak my shorts by the time I was done running a mile. And so, you know, this is something that I lived with for a long time, and I was really scared to do any kind of surgery around it, which I ultimately did.

But I tried to strengthen the pelvic floor. But my case was so far gone after having three kids and letting it go for so long, like, I had so much shame around it, Doctor Rena, that I didn't talk to anybody around it. I got pregnant again, had another baby. It got worse. I just started wearing maxi pads like it was a constant thing. And then finally I'm like, this is interfering with the quality of my life. And I might have been able to do something had I had the courage to talk to a doctor like you right after Sawyer's birth to try to strengthen the pelvic floor. What other role does your pelvic floor play in your overall wellbeing and health?

So it's sort of like an under recognized important structure in your body, right? So I always give it the example of, like, people who get TMJ, right? You never think about these muscles here until you're grinding your teeth at night or you're causing problems. You're waking up with headaches because you're having TMJ. It's the same thing. Your pelvic floor is really important. It does a lot of things. And if it's functioning normally, you never need to think about it. It's doing all it needs to do. You're feeling fine, everything's great. Good. That's wonderful. And I really want to thank you for sharing your story, because it is so common. This is what I trained in, female pelvic medicine. Oh, you did? That's what I did my fellowship in. Yeah.

Wow.

And I can't tell you the number of women who wait years, like, you asked them, how long have you had this for? 20 years? 40 years? Like, no joke. They've been living with leakage or prolapse or overactive bladder, which I know we're going to talk about. Um, for years, and they've been so busy taking care of their kids, their partner, their parents, anyone who needs them but themselves. And so I hope, whoever is listening, I hope if you're listening, that you're having these troubles, that you can take the courage it takes to go to the doctor and talk about this, because, one, you might save yourself a surgery, but two, you're prioritizing yourself. And I always tell people, like, take care of yourself because you are worth it. And, like, you need to do that. And I'm glad you did it. I wish you had done it earlier, but this story is going to help millions of people. Like, they are sitting at home struggling with the same thing, crying about their diapers, right? Like, oh, my God, I have to wear adult diapers. I can't believe this. I'm 40 years old, or I'm 30 years old.

I just had a baby. It is extremely devastating. And we just like, oh, everyone leaks a little. Like we just sort of brush it off like it's nothing.

I wish I had addressed this at least a decade before I did, if not even a decade and a half. And so the thing that I really want you to hear, whether you are younger and this is happening or that you have had kids and this is happening, or you're older and you've been living with it, is that there's actually a lot that you can do about this, and so you can change this. And what I would love to talk about is, could you just list off the symptoms that you may be dealing with a pelvic floor issue?

So let's start with urine. Urinary urgency. Gotta go, gotta go. Urinary frequency. Going more often than usual. Urinary leakage. So that can be leakage that occurs because you cough, sneeze, do heavy things, do any. Any exercise. That's called stress incontinence. And then there's leakage that occurs because you gotta go, gotta go, can't make it, and that's urge incontinence. They're different processes and they have different treatment options. Just. We can talk more about that if you want. You could have a little bit of both if you're having difficulty emptying your bladder or if you're having pain with urination and you've ruled out a urinary tract infection. So there's a common urinary complaints. Pelvic floor pain related complaints can be just feeling pain in the pelvic floor. So, like, you feel pain in the vagina, pain with sex, pain with orgasm can be pain in the hips or backs that might be correlated with it. For bowel symptoms, you can have constipation. So if you're having difficulty emptying, it could be a fact that your sphincter or your muscles around the sphincter are not relaxing, and so you're having difficulty emptying or evacuating your colon. And so those are probably the most common symptoms.

And I would just say if you're having any of those, it's valuable if you're bothered particularly or if you're having pain, to see a doctor, urologist, a pelvic surgeon, a female pelvic surgery expert, urogynecologist, anyone that is available to you.

I know it sounds like a dumb question because I hear urogynecologist or urologist. And I'm like, oh, that's a peepee, doctor. I don't think about, you know, we go there and we talk to them about constipation. But I could see how, as we're learning, that the pelvic floor and your pelvic floor health has way more function and importance from everything from normal bladder function to normal elimination function to orgasm, to the overall health of that region of your body. It makes a lot, lot of sense. How many people have pelvic floor issues?

I mean, I don't think we have an accurate number because I think many are under diagnosed. But we know that up to 40% of women will have some prolapse. Very few of them will need anything for it. We know that up to a third of women will have urinary leakage. So it's very, very common. And to your point about, you know, should a urologist or urogyne oncologist be able to talk to you about these things? A good urogyne oncologist or urologist with female urology training will talk to you not only about your urinary symptoms, but about your constipation, about your neurologic symptoms, because I mentioned sometimes it can be neurologic in nature.

What do you mean?

So maybe you had a back injury, and maybe you injured something in your spine that could be causing issues. So they'll talk to you about that. They'll talk to you about your sexual function. So you should be having a really holistic approach in terms of, like, the, all these things can contribute. So a lot of people don't know that constipation can cause urinary problems just in and of itself. So if you're just constipated, you might find yourself going more often to the bathroom, you might find yourself going more frequently, going urgently or waking up at night, because it's all full of stool and it's pushing against the bladder. Sometimes people will be more likely to get urinary tract infections if they're constipated. So, like, these are things that are very interconnected, which is why we always talk about them.

You know, I'm just curious, why is there so much shame around having a leaky bladder?

Well, I think it just feels very degrading to people. You feel like you're not in control of your bodily functions, and it's like wearing a diaper, smelling like urine. It is very, very debilitating for people to the point where they stop going out in public, like, they stop seeing their friends, they stop going to movies because they can't sit through the movie without having a leak, or they stop doing things they love because they're so embarrassed by it. And it's one that if you're not embarrassed, great. But I think the majority of people really fall into that category once we're there. Like, it's not just the implications of, oh, you're leaking. It's the implications of, okay, now you're not having social connection, now you're depressed, now you're not productive in life. It's very multifactorial, the impact of incontinence and why we just throw it away. Like, it's nothing. Like, it's really an important problem. And I'm sorry, but for a lot of people, pads are just. That's not an answer they want to live with. But for some people, that's. That is, and that's fine. But pads are also really expensive. So, like, for a lot of people, spending money every month on pads is an exorbitant expense.

And so I think, like, you don't need to suffer in silence. You don't need to suffer in shame. We are here to help you. Like, I love taking care of patients who have these issues because I can change their life. Like, they are dramatically happier after they see me. Right. And sometimes it takes a little work. Right. Like, if we're going to try medications or try some things, the first thing may not work, and that's okay. We're on a journey together to get you better.

Awesome. Okay, so what is the pelvic floor?

Yeah. So the pelvic floor is actually part of your core. So people don't realize this. They think of core, they think of abdominal muscles, but it's actually a bowl of muscles that sits in the pelvis, that holds up your organs. So holds up your bladder, holds up your uterus for women, holds up your rectum, and it also attaches to different parts on our bones. So it attaches to the coccyx, which is like the end of the spine. It attaches to the hips and to the pelvic bones. And so these areas are all interconnected. And it's a very important group of muscles, and it does a lot of different things for us. So it does things like control our sphincters. Right. So when you want to urinate, your sphincter is, uh, is holding until you're ready and at the bathroom. And it relaxes and allows urination to come out. Similarly with your bowels, your sphincter is contracted until you're ready to defecate or have a bowel movement, and then it opens and you have stool come out. Right. And so that's part of it. It's also part of supporting your organs. So for women, very often you'll see women can develop something called prolapse, where they.

They may have a vaginal hernia, and that's usually because of a weakness of the pelvic floor. So it's important for supporting these organs. It's important for stability. So every time you take a step, you're actually activating your pelvic floor. So it helps us with stability, and it also helps us with sexual function. When you have an orgasm, those muscles contract and squeeze, and that's sort of what gives you that sensation of. Part of the sensation of an orgasm. And then it's also a sump pump, so it helps with lymphatic fluid and clearing our lymphatic fluids and pushing it up to our heart and clearing that through our bodies.

So I'm going to take a quick pause. We're going to hear a short word from our sponsors. Please share this. Share this with your partner. Share this with somebody that you want to talk about with this. Share this with somebody that could use this information. This is important, even though it's kind of embarrassing. I'll do the embarrassing talk. You stay with me because we're just getting started. I'll see you after a short break. Welcome back. It's your friend Mel Robbins. And you and I are here today with the extraordinary doctor Reena Malik. Doctor Reena. So when anybody used to say pelvic floor, I would throw that term into a giant word casserole with kegels and your abdominals. Like, I really didn't even know what that people were talking about. And so I want to get really granular just because, again, you said this is a very important part of your anatomy that we don't talk about enough that has an impact on everything from normal urinary function, normal pooping, your orgasm, all of it. And so the way you just described it, it almost sounds like it is this web of muscle that goes from what, like, the top inner part of your legs and all around.

Like, is it like a hammock down there?

Like, what is like a hammock? Yeah, it's a bunch of different muscles. There's actually layers to it. So if you look at a pelvis, there's, like, the outer layer, and then you peel it back, there's more layers deep inside. But to give you an example of how we assess the pelvic floor that maybe sort of help you in three dimensions. So when I assess a pelvic floor for a female, I will touch them with a gloved finger, obviously, with consent, all those things. I'll actually insert a finger in the vagina and say, squeeze my finger with your vaginal muscles, and I can assess if they're working appropriately or if they're weak or they're strong or they're tense. For men, we do this exam through the rectum, because there's no vagina. Right. And so that's how we can feel the pelvic floor muscles. There.

Got it. Okay. So if I'm sitting in this chair right now, am I sitting on my pelvic floor?

Yeah.

Okay.

It's engaged.

It's engaged. Okay. And it's holding organs in place. It's helping with the proper function of all the organs in that region of your body. And. And what happens in a woman's body when your pelvic floor muscles are weak?

Well, so why do they get weak? First of all, let's talk about that, right?

So because we. We work hard to, like, lift weights, and all of a sudden, you see definition in your bicep, and so, ooh, I got, like, strong bicep muscles. Are we born with strong pelvic floor muscles, or is this something that we're supposed to be working on?

So, because you're using them all the time, right. You're activating them with steps. You're always using them, right, but it's a matter of, like, are they going through their full range of motion, or are they tight or are they weak? And you can't really put them through their full range of motion. So there can be causes that can make them too tight, and there's causes that can make them too weak. Let's start with weakness. So weakness most commonly happens because of childbirth, right? So you're carrying a baby, whether you have a vaginal delivery or a c section, you're still carrying that extra weight for nine months, right? So that can put strain on those muscles. Also, if you have a vaginal delivery, that's another yet insult to the pelvic floor that can cause weakness. And then say you have a job where you stand a lot, right? Say you're, like, on your feet, like a hairdresser, a nurse. You're on your feet all day long, or you have a chronic cough, or you have a neurologic condition, or you have a genetic condition. All these things can affect the pelvic floor and cause it to be weak.

Now, what does that mean? Right. Who cares if it's weak, right. So the most common thing you'll see is that women will have leakage. So they'll leak with cough, with exercise, with bending over, with standing up, or even as little as very small exercise, depending on how weak their pelvic floor is. I want to reassure you that it's not dangerous, but it can be very uncomfortable and inconvenient.

And what I would love to talk about is how does childbirth impact the functioning of the pelvic floor?

Yeah. So when I describe the pelvic floor, sometimes think of it like a boat, right? A boat that's held up by a rope, and then you've got the water below it. Right.

Okay.

And so think about the muscles as the water below it holds, holding it up. Oh, hold on.

Let me just see if I'm tracking.

Yeah.

So the boat is actually like your bladder and your vagina and your rectum and all that stuff that's in there. And your pelvic floor is the water it's floating in, right?

So think about when the water goes down. Everything's coming down. Or the water can stay reasonably strong, but those ligaments can stretch. Those ropes that are holding from having childbirth, those ligaments can stretch and get weak, and that can then cause problems. So sort of there's two different ways you can. Can see pelvic floor problems. They're both related to childbirth. One is your muscles get weak because they've been carrying this heavy thing around, and then you have a traumatic childbirth. I'm glad you talked about forceps and vacuum deliveries. Those things can also increase your risk, maybe even episiotomies. You know, back in the day, they used those routinely, right? Everyone got an episiotomy. And so that can weaken the pelvic floor as well. So all these things can affect your strength of your pelvic floor. And for those people who have these issues, strengthening your pelvic floor, as you mentioned, can be very helpful. But people are like, okay, how do I do that, right? So people will hear about kegels, and they'll be like, how do I even do that? Right? We think that as women, we know how to do that. Right? But I will tell you, nine times out of ten, I'll have a woman come in and I'll be like, this is how you do a kegel.

And she's like, oh, my God, I wasn't doing it right. Sometimes it's very helpful to see a pelvic floor certified pelvic floor physical therapist. It's like going to the gym with a trainer, right. They're going to actually guide you on how to do these exercises and monitor your progress. But basically what it is, is you're squeezing up and in those muscles. So it's sort of like if you were peeing and you stop the flow of urine.

Okay.

Or if you're holding in a fart, right. Those are sort of the muscles you're contracting, but you don't want to squeeze your belly and your butt. You just want to focus on those vaginal muscles.

See, I just tried one and I squeezed my butt. It was like butt cheeks. No. Okay. That's not a clean.

It's very hard to do. Right. It's not that easy. And so it actually requires some training and to make sure you're doing it correctly. And people think, oh, I got hundreds of them, right. When you go to the gym, you don't do hundreds of bicep curls on the first day, right. So I tell people, do it lying.

Down first, and what do I do? So I'm lying down.

You lie down. You focus on trying to contract those muscles, like, visualizing, like, oh, I'm squeezing, you know, holding fart in, but I'm not squeezing my butt.

How the hell. How do you hold a fart in without squeezing your butt? Well, doesn't your butt, like, block the like.

But.

I know, but what about, like, if is there, because you mentioned something about, as a doctor when you're doing an exam.

So, yeah, I put a finger in the vagina and I have them squeeze it. So if you put your own finger and you can actually feel the squeeze and the relax.

Okay.

Right. So you can do that. You can also, like, when you're peeing, just to get a sense, stop the flow of urine. Don't do that all the time. I don't want you doing kegels every time you pee, but just to understand where the muscles are. Right.

And then you can go to your back, because now you understand the motion that you're asking us to do.

So start lying down.

Okay.

Don't focus on standing. Sitting. You're not using any other muscles, are you? Just really focusing on those. 5 seconds, squeeze, 5 seconds, relax. 5 seconds, squeeze, 5 seconds, relax. Do like ten to 15. And then, you know, do maybe once a day, then go to twice a day, then do a couple sets of it. Right. Once you get really comfortable, then you can start doing it sitting. Right. And then again, once you get really comfortable, you can do it standing, but it's just like going to the gym. It takes progression. You're not just going to be a skilled, amazing Kegeler just because you heard about how to do it. If you have access to a physical therapist, they are like. Like they're gold. Like they're so helpful.

Well, you know, I implore you to take Doctor Rena's advice because it was too late for that kind of intervention for me because I had gone a decade and a half and everything was so far destroyed from that birth trauma and a lack of any kind of intervention on my part that I think it's really important. I want to ask quickly, though, because I know that women who have had a childbirth experience or carrying a child can have leaking issues and pelvic floor problems. But younger women who are in their twenties can also have issues with leaking. Why does that happen?

So either it can be they have a weak pelvic floor because of a genetic issue or because of some other thing they've been doing. But more often what happens to is that their pelvic floor is very tight or very tense. Like we see this often in, like, gymnasts or like very active young women where the pelvic floor is very tense and they actually can't squeeze those muscles when they need to. Right, because it's already so tense. So say they're going to do a stressful activity, like jump on a trampoline. Their muscle can't squeeze because it's already super tense. It can't move anymore. And so then they leak because of that. And so it can be either weakness or too tightness, but it can present in different ways. And sometimes it can just be like, yeah, they've. They've smoked and they cough a lot or they're getting other. It can be non childbirth related, but they could be getting a lot of stress from other things that are going on in their life, whether it's a health condition or cough, chronic cough or things like genetic issues. So it always needs to be evaluated because there's not, like, all young people have tight pelvic floors and all old people have weak pelvic floors.

It's very unique to the individual.

Got it. So do you see a tight pelvic floor more with athletes?

Yeah, probably. Probably. I mean, I think it's. It's sort of a function of like, they're doing a lot of exercises that sometimes may also be contracting the pelvic floor. A lot of times we'll see, like, people are not breathing well when they're exercising, right? They're holding their breath. Usually elite athletes know how to breathe and all that, but it's like usually people who are not elite athletes and they're breath holding a lot. So when you exert. You know why trainers teach you when you exert, you need to exhale. It's because your pelvic floor stabilizes when you exhale. And so you need your pelvic floor to be strong when you're lifting. And then when you relax, you can then inhale. And so you actually have to actively do that so that you're not straining your pelvic floor every time you lift.

So we've talked about the exercises, but are there ways to strengthen your pelvic floor to also reduce pain that you may feel in this part of your body?

So if you have pain, I think before you start any exercises, please see someone who's an expert in female pelvic medicine or urogynecology, because you may have a tight pelvic floor. And if you have a tight pelvic floor, kegel exercises are going to make it worse. So it's really important. Yeah. So if you have tension in your pelvic floor, you're just squeezing muscles that are already too tense, right?

How would you know if it's tense versus loose?

It's really hard for you as an individual to know, like, you can actually, like I said, like I do an exam, I feel the muscles. You can feel the muscles and see if they cause tension. So I think ultimately, it's really important to get evaluated appropriately because kegels are not for everybody. And there's more than just kegels. Let me just preface that. We talk about kegels a lot, but there's many exercises you can do to strengthen the pelvic floor. A lot of, like, yoga work and pilates work is actually quite good for the pelvic floor. But if you have tension in the pelvic floor, you want to focus on muscles that stretch and elongate those muscles. So some of these can include things like happy baby pose or child's pose, or like a really low, deep squat. So on my podcast, we interviewed a pelvic floor physical therapist and made, like, a pelvic floor day. And so that was sort of like what we came up with in terms of these are things you can easily do at home, a few sets of them, ten of them, and that will help you relax the pelvic floor as well.

And so I think it's really important in those cases that this can treat a lot of different issues. Also, one I didn't mention is recurrent utis. So it's not that they're actually getting utis, but they're feeling pain when they urinate, which is very similar to a UTI, but the cultures keep coming back negative, and that could be due to an overly tight pelvic floor.

Wow. I have somebody in my life who's coming to mind who I think has a very tight pelvic floor.

Yeah.

And I think it's why this person struggles with constipation and urinary tract issues.

Yeah. I hope that everyone can identify one person that they can tell to get. Get evaluated, because that you could change their life.

Doctor Rena, this feels like a great time to take a quick break, and we will be waiting for you after a short word from our sponsors. So don't you dare go anywhere. Stay with us. Welcome back. It's your friend Mel, and Doctor Reena and I are waiting for you. We're going to keep digging into the science, the medicine, everything that you need to know know about improving your sexual health. And you know what I want to talk about next? Doctor Rena, how do you know when leaking is something that's just, like, incidental versus something that is a problem?

So, again, it's usually not a huge issue. It's more of a quality of life issue. But when you're starting to have recurrent infections, it may be a sign that you're not emptying your bladder. Well, that's part of why you're leaking. So that's one sort of thing. And two, like, your quality of life does matter. So what I worry about a lot in my patients is them waking up at night to pee, because if you wake up at night, it's dark, you're navigating to the bathroom, something's in the way you fall. If you fracture your hip and you're a little bit older, your risk of dying in that year after a hip fracture is, like 20%. So it is a big deal to wake up at night. It's not only just interrupting your sleep, but it puts you at risk for falls. And so I think it's really important if you're having a very challenging quality of life because you're waking up a lot at night or you can't even do your job because you're in the bathroom every 30 minutes. These are important things. It's not just a nuisance or something incidental. It's important.

Yeah. I mean, for me personally, it got to the point where I stopped doing things like dancing. I didn't want to dance at a wedding because the spinning around and all that stuff, which I love to dance with my husband, I would have to change the maxi pad that I was wearing. And the other thing that started to really bother me is, you know, I could tolerate, okay, I'm going to go climb a mountain. And on the descent, it's going to be an absolute nightmare. I could tolerate that, knowing it was just a day of dealing with it. But what started to really bother me is I would go to get up out of my chair and I'm leaking.

Yeah.

And I'm like, that's it. And every time I would go to go to the bathroom, I would empty the bladder, and then I'd have to stand up halfway and do a squat and get in a totally different physical position in order to empty it the rest of the way. And I'm like, okay, there is something profoundly wrong here. Yeah.

So what you're describing is people do end up having to do certain maneuvers to help them empty. Sometimes they'll have to splint, which is like, they'll actually put their fingers in the vagina and either push down the rectum to poop or push up their bladder to urinate. Again, this is not, like, life threatening, but it is a huge quality of life issue. And I think in society, like, people are, especially doctors, they have so much to do. They're like, if you're not having a heart attack or diabetes or high blood pressure, you're okay, but I don't think you're okay. Right. I think your quality of life matters a lot, and I see the far reaching effects of it, not just physically, not just the risk of falling, but the emotional toll it takes on people. It is really remarkable.

Should you be worried if, like, you're jumping rope or you hop on a trampoline or you're going for a run and you find yourself leaking when you do those things.

Yeah. So again, very common, as I mentioned, not normal. So what can you do? Right? You can do nothing. You can be fine with it. You can buy things over the counter. Like, some people will put a tampon in because it'll put some pressure on the urethra. You can even buy a product that is made for incontinence. It's like a tampon. It's a bit wider.

I used to use that.

Yeah. And so that can help because it's.

Like lifting everything up. It's sort of like, if you think about it this way, your muscles are supposed to be doing that job. But when you use that product inside yourself, the muscles then activate to clench that thing.

Yeah.

Which then, you know, snatches it all right up.

So you can buy that over the counter, or you can get a pessary, which is like a pessary pessary silicone dish. And they come in different shapes and sizes. The most common is, like, a dish shape. So if you remember diaphragms from, like, back in the day, it's sort of like that. You put it in the vagina and you get fitted for one at your doctor's office, and it lifts things up. And it also, in people who leak, sometimes has a little knob on the end that pushes against the urethra. So there are options like that available, and then there's surgical options, which I think people get really scared when they hear surgery. But there are now procedures that are quite effective, that are, like, done in a day in the office, and you go home the same day and you don't have any downtime. So there's like, what's called bulking agents, where you inject, the most popular one is, like a water based gel into the wall of the urethra that then acts like a cushion. The urethra, again being the pee tube that acts like a cushion. So that when you, um, cough, sneeze, lift heavy things, there's a little bit of resistance there.

Now, when you do those things. And so that's sort of like a very quick and easy procedure that you can try. And it doesn't burn any bridges in terms of, like, if you want to have surgery later down the road. And then there's slings, as I know you've had, which is either you can use mesh or you can use your own tissues to put underneath the urethra that acts like a backboard. So that when you do these activities where you cough, sneeze, lift, heavy things, there's now this support there that prevents the urine from leaking out.

Yeah. The sling changed my life, and I avoided that surgery for five or six years because I was terrified. I was scared something would go wrong. I was scared like that. I don't know, there would be some complication. And it was so easy. And as soon as I was done with it and I got over my shame and my embarrassment and just frustration, and I finally, like you're talking about, went to see a specialist and understood that this is common but not normal. I didn't need to live with this. It was a procedure that was literally in and out two days of rest. And my whole life changed. My whole fricking life changed. How do you know if you have an overactive bladder? What are the surprising signs?

So we talked about some of them. So it's usually you're going more often. So, like, more than eight times a day. Eight is considered technically normal. So if you're going more than eight times a day. Now, of course, I caution that with, if you're drinking a ton, like, a lot of people are drinking a gallon of water, they're walking around with that big water bottle, you're going to go a lot, right? So, like, sort of use your judgment in terms of like, okay, maybe if I cut back my fluid, it'll save you a trip to the doctor, right? Maybe if I cut back my fluid and see if it's still a problem, then you can make a decision. Like, I love my water intake. I'm going to keep doing it. Fine, but you're going to go a lot, right? So that, I think a lot of people, sometimes it's like, hey, you know, look out at your fluid intake going urgently. So usually you get an urge. Everyone gets an urge to pee, right? But can you delay? Can you actually, like, take a second, finish what you're doing, walk calmly to the bathroom? Or is it so strong that you got to go, got to go and you can't wait?

And is that becoming a problem? Right. Of course, occasionally we've all held our urine, right? You're in a long car ride, you've done something, and then that urge does become very strong. But say that becomes very bothersome, very problematic. That's another sign. And then waking up at night to urinate, and that's sort of more complex because a lot of factors at nighttime that wake you up, but certainly waking up at night to urinate, and that's usually one or more times. If you're above the age of, like, 55 to 65, usually people wake up once before that, usually not. And the reason for that is because your body starts making about a third of your urine at night because of changes in your hormones and things and signals from your brain. And so you'll start making about a third of your urine at night. And so you will have to wake up once because your bladder just can't hold that much.

So how often is it normal to pee at night or should you not be peeing at night?

None if you're younger than about 55 and once after about 55.

And if you're drinking, though, if you're.

Drinking a ton either before bedtime or some people will, like, have a glass of water at their bedside, and they'll wake up to pee. Yeah, absolutely. You're going to have to wake up. So you sort of manage your quality of life versus how thirsty you are and, like, how bothered you are, right. But if you're like, man, I really need my sleep, then you got to quit that glass of water by your bed or stop drinking a couple hours before bedtime.

How does alcohol impact the bladder?

So alcohol and caffeine, which we're drinking today, too, is a bladder irritant. And there's a few other bladder irritants I'll name, but basically, these are probably the most popular or most common culprits of bladder irritation. And so what they do is they change the sensitivity of the bladder so it spasms, and it gives you that urge to go more often. Also, caffeine and alcohol are diuretics. So you make more urine than you put in. It's not a lot. It's not a huge amount of change in volume, but it is a little bit more. And so both those things can affect you, and it can change over a lifetime. So somebody can be like, I've been drinking the same amount of coffee my whole life, and now I drink that cup, and I gotta go. And I tell people, look, I would never stop drinking coffee, so I'm not gonna tell you to stop, but I would say, hey, why don't you drink one cup caffeinated and one cup not. Or have half caff or, you know, just experiment with it, just so you know that that's what's causing it. And once you know, you make a decision.

Right? Because I'm not gonna tell you what to do. You make a decision, it may not bother you at all. Some people do develop a tolerance, and same thing with alcohol. Some people depends on the type of alcohol, but certainly people will notice they're going more often with alcohol.

Are there things that you should avoid eating or drinking if you struggle with constipation?

So, yeah, with constipation, in terms of what you should do is increase fiber intake. So that's really helpful. And, of course, if you're increasing fiber intake, you need to drink more fluid, walk more, move more. That helps your bowels move more. And then you can also try things like day or Kiwis that can help sort of move things along a little better. I have this little recipe I'll sometimes give my patients. It's like applesauce, prune juice, and, like, a little bran fiber. Mix it, and they make this little concoction, you just eat a spoonful. I mean, it works for some people, and for some people it doesn't. But I think ultimately there are things you can incorporate in your diet, and then things that are sort of going to stop you up are like cheeses and meats and those sorts of things. So if you. All the good stuff. So, like, you know, if you're going to have a bad weekend and I eat a bunch of crap, like, you're probably going to get a little backed up. But as long as you go back to the good, healthy, sort of fibrous, nutritious foods, you should get back to normal.

Can you talk a little bit about Utis?

Yeah, I'd love to. So urinary tract infections are essentially infections of the bladder. And what you often see in terms of symptoms are pain with urination, you'll have pain in the lower abdomen. You'll have sometimes pain in your lower back or upper back because sometimes it can cause kidney pain. It can cause more of that urgency frequency we've been talking about so much. And sometimes people will, they'll describe it very sort of textbook. They're going a lot, but when they get there, very little is coming out and it hurts. That's sort of the very textbook thing. But it doesn't always have to just be that.

Why does it hurt?

So there's always some bacteria. There's this, like, misnomer that urine is sterile. We know now that urine's not sterile. There's always some bacteria, but you're getting a high concentration of bacteria that's causing your bladder to have pain. Right. So it's causing pain. So when you have a lot of bacteria, think of any infection, right. You cut your hand, you get an infection, it hurts. Right. So you get an infection, it hurts. And then typically it's treated with antibiotics. And so very commonly, women get utis. Usually you'll get one in your lifetime, and then, you know, it's common to get more than one. But when it becomes a problem is if you're having what we call recurrent urinary tract infection. So that's defined as two within six months or three within a year. So one thing you can do for your recurrent utis is increase your fluid intake. So they've actually shown that if you drink two to three liters of water a day, it will reduce your risk of Utis by 46%.

Wow. So just drinking two to three liters of fluid a day decreases uti risk by 40 plus percent.

Correct.

Wow. Okay.

So that's an easy one, right. We're diluting the bacteria, and our bodies are pretty amazing that 40% of the time, if you have any bacteria, your body will just take care of it. Right. And you don't have to treat it if it goes away. Right.

Does cranberry truly treat it to.

So, yeah, cranberry. There's some data on cranberries, actually, in our American Urological association guidelines for recurrent utis, that you can use cranberry. The evidence is solid enough that cranberry may help prevent recurrent utis. Now, what kind of cranberry. Right. If you're buying the sugar filled cranberry juice, that's like 5% juice. That's not going to work.

Right? The cranberry cocktail?

Yes, that's.

We're not talking about that, everybody.

You can try concentrated cranberry juice, although I find it to be very difficult to drink and, like, it's very unpalatable.

Yeah.

So usually you want to look for a cranberry supplement that's made from the berry itself. Not. You don't actually don't want a whole berry product because they're using the skins and the stems of the berry. You actually want it from the fruit of the berry itself. It needs to be in a soluble form, and it needs to have 36 milligrams of proanthocyanidins. So you'll see that on the supplement itself, 36 pacs is a short number for it. So that has been shown to help. I use it all the time for my patients. I think, think it's successful in helping a lot of people prevent Utis. And then the other thing is, we talked about constipation, but commonly that's an issue. And then, you know, we want to make sure there's nothing else going on. So if you try those things, you're still getting Utis. You want to make sure you don't have a kidney stone. If you've had a surgery down there, like, say you've had a sling, you want to make sure there's no stitch or anything in your bladder. So you want a urologist to look in there and make sure there's nothing going on.

So if I'm hearing correctly, is there a connection between being constipated and getting a UTI?

Yeah, absolutely. So when. I mean, we don't know the exact reason, but likely it's because it's full of stool and there's more bacteria from the stool that are more likely to get into the vagina and into the urethra. And the reason women get them more often is because our urethra is shorter. It's about two to 3 cm long, whereas men's urethra is significantly longer. So men don't get Utis that much. And if a man gets a UTI, he shouldn't wait for two or three. He should see a urology, because men shouldn't get UtIs. So there may be something really going on. Maybe he's not emptying his bladder, maybe his prostate is inflamed, whatever. But just to get evaluated to make sure there's nothing else going on.

Doctor Rena, do you also recommend that after sex, you go to the bathroom right away?

Yeah, so that's a great question. I think that people think that you have to, and I say there's no good data saying that if you pee after sex, like you're, you know, you're definitely preventing a UTI. But you bring up a good point that utis after sex are common. Now. It doesn't mean that you're dirty or your partner's dirty. It just means that the actual action of sex is going to make it so that you're having this thrusting motion. Bacteria are more likely to get into the urethra and have a urinary tract infection. And, you know, if you're having specifically infections after sex, there are sort of techniques that we can help you with in terms of, like, you could try maybe a cranberry supplement on the day of sex. On the day after, you can try increasing fluid intake. You could even take, like, a very low dose antibiotic after sex if it's really an issue, but ultimately get evaluated to make sure nothing else is going on. And then we have some sort of tools in our toolbox to help.

Is cranberry really that effective to prevent it? Because, you know, I think a lot of us have had an experience where you had an amazing weekend. You went away with the person that you're crazy about. You have sex all freaking weekend long. You come home, you're exhausted, you're a little sore. Next thing you know, Uti, like textbook yeast infection. Boom, Uti. And so simply that cranberry with the 36. Like, that's powerful enough if you kind of do it before and after, you.

Know, there's no data on that. But that's sort of something that, like, if you don't want to take an antibiotic, like, say, you know, you definitely don't want to do that. It's something we can try.

Got it.

And what I would say is, you know, if you're having a crazy wild weekend, you're probably a little dehydrated, right? So that's probably part of it. Or you're traveling, you're not drinking as much, you're not moving as much. Like, there's a lot of factors. Very often we see it around travel. So because people are dehydrating themselves around travel, you don't realize it, right? You're just like having a great time. You're not thinking about how much fluid you're taking in. And so those are usually part of it too.

And the hydration is important because it helps you flush any bacteria that you've picked up out of your system.

Exactly.

Amazing. You make this so easy to understand.

Thank you.

Which then makes me feel very empowered to be able to take care of myself.

That's wonderful. That's the goal.

And I understand that you say that men should pee sitting down.

Doctor Rita, I don't think you have to pee sitting down. So where this came from was there was like this study done where they interviewed like 7000 men around the country, around the world, and they found that german men sit more. And like 40% of old german men sit to pee, whereas, like, obviously in the US and other countries like UK and Australia, no one sits right. And so then people are like, oh, sitting is better, sitting is better. So when you're sitting, you can really relax your pelvic floor so it will allow the urine to flow better. So what I tell women when they're struggling to pee is like, sit down, open up your legs wide, lean forward and sort of just relax and try to let the urine fro. Similarly, men can do those things to help urine flow through the pelvic floor. If they have something like an enlarged prostate or, you know, that's usually the most common cause of difficulties urinating, they may actually have a better time or be more effective emptying their bladder sitting down. Now, if they don't, it doesn't matter. Stand, sit, whatever you feel comfortable with.

But sometimes people do find benefit for going twice. So if you feel like you're not emptying, what I tell women to do is sit, pee, relax. Like, open your legs wide, really bend forward and then stand up, walk around, sit back down and pee again. So if you have like a little bit of prolapse, even sometimes, that urine can sort of shift and help it come out. And with men, I'll say the same thing. Like, if you stand to pee, stand to pee, walk away, do a little walk, come back and try to pee a little more, and sometimes it'll get a little bit more out. If you're having issues, like, you know, you're maybe going a lot to the bathroom or you're having Utis, you might have a little leftover there. And so when you come to the urologist, we actually scan your bladder. So after you pee, we'll put a little scanner on there to see how much urine is left so we can get a sense of what's actually going on.

So why do men have trouble peeing as they get older?

So the number one cause is the prostate. So the prostate is essentially this walnut shaped organ that sits underneath the bladder, sits around the urethra or the p tube, and it enlarges. So if you think about it enlarges on almost everybody, 80% of 80 year olds will have an enlarged prostate. So it's very common. So it's like when you're drinking from a straw. So, say you go and get your bubble tea, and you have a big, wide straw, very easy. So that's a normal urethra. Think of that, then say you get a coffee straw, those little tiny ones, and you try to drink through that. It's extremely hard.

Will not go up into that straw.

So that's what's happening. As your prostate gets larger, that straw is getting thinner and thinner, and so it's more and more difficult to pee. And so that's usually why they have problems. And so we usually treat that prostate, whether it's with medication or with surgery if needed. And there's so many different options for surgery now. So definitely see a urologist, because there's, like, so many options that we'd be here all day talking about it. But ultimately, there's. There's tons of even minimally invasive options that can help.

And if that's happening, you should go talk to somebody.

Absolutely. I mean, it's a quality of life thing, right? You go to the bathroom every time you're struggling. Can you imagine, like, what that would.

Be like, standing there, like, come on, let's go.

It's very difficult. And especially, a lot of them will wake up at night more often because they're not emptying as well, you know, because they're. That straw has gotten so narrow, and so they'll wake up at night to pee a lot. So their. Their whole night is disrupted. That's really impactful for their quality of life.

So is it normal for a guy to have, like, a little urine dribble out at the, like, when they're done peeing?

Yeah, it's very, very common. So we call that post void dribble, and it's actually sort of a challenging problem. So sometimes it can be because of the prostate. Right. So some urine gets stuck in the. In the p tube, and then it dribbles out after. Sometimes it can be because there's maybe a narrowing in the urethra, like a stricture that's more rare, like you've had some trauma or something, and there's a narrowing and then that needs to be fixed. Sometimes it's because you're just, you know, it's sort of like just the way your anatomy is. And some people always have a little dribble, so it's a little bit challenging and. Or the streaming is so weak that it doesn't all come out. And so then there's, like, you can maybe try to do some strengthening of the pelvic floor to help that urine come out.

Doctor Rena, what tools do you recommend for somebody who's listening to you going, I think I have an overactive bladder.

So we talked about some. I think that avoiding bladder irritants, watching how much you drink. So I actually encourage people to take a diary. You can even Google Oab diary, and you can find one, like, urology care foundation has one. And you can write down what you're drinking, how when you're peeing, how much you're peeing, and it'll sort of give you an idea, like, what's going on. Right. And it can be diagnostics. You can take that to your doctor, but it can also be therapeutic. You're like, oh, my God, of course I'm peeing a lot because I'm drinking all this, or I always pee very much after I have that coffee. Right? So that's one thing I think it's very helpful for a lot of people. I'll often joke like, it's not homework. If you mess up, it's okay. Like, just do it and just sort of figure it out. If you're smoking, quit smoking. Smoking is a bladder irritant. So we talked about bladder irritants. Smoking is another one, constipation. Manage that. If you're overdevelop and you reduce your body weight by about 8%, which is not a huge amount. Depending on how much you weigh, it significantly improves your urinary issues.

So weight loss can be helpful for people who are overweight. So those are sort of the things that we generally recommend for everybody, and they're easy and they're free and things you can sort of figure out on your own. Now, if those don't work, then there's medication options and there's even surgical or third line options that you can botox your bladder. You can have what? You can have acupuncture? Yeah, there's a whole bunch of things that we have in our arsenal that can help.

Does acupuncture help?

So it's called percutaneous tibial nerve stimulation. So it's based on acupuncture. It's a little acupuncture needle that goes into a nerve in your ankle that actually, if you follow that nerve all the way up, it goes to the nerve root of the bladder. You come to the doctor's office, we put that little acupuncture needle in. It's attached to a little device that sends a little electric stimulation there. And so it stimulates that nerve and it sort of restores normal nerve function. And so you go to the doctor's office, 30 once a week for twelve weeks, and if it works, you'll sort of see by about the 6th week, and then every month after that, you know, it's time consuming. I tell people there's very little risk except for you might get in a car accident on your way to the doctor's office, but it's pretty safe. And then, yeah, you can botox your bladder too. So if you inject botox into the wall of the bladder, it can actually relax the wall of the bladder so that you have less urgency, less frequency. Now there's obviously risks with all these things, but this one has a little bit of risk of not being able to pee afterwards.

Can we just talk a little bit about pooping?

Yeah.

Like, what's normal? What should cause alarm? What should you be looking for? Should you be looking like, what do you want us to know?

You should always look right? You should look at your urine, look at your poop. Right.

Okay, what am I looking for when I look at my urine? Because I used to be obsessed, this may sound like a weird little thing, but I used to be obsessed with having urine. That was clear because. Cause I'd look and be like, oh, I'm really hydrated. But now I take all of these supplements and I'm like, okay, that's expensive urine, because that's like bright, bright, bright yellow. Yeah, but what should we be looking for when we're looking at our urine? Let's start there.

So for urine, what I tell people is you don't need it to be clear, and you don't need to be dark yellow because dark yellow means that you're probably not drinking enough. If it's clear, you're probably over drinking a bit. And it's usually not an issue, like, unless, like, what we've seen in marathon runners, for example, who do these really long distance run, they drink a ton. Some of them get sick, and you check their blood and their sodium is actually low because they drank too much. And that's a rare occurrence. But you don't need to drink to clear. What I tell people is drink too. Lemonade yellow. Right? Everyone knows what lemonade looks like. It should be about lemonade yellow. If it's darker than that, drink more. If it's lighter than that, you can stand to drink a little less. You want to make sure there's no blood in the urine. There are usually bubbles from the force of the stream. But if you're starting to see really foamy urine, that could be a sign that some, there's a problem going on. On. So blood in the urine, foam, urine. What I also tell people is if it's cloudy or stinky and you have no symptoms at all, you don't need to worry.

Just drink more water.

So, Doctor Rena, if the person listening to us were to really just focus on one takeaway that you think is the most important place to start, what would it be?

I think the one takeaway I would have for you is one. If you are struggling, ask for help. Ask for help. Even bring it up to your primary care doctor. But don't get discouraged because a lot of people don't have the tools. They don't know what to do. That doesn't mean they're a bad doctor. They just don't treat it. And so you need to find someone who can help you with those things. There are plenty of really well qualified doctors all around the world who'd be happy to help you. And so please don't give up hope. Please make that appointment, talk to your doctor, and use some of the tips I gave you in this episode, because it could change your life for the better.

And what are your parting words?

That you're worth it and you deserve to take time for yourself, to take care of your body. Invest in yourself so that you can invest in others like you want to.

Doctor Reena, I'm literally going to go to lay down on my floor and start doing those pelvic floor exercises, even though I have a sling, is, in describing it the way that you did, I now understand why this is important and that my bladder and the rectum and like it all deserves to have that pelvic floor strength in place because I want to live a long and vibrant and healthy life and taking care of that now and making it something that I care about will help me do that.

Absolutely.

And so thank you. Thank you. Thank you for explaining it in a way that I can understand it. Thank you for giving us tools that we can start using immediately. And thank you for empowering us to not feel so ashamed about these things that are so common and you can do something to improve your quality of life. So I just so appreciate you hopping on a plane and being here with us. We love you.

Thank you for sharing your story, because that's so important.

My pleasure. And for you. Thank you for tuning in and listening to this because it's not the sexiest topic, but having struggled with this personally for more than a decade and knowing the way that it can rob you of your dignity and your quality of life, this is so important for you to empower yourself to address and to face and to stop feeling ashamed about because common. But you don't have to live with it. And so I hope through my story and through the expert advice, you feel empowered, you feel inspired, and you feel equipped to take better care of yourself and to get the expert help that you deserve. And in case no one else tells you today, I wanted to be sure to say, I love you. I believe in you. I'm proud of you for listening to this and empowering yourself and the people that you love. And I hope that you use every single word that she shared with you to improve your life. Alrighty. I'll talk to you in a few days. And I'm not talking about dribbling on the basketball court. I'm talking about dribbling after you go to the bathroom.

I'm gonna say that again.

That sounds like a UTI if you ask me. Your pelvic floor and your. Okay. How are we going to get. Get out of this? What's the closest? I don't know. What the. Okay. Okay.

There we go.

I'll do that later.

Thank you.

Wow. That was so good.

Thank you. Thank you.

Oh, and one more thing. And no, this is not a blooper. This is the legal language. You know, what the lawyers write and what I need to read to you. This podcast is presented solely for educational and entertainment purposes. I'm just your friend. I am not a licensed therapist. And this podcast is not intended as a substitute for the advice of a physician, professional coach, psychotherapist, or other qualified professional. Got it? Good. I'll see you in the next episode. Stitcher.