As many as one in three of us suffers from bladder trouble. Here, the best remedies for lasting relief.

The days of being shy about PMS and pregnancy pain are way over. But that bladder accident or the fact that your insides feel like theyre falling out of your vagina? Now, thats embarrassing. And thats why millions of women may be suffering in silence. A recent study found that up to one in three women under age 54 has an overactive bladder, dropped pelvic organs, or another pelvic-floor disorder. Vaginal childbirths are often cited as a big risk factor, and being overweight ups the odds. The good news: These disorders are easy to treat, says Karl Luber, MD, a urogynecologist at Kaiser Permanente San Diego Medical Center. Here, three clues that you may have a pelvic-floor disorder and how to find relief.

You cant stop going
Problem: Overactive bladder. You have such a strong urge that its overwhelming (even when your bladder is half-full) and leakage is often the byproduct.

Solutions: Kegels, the squeeze-and-hold exercise specifically designed to target the pelvic floor postpregnancy, can help strengthen the area around the bladder and reduce the urge to go. Combining Kegels with behavior modification (scheduling your bathroom trips, resisting the urge to urinate between trips, and gradually expanding the intervals between trips) can be especially effective. Prescription meds like Detrol and Ditropan can help, too.

The newest treatment: Botox injected into the bladder muscle. Though the Food and Drug Administration (FDA) hasnt approved it yet, lots of docs are already using it successfully. “Botox works the same way on the bladder as it does for wrinkles—it paralyzes the bladder so it doesnt contract at inappropriate times,” says Tiffany Sotelo, MD, director of the Pelvic Floor Center at George Washington University Hospital. Ask your doctor for more info. The treatment may need to be repeated and may not be covered by insurance.

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  • You cough and a little urine leaks out
  • Problem: Stress incontinence. Weakening of the tissues and structures around the urethra (bladder neck) can prevent it from holding back urine when even the slightest activity puts pressure on the abdomen (and watch out during more-energetic activities like sex or exercise). The same may happen with stool or gas, due to damage to the ring of muscles that keep the anus closed.

Solutions: Exercises that strengthen the area can help. Ask your doctor to refer you to a physical therapist specializing in pelvic-floor disorders, or check with the American Physical Therapy Association ( or the National Association for
Continence ( Believe it or not, wearing 1- to 2-inch heels may help strengthen the key muscles, too, according to a new European study. The heels lead to a tilting of the pelvis that contracts those muscles.

Another option is biofeedback, which uses a computer screen to show when youre squeezing the right muscles. To find a biofeedback expert, check with the Biofeedback Certification Institute of America ( Dietary changes are also helpful: Eat more fiber to normalize the stool and avoid caffeine, carbonated beverages, dairy, spicy foods, and acidic fruit (like oranges and pineapples), which can irritate the bladder.

Incontinence symptoms can also be eased with a pessary, a small rubber device (kind of like a diaphragm) that is placed inside the vagina and may help support the urethra. “Its essentially like putting in a tampon,” Sotelo says. And some doctors may administer collagen injections; instead of pumping up your lips, it pumps up your urethra, allowing it to hold back urine.

Theres a surgical fix, too, and these days its relatively minor. While youre under general anesthesia, a small mesh sling is placed through a tiny incision in your vagina. The sling supports the urethra, keeping it closed when the pressure comes.

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  • Somethings falling out down there
  • Problem:Pelvic-organ prolapse, or when pelvic organs protrude into the vagina. A large baby, a long labor, and the use of forceps and extraction devices all can increase your risk. Other common risk factors include obesity, hysterectomy, menopause (the reduction of estrogen further weakens the pelvic floor), and straining from constipation. The condition can cause pelvic and back discomfort, increased urinary tract infections, and problems emptying the bladder or bowel. A new Johns Hopkins University study found that symptoms are also associated with diminished arousal, infrequent orgasms, and painful sex. And research from St. Louis University found that pelvic-organ prolapse may run in families, which increases the risk by 40 percent.

Solutions: Kegels again! “If done right, these can do wonders, because they strengthen the muscles that hold everything up,” says Marie Fidela Paraiso, MD, director of The Cleveland Clinics Center for Urogynecology and Reconstructive Pelvic Surgery. Another treatment: pessaries (some are used for prolapse, incontinence, or both) to hold the organs in place; some can be inserted and removed by you, while others require doctor assistance. Surgical repairs can also be extremely effective. Many of these procedures are done through the navel or a small incision in the vagina and have cure rates between 70 and 100 percent, Paraiso says. To find the right treatment, ask your doctor to recommend a pelvic-floor specialist.