Urogynaecological conditions: prolapse, bladder and pelvic floor problems
Managing through lifestyle changes
Lifestyle changes – like exercise, looking after diet and digestion, and wearing incontinence pads – can be used to help manage urogynaecological symptoms. Some people we talked to told us that changes to lifestyle had improved or stopped their symptoms.
This section covers:
· Physical activity, exercise, and weight management
· Food and drink, including bladder training
· Bowel and gut health
· Vitamins and supplements
· Using incontinence pads and clothing choices
· Relaxation and looking after yourself
In this section we use the terms:
Pelvic organ prolapse (prolapse) is a condition in which pelvic organs, like the bladder and uterus (sometimes called the womb), move down or slip out of place and may bulge into the vagina.
Urinary incontinence is the unintentional loss of wee/urine. There are other bladder symptoms that do not involve incontinence, such as needing to urinate a lot, getting up at night a lot for a wee, or difficulties emptying the bladder.
UTIs (Urinary Tract Infections) are when bacteria infect the system that stores urine (such as the bladder). There are other types of conditions that can involve bladder irritation and pain, such as interstitial cystitis (also called bladder pain syndrome).
Physical activity, exercise, and weight management
For some, starting or getting back to being active was an important way of managing the emotional and physical impacts of urogynaecological problems. People mentioned a variety of different forms of exercise, including walking, running, strength training, and yoga. To read more specifically about pelvic floor exercises, also called Kegels, see the section on physiotherapy.
Kerry worries that some exercises could make her prolapse worse, so she has sought out different ways to stay active.
Kerry worries that some exercises could make her prolapse worse, so she has sought out different ways to stay active.
I’ve always been quite active. I know that if I’ve very physically active, like we do a lot of gardening, if I’m very, I do a lot of lifting and shifting of sort of digging ground that I feel it the next day in terms of the prolapse, that’s not always the best thing for me. I did, I was using a rebounder, I don’t know if you know what a rebounder is, so like a little trampoline that you exercise on because that’s very joint friendly and it’s very good for the lymph system and I’ve had to stop that completely which I’m sad about but again I can’t risk making things worse so yeah. But everything else, we walk a lot, it hasn’t stopped me walking. I think very early on I was I used the Nordic walking sticks sometimes and they, they provided quite a lot of support because they lift you through the core when you walk that push with sticks and again I’ve pretty well stopped that but I know they’re there if I have a bad day and I want to go for a walk, I can use the sticks. We cycle a lot; the cycling seems to help. Swimming is fine. So, there’s plenty of exercise that I can do, yeah and everything else, yeah, it’s not impacted.
Jo, Rose, and Kerry had been told that some forms of activity could make their pelvic floor issues worse. Rose had worried about running with a prolapse, but felt confident enough to get back to it when she found a pessary (a plastic device to hold the vaginal tissues in place) that worked for her. Catherine was grateful to a physiotherapist who helped her get back to running, which had been a central part of her life before a previous physiotherapist had advised her to stop. She is now back to running regularly, and tries to stay mindful of the rest her body may need.
Finding more gentle or low-impact ways to exercise could be helpful, particularly for those worried about making their conditions worse. Sharon, who used to enjoy running and squash, has been pleased with the benefits of “daily gentle movement’. Kezia tried a mix of different exercise classes so that she could find some which felt helpful and avoid those which seemed to make her symptoms worse.
Catherine learnt to listen to her body after having her baby, and to take things at a slower pace.
Catherine learnt to listen to her body after having her baby, and to take things at a slower pace.
I remember the one thing that my physio and it really-, my second physio said was, “Never underestimate the power of walking,” and it’s so true. So because I couldn’t run, I was just walking every, so I was on my, when I was on my maternity leave, was I still on my maternity, even my maternity leave I was walking, it was just nice just to get out the house. And obviously my maternity leave was through the summer, so I was able to do that. But, you know, it’s like, certainly it certainly helped me, and I tell people that a lot as well particularly if they’re in the same situation. It’s like, yeah, you know, there is a light at the end of the tunnel but you’ve gotta be, it is a slow process and you are gonna have rubbish days but you just kind of got to take it kind of steady and slowly and I think that’s the thing is when you don’t realise that your body can take up to a year to go until you’ve actually get, recover from pregnancy because you can’t see it, it’s not like a broken leg where you know you’d had like the plaster and then you have physio, then you’re kind of good to go. You kind of think you’re good to go and then you do something because obviously you’ve got the pro, hormones still in your body and they can react very differently with like less elasticity within the joints and things like that and people, you know, and I’m one of them, I put my hands up, you wanna go back to how you were pre-baby but you forget that you’ve kind of had a baby if that makes sense and obviously things, your body had changed, you’ve got bigger boobs, your hips are now wider. It’s, it’s getting used to that side of the change in your body as well as well as everything, and if you’re breastfeeding, again you’re gonna have the milk still there as well and that can affect, you know, not the, affect the exercise but obviously you’d need more of the supportive bra. You might not be willing to do high impact exercise. Again, if you’ve got the prolapse and you’re incontinent, you might not want to do and again it’s those kind of things that I think we need to be more aware of I think.
For some, being active improved their symptoms. Mary X noticed that her stress incontinence improved when she was exercising a lot with a rowing machine, which she thinks must have helped strengthen her pelvic floor. Vickie, Kerry, Sharon, and Sophie did Pilates or yoga which helped to strengthen their core muscles.
Weight management was mentioned as a concern by some people, as they had found it difficult to keep active because of their urogynaecological symptoms and concerns. Jo and Janet tried to manage their weight through moderate exercise to avoid putting any extra pressure on their pelvic floors.
Tiana, a specialist urogynaecology nurse, reflects on the important but sensitive topic of weight management in relation to urogynaecological symptoms.
Tiana, a specialist urogynaecology nurse, reflects on the important but sensitive topic of weight management in relation to urogynaecological symptoms.
I’ve had more patients be concerned or, or worried about discussing their weight, and you know again we do that in a very sensitive way to say that this isn’t about the way you look, it’s about the impact it has on your, your medical, you know your, medically what this has an impact on as opposed to you know worrying about that. But often that can go hand in hand if somebody is particularly overweight, or they’re struggling to lose weight, and then that causes problems with intimacy, and, and they are, or they’re avoiding these sorts of things, and then that on top of any problems that they have with for instance incontinence during intercourse, you know that, that, that, that is also, it kind of spirals on for a lot of our patients who have one problem that they’re really worried, really concerned about, but actually then that has a knock-on effect. Or, being incontinent then isn’t allowing them to do certain exercises for them to lose the weight, and then that becomes a really, really difficult cycle that we recognise and acknowledge that it’s not easy to fix. It’s easy to have a discussion about, but it’s not easy to address.
Food and drink, including bladder training
Some people found that making changes to what they ate and drank had an impact on their urogynaecological symptoms.
Alice, Sue Y, Chelsea, and others with urinary incontinence sometimes cut back on drinks to try to relieve their urinary urgency and leakage. Holly feels she has become “a bit obsessive” about planning how much she drinks if she is going out of the house. Jenni said she sometimes doesn’t drink enough in the hope it reduced symptoms, even though she didn’t feel this was really the case.
Whilst some thought that drinking less reduced some urinary symptoms, dehydration could make urogynaecological problems worse. Jane was concerned that restricting fluids might increase the risk of getting a UTI, and drank extra water to reduce the risk of infection after having sex. Some people like Megan tried drinking cranberry juice to fight off UTIs, but they weren’t always sure that it worked. Fiona drinks plenty of water to “clean” her “insides out”. Eve makes sure that she keeps her fluids up to avoid constipation which makes her prolapse worse.
A few, like Mary X, Laura, and Leah, feel a bit confused because some people (including healthcare professionals) had told them not to drink ‘too much’, whereas others had told them to ‘drink plenty’.
Alice, who has a hearing impairment, realised that she had misheard as a child how much water she should be drinking per day, thinking it was 6-8 litres rather than 6-8 glasses. As well as reducing the overall amount of liquid she was drinking every day, she had some success with managing her overactive bladder through bladder training (also called bladder drills). Bladder training, or retraining, is a technique to increase how much urine the bladder can hold and aims to reduce symptoms of urgency and leakage. It involves waiting for a little longer before going to the toilet and increasing the amount of time slowly. After around eight weeks of bladder training, during which time Alice was tracking how much she drank and weed, she noticed that her bladder seemed to have “increasing capacity”.
Some people we talked to said that they had found out by ‘trial and error’ that certain foods or drinks could make their symptoms worse. Vickie stopped having coffee and fizzy drinks before bed, as caffeine and carbonated drinks both irritated her bladder. Jan, Jessy, Sue Y, and others also avoided drinks with caffeine, like tea and coffee, although Elly thinks it can be difficult to avoid caffeine when you are running around after young children. Alcohol also caused issues for people, including Eve and Rebecca, so they tried to avoid it. Helen and Megan avoid spices because these seem to trigger their bladder symptoms.
Megan has to watch what she eats and drinks because she has an ongoing urinary tract infection.
Megan has to watch what she eats and drinks because she has an ongoing urinary tract infection.
But cystitis is a hard one to kind of like explain and to deal with, because sometimes people think like cystitis you can help it with cranberry juice and stuff, and drink lots of water, but they tell you with the chronic UTI not to drink cranberry juice, cos that can make it worse. And when you’re on long-term antibiotics they tell you not to drink loads of water because it can flush the antibiotics out, so it’s like they’re not actually doing their job in the bladder. So it is quite different, like things that people tell you to do when you’ve got a UTI that you can’t do when you’ve got like a chronic UTI. So, and like certain foods I can’t eat, spicy foods and chocolate, I can’t have and carbonated drinks, alcohol, I don’t think I’ve had an alcoholic drink for nearly two years.
Or chocolate, that’s hard when it’s Christmas, and you can’t eat chocolate. But it’s good in a way because if I was able to eat chocolate and I’d been off work I probably would have put on loads of weight. So it’s worked out well in the end.
Helen finds it tough when food restrictions stop her from going out for a meal with friends or family. Rebecca found avoiding certain foods and caffeine required a “very restrictive way of living your life”. Laura, who is vegetarian, found that cutting out foods which can be bladder irritants, like tomatoes and citrus fruits badly limited what she could eat.
Helen finds it very difficult to relax and enjoy an evening out because she has to be careful about what she eats and drinks.
Helen finds it very difficult to relax and enjoy an evening out because she has to be careful about what she eats and drinks.
Y'know, dietary stuff. I don’t massively limit my diet but even if you try and exclude the obvious things like spicy foods and y'know, acidic foods and anything with any caffeine or y'know, even just doing that it’s still quite restrictive and y'know, you can go out for a meal and y'know, want to have a nice time. But you feel that you’ve gotta be that person whose y'know, going through the menu, asking exactly what’s in something or if you don’t you get presented with something and then you can’t eat it. And y'know, that’s not me at all. I eat absolutely anything you put in front of me, normally. You know and you can’t really drink. I mean, I find the odd glass doesn’t make any difference. But certainly you couldn’t sort of just relax and enjoy an evening, y'know, with a few drinks with friends or anything.
Bowel and gut health
This included limiting food and drinks that made symptoms worse, which for some people included alcohol and caffeine.
Eve, Janet, Alaina, Jan and others told us that they try to avoid getting constipated because it can have a dramatic effect on their prolapse or incontinence symptoms. Eve and Jan could not believe that no one had told them about the effect on the pelvic floor of getting constipated, and wish that someone had told them earlier. Jessy, Phoebe, Liz, and Kerry do their best to cut back on processed food and eat fibre to promote ‘gut health’ and avoid getting ‘bunged up’. This was difficult for Phoebe, as she has irritable bowel syndrome (IBS), which can make digesting fibre more difficult. Sophie, amongst others, tries to keep her bowels in good working order through diet, laxatives, and an occasional glycerine suppository (to soften stools).
Kerry has pelvic organ prolapse and coeliac disease (an auto-immune condition where the gut is damaged from eating gluten). She manages her diet to avoid constipation worsening her prolapse symptoms.
Kerry has pelvic organ prolapse and coeliac disease (an auto-immune condition where the gut is damaged from eating gluten). She manages her diet to avoid constipation worsening her prolapse symptoms.
I’m vegetarian anyway so I eat, my diet is very, very vegetable-based but I find that if I don’t, if I don’t get at least my five portions of fruit and veg every day and we’ve really both of us have cut back massively on processed food and I guess I haven’t eaten white bread in a very, very long time, not even the gluten free white bread. We don’t eat a lot of carbs. We do eat a very high fibre diet which keeps the bowels very, very open. I eat quite a lot of fermented food so yoghurts, I make my own sauerkraut those sort of things. They all seem to be quite important in my gut health. If I have and I can do it, you know, I can have a day where I eat pizza and, you know, those sorts of things but I have to make sure that I really probably eat a handful of prunes before I go to bed. I take my magnesium citrate every night anyway so you know, just to make sure that the stools stay soft and that it keeps me very regular. I don’t, what I don’t want is to get constipated.
Several people who had prolapse, including Eve, Kerry, and Rose, said that they sometimes had to use their fingers to ‘splint’ the back wall of their vagina to help empty their bowel. Rose says that you can get a kind of “shoehorn” device for splinting, but she finds it easier to use her thumb.
Eve got very constipated when she was pregnant and had to ‘splint’ in order to empty her bowel.
Eve got very constipated when she was pregnant and had to ‘splint’ in order to empty her bowel.
And then when I was pregnant I got very bad, badly constipated and couldn’t, I couldn’t pass it. I mean I did in the end, it probably took something like forty-five minutes and I really did what they tell you not to do and I had to strain to get it out. I also had to what they call splint which is where you use your fingers, well most people use their fingers, you can actually get a device to help support the vaginal wall to get the bowel moment out so and I think that just stretched the skin even more so now whenever, on like the groups that I was talking about, when women talk about their pregnant again for the second time, I’m always just like, “Right, okay look after your bowel health, you know, drink lots of water, keep moving. Like everyone says it but no-one really explains the consequences of like not doing those things, you know, midwifes will be like, “Oh make sure you do pelvic floor and squeeze,” and everyone thinks that’s about just oh a little bit of weeing when you sneeze or stuff like that. I don’t think it’s properly explained but your, you need to strengthen and protect your pelvic floor because it’s literally holding up your organs. I, I that’s just never been explained to, that was never explained to me so yes so keep regular, keep regular and drink lots of water and all those things that keep everything going.” I wish I’d known that because I could have actually potentially prevented that severe constipation which I’m pretty sure that probably is what made it worse second time round.
Vitamins and supplements
Some people had tried taking supplements, often in combination with lifestyle changes to diet.
Rebecca, Phyllis, Emma, and others had tried taking D-mannose (a sugar derived from fruits) for their UTIs. Other supplements tried by the people we talked to included: vitamin C, vitamin D, primrose oil, garlic tablets, quertcetin, and uva ursi. Often they had heard about these options through friends or through the internet.
Rowan’s urogynaecologist recommended she try D-mannose, which has worked really well for her.
Rowan’s urogynaecologist recommended she try D-mannose, which has worked really well for her.
Anyway, so I trundled along and this consultant urologist, male was just brilliant. Made me feel very comfortable, did all the, all the looking at because obviously knows that I’d got bladder cancer but in fact he said, “You haven’t got bladder cancer, everything’s okay but because you had chemotherapy so early on it really has affected the lining of your bladder and all the and the tubes going into your bladder,” and he said, “What I’m going to tell you to do now is not something that what I would tell people because I’ve had, he wanted to, he suggested first that I had this a hormone thing to put inside me but then he said, “Well you can’t really have that even though you’ve had breast cancer a long time ago, I wouldn’t recommend it. What I’m going to tell you to do is something that a friend of mine regularly tells ladies to do is to take a fruit sugar called D-mannose which is really-” I, “Pardon?” Anyway, so he said, “I don’t normally do this, but I think it actually might help you.”
So, I thought, ‘okay’ so I have to track that down. So Holland and Barrett sell it which is very good and you get it online and he said, “Take as much of it as you like just to see if your symptoms will settle down.” So, I started taking this and some bio stuff for my tummy to try and neutralise the acid in my tummy as well and I started taking it and I didn’t have a UTI then for six months after I’d been on antibiotics every two or three weeks so I thought, ‘oh okay’ so I kept taking it. Then I didn’t have another one for another six months. I thought, ‘oh maybe it’s stopped, it’s stopped, it’s working.’ Anyway, it’s now two years, actually two years I haven’t had a UTI, and I’ve actually recommended this to obviously female friends who’ve had constant UTIs but also to a male friend who was really, really poorly with his bladder and it’s worked in various ways for all of them including this the male friend who was having problems.
So, I can’t believe that GPs don’t know about this stuff when it’s non-invasive, it’s a fruit sugar and it’s not an antibiotic so it’s not going to lower your ability, you know, to take on antibiotics and make your immune system struggle. I don’t know if I’m phrasing this properly really but anyway so that’s my story really after, after 40 years of that pain and horribleness, I now have had two years of, of no pain, no horribleness. If I feel that I’m getting a UTI I just take more tablets and it, and it goes away.
Although some people said that taking supplements was helpful, others did not, and there is limited scientific evidence that they work. Fiona felt that vitamin D “helped a lot”, while Elizabeth found that cranberry juice “irritates it even more” when she has UTI. Phyllis found that D-mannose “doesn’t cure, but it can sometimes help the symptoms”.
Using incontinence pads and clothing choice
Many people we talked to, like Jenni, Sue X, Jessy, and Pauline, wore incontinence pads or pants to prevent urine leaks. Some wore them day and night; others only at particular times (daytime, night-time) or when exercising. Different levels of absorbency of pads were used. Pauline had to wear pads when her pessary came out and she had urine leaks. Felicity and Sue Y, who are in their 40s, felt too young to be needing a pad. Julie was embarrassed that someone might notice she was wearing an incontinence pad. Jan also found it a bit “humiliating” at first, but liked the fact that wearing a pad meant that she could keep doing sport.
Mary X opted for a more absorbent pad if she was going out and about for any length of time, and always made sure that she would be near a toilet. Freia uses rubber pants and a rubber bedsheet at night, though she sometimes still needs to change these midway through the night.
Sue Y feels too young to wear pads but has to wear them to prevent leaks.
Sue Y feels too young to wear pads but has to wear them to prevent leaks.
Well when it got really bad when I was peri-menopausal, that was probably the first time I’d started having to wear pads, which obviously I found at, you know, I was only, I don't know, mid 40s I think at the time which obviously I found not particularly nice. I didn’t, y'know, I didn’t think at mid-40s I should have to be walking around wearing pads, but there you go, I did. But giving up the caffeine and, and all of the various things I adopted did help [exhales]. I can’t do exercises where I jump. So, for instance, going on the trampoline is definitely a no, no. Star jumps are definitely a no, no. ‘Cos I’m quite sort of fit generally. I up until Covid, I used to go to the gym twice a week and I cycle and walk and all that sort of thing. So, walking it can sometimes be a problem because unless I’ve been to the toilet just before I’ve walked then I can get leakage when I’m walking. So, that’s, that’s a bit of a nuisance. Like yesterday, we were out on the beach and I had to nip up to the not very nice loo several times. So, yes, obviously, it has an impact every day. But not for some people. I know some people, people are much worse. So, y'know I do thank goodness it’s not as bad as it could be. But yes, it impacts on daily life, definitely.
Not everyone chose to wear incontinence pads. María and Julie were worried that pads might smell. Parminder found them very uncomfortable. Sophie and Iris feel that it’s important for people to get help to improve their pelvic floor muscles, rather than rely on having to wear thicker and thicker pads. Sabrina prefers not to wear a pad when she is at home. Some felt their symptoms were not severe enough to need an incontinence pad, and managed with a sanitary towel or menstrual pad, or changing underwear more often.
María prefers to bring a change of clothes with her rather than wear a pad.
María prefers to bring a change of clothes with her rather than wear a pad.
I used to use pads, pantyliners I think they are called, but then I found myself like very uncomfortable because they will become smelly easily. So I stopped using them because, also because they make me sweat more in the area, so I feel like it’s not hygienic. My mum uses, for instance I knew about them because of my mum. But then over the years I just dropped them, I don’t like to use anything. If, when I am with my period it’s like I use pads of course, but it’s really challenging because I can get infections, it gets sweaty, so I prefer not to use anything. I just like change my clothes, working from home has helped, you know like I change my clothes whenever I need them. But when I am working from office, yeah, I cannot change my clothes. But for instance if I am going one day, if I am, I know I am going somewhere for one entire day, I am going to bring a couple of panties, like in my bag, just in case you know because I never know, and I don’t want to get all like smelly, so.
A few people said they were worried about the financial and environmental costs of disposable shop-bought pads. Chloe tries to use washable absorbent pants to be ‘eco-friendly’, but this is not always practical. Freia and Mary X are concerned about the cost of pads from shops and wonder how anyone on a tight budget can afford them. Mary X was considered donating some pads to a food bank. Minnie had some incontinence pads through an NHS incontinence service but, after a mix up in communication, she was taken off the list for receiving new orders.
Freia uses environmentally friendly pads. While she is glad they are reusable, she worries about things like the energy cost and people noticing them in the laundry.
Freia uses environmentally friendly pads. While she is glad they are reusable, she worries about things like the energy cost and people noticing them in the laundry.
There’s, there’s and there’s also maybe the pads that we’re using, I know there’s the throw away ones but oh my god what’s that doing to environment as well. At least my ones would go in the wash but God knows how much my electricity’s going to be, I haven’t, I just shut my eyes to that but I’m now washing every day. I never did that before, especially living on my own, it’d be once a week and that maybe sounds disgusting but I’ve got enough clothes to do that. But now, you know, and it’s like I don’t, I think my kids must notice this when they’re staying with me, they’ll be saying, “What’s the washing machine on again for?”
But that’s my fear if they can see my pads out, my blanket pads outside and I’m thinking ‘oh what if the gardener sees them or-?’, that I’m in constant [ugh] anxiety that somebody might spot this or if I’ve got them over the radiator, they’re washed and all that and I’m thinking, ‘oh this is maybe not hygienic for drying’ but they take quite a while to dry for me then to go through two in a night and they’re expensive.
I mean they’re maybe too expensive for people as well, that’s a thing that I don’t know how older people, again especially women who are not getting their pensions they cannot afford this, all these things. This is an extra charge, you know, apart from the winter allowance, an allow- that some people need, nobody’s saying, “Well actually she needs, she’s spent a lot of money on incontinence pads”.
Jessy, Rose and Mary X told us that they tended to be a bit careful about what clothes they wore in case they had a leak. Rosie would wear black leggings and a pad if she was running, and Liz would wear a long T-shirt. Some people, like Parminder, said that they chose clothes which make it quicker to get undressed when needing the toilet.
Relaxation and looking after yourself
Managing stress and anxiety levels could help lessen the mental strain of urogynaecological symptoms. Some of the people who we talked to, like Melanie, Felicity, and Sharon, told us that they were learning to take care of themselves more and to not be so tough on themselves.
Fiona, Sharon, and others found mindfulness techniques helped to relieve stress and connect with their bodies. Sharon has become more conscious of her needs, and does not try to go at the fast pace that she used to. Melanie practices mindfulness to “get the right sort of headspace”, which has been a key way of looking after herself. Felicity takes the time to get off her computer and goes for a walk in nature. She thinks that everyone should take half an hour a day to look after themselves.
Sharon has found a more accepting way of living with prolapse which focuses on healing, rather than fixing, herself.
Sharon has found a more accepting way of living with prolapse which focuses on healing, rather than fixing, herself.
You know, I’m not gonna be fixed in the sense that I thought I was for when I was first diagnosed I was thinking, ‘I need to be fixed’ and now I’m thinking, ‘I’m not fixed but I feel healed and I feel whole again but that’s’ that’s thanks to finding a more holistic approach which is pelvic health exercises, Kegels, movement, the right kind of movement, strengthening the muscles around my pelvic floor, knowing how to safely move and stand and lift things and squat, not being afraid when I get a cough or a cold, you know, I was told, ‘Don’t get a cough or a cold’ which is terrible advice because we live in the world, we are going to get coughs and colds. I was told, ‘Don’t lift your baby,’ awful advice because you have to lift things and so I know, I have developed the tools and I and I’m stronger now but it’s taken a long time, I’ve cob-, cobbled that together from, from different people I’ve found mainly virtually because and I’ve finally found a really fabulous in-person physio but it’s taken some time.
Felicity, Anna, Sue Y and others noticed that stress and anxiety made their bladder and pelvic symptoms worse. Elizabeth, who has recurrent urinary tract infections, has tried complementary therapies, acupuncture, hypnotherapy, and “mind over matter” techniques. However, she told us that it doesn’t help if people imply that physical health problems are instead “an anxiety issue”. Georgina and Mehar tried to distract themselves from their symptoms by focusing on other things.
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