As women, all of us have issues that may make healthy aging difficult. Sometimes these issues involve the pelvic area.
I recently had the chance to address some of these issues with one of my patients. A patient I’ll call Susan came to see me because she was experiencing pelvic pain with intercourse and a leaking bladder.
As I do with all my patients, I asked her the following question: “How do you want to be in five years?” She didn’t have to think for long before she said, “Active and able to take care of myself.”
She then told me about her mother who had experienced pelvic prolapse—a condition where the ligaments and muscles that support the bladder, rectum, vagina and uterus begin to relax, causing these parts to fall out partially or all the way. When these parts “drop,” women may begin to experience any or all of the following: difficulty emptying their bladder, leaking urine, and difficulty or pain with intercourse.
Susan’s mom had dealt with several of these issues, which limited her ability to be active and maintain her healthy weight. In fact, the leaking and weight gain from being inactive sped up how soon she had to move into a nursing home and forced her to become dependent on others far too soon.
Susan was afraid of losing her independence, so she came to me to find out how she could stay active and healthy.
Susan had been experiencing pain with intercourse for more than a year, which she had accepted as a result of aging. She thought there weren’t any options for treating the pain, but she really wanted to have intercourse without pain.
On the plus side, Susan was 15 months from her last menstrual period, and her hot flashes were just starting to get better. She had begun reading our blogs and learned some healthy lifestyle techniques: drink plenty of water, be aware of triggers such as sugar and stress, and get plenty of sleep.
She had chosen not to take hormone replacement therapy, and therefore thought there were no options for menopausal vaginal dryness and bladder leaking.
After examining Susan, I found she had obvious low estrogen effect with a high pH (low acid level), flat vaginal walls and pale vaginal skin. Her pelvic muscles were tight and tender to touch; there was no infection, and the outside skin appeared normal. In addition, I noticed some relaxation of her bladder neck, which would explain her leaking.
Looking at all these factors, I diagnosed Susan with menopausal vaginal dryness and high-tone pelvic floor dysfunction.
What does all this mean?
In simple terms, Susan’s estrogen level was low in her vagina, causing dryness, and her muscles were tight, causing her to have pain every time she tried to have intercourse. So, we made a plan: she decided to try vaginal estrogen and meet with one of the specialists with Spectrum Health’s Pelvic Rehabilitation Program.
When Susan went to her appointment, she talked with the pelvic floor specialists about both her concerns and her goals, and then she had a physical exam. They also found tight pelvic muscles in a much more detailed way than I did, and they were able to teach her some pelvic floor exercises for her leaky bladder.
They also recommended that she use dilators to help teach her pelvic floor muscles to relax and allow for intercourse without pain.
I’m happy to report that after three months, Susan came back to me for a recheck and was so happy.
After two months of exercise, her bladder leaking had improved, the dilators had helped her muscles relax, and the vaginal estrogen therapy helped her have intercourse without any pain.
When Susan first came to see me, she had two main goals, and we were able to achieve both of those goals within just a few short months.