Managing urogynaecological conditions 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.

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.

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.

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.

Sian found that she got more infections when she got dehydrated.

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.

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.

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.

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.

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.

Rebecca takes D-mannose as a preventative measure after having sex. She finds it frustrating that women have to be “like pioneers” to figure out what works for them.

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”.

Jane manages her UTI symptoms with over-counter UTI sachets and D-mannose.

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.

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.

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.

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.

Parminder is careful about choosing clothes that mean that she can go to the toilet quickly.

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.

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.

Georgina gets lost in a book or TV programme to distract herself from pain.

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