I’m a Millennial Who’s Never Been Pregnant—Why Am I Having Pelvic Health Problems?

The surprising things I learned about my pelvic floor and my bathroom habits

I’ve watched many of my friends make the journey into motherhood, and so I’ve heard a lot about the pelvic floor. For our millennial generation, it’s common knowledge that urinary incontinence can be a side effect of pregnancy and labour—almost one-third of women will have bladder leaks after the birth of their first child—and all my friends have prioritized pre- and/or postpartum pelvic-floor physiotherapy as prevention or treatment. Since I’ve never been pregnant, I thought I was off the hook.

Imagine my surprise when, the year I turned 35, I started waking up to pee multiple times in the night while also experiencing urgency during the day and the occasional itty-bitty leak. At first, I figured the disruption was temporary. But after about a year, I realized the problem wasn’t going away. At the time, I was busy working at a celebrity news magazine, plus I was emotionally exhausted from dealing with an early-stage cervical cancer diagnosis that required two minor surgical procedures. I was told that the urinary frequency wasn’t related to the cancer, so I put it on the back burner, even as it continued to disrupt my sleep and daily life. (My boyfriend once joked that going out with me for the day was an opportunity to tour Toronto’s many bathrooms.)

So it felt fortuitous when a press email about Urospot, a rapidly expanding chain of Canadian pelvic health clinics, popped into my inbox. If I hadn’t responded, and subsequently booked a consultation at one of the Toronto locations, I might never have learned about my body’s reaction to stress, as well as the bathroom habits that were impacting my wellness.

Urospot is a franchise that was started by entrepreneur Erin Craven in 2019. “I was in my early forties and I was struggling with bladder leaks, urgency and waking up at night to go to the washroom,” she told me. A mother of four with a busy career in the health-care industry, she believed she was too young for bladder troubles to be impacting her life. So she started researching her condition and was appalled by the lack of education and treatment—the available physio, medication and surgery options seemed disjointed, insufficient and hard to navigate, despite the fact that pelvic floor disorders likeurinary incontinence, fecal incontinence and pelvic organ prolapse affect one-quarter of all women and over a third of older women. “One of the saddest stats is that 45 percent of women [dealing with incontinence] give up intimacy entirely because they’re afraid they’ll leak during intercourse,” she says. “And 46 percent of women give up exercise. But we’re just expected to live with it and think it’s normal.” That’s why Craven created Urospot: to change the conversation around pelvic floor dysfunction and bring more treatment options to the masses.

The clinic’s buzziest attraction is its “Kegel Throne” (a.k.a. Emsella chair), which uses high-intensity focused electromagnetic stimulation (HIFEM) to strengthen the muscles of the pelvic floor. One 28-minute seating contracts the muscles the equivalent of 11,000 kegels (a form of exercise that targets the pelvic floor muscles). The difference from other places, like med-spas, that bring in Emsella technology is that Urospot also uses education and physiotherapy to create a well-rounded treatment plan. That way, if issues other than muscle weakness are present, they can be addressed.

That’s what I discovered during my first in-person meeting, when a nurse took me through a series of questionnaires commonly used by health professionals, like the Female Sexual Function Index, the Pelvic Floor Disability Index, and the Pelvic Floor Impact Questionnaire. I ended up scoring high on the short-form version of the Central Sensitization Inventory, which measures a nervous system response that can cause women to hold tension in their pelvic floors. If you sit on the Kegel Throne while your pelvic floor is in a “protective” state, it might not be beneficial. It’s like trying to do a bicep curl without fully extending your arm; you won’t be able to properly strengthen that muscle.

So, instead of having me jump straight onto the Throne, the nurse at Urospot referred me to registered physiotherapist Nicole Guitar, and I can honestly say that our first virtual consultation changed my life. I learned that pregnancy and childbirth are far from the only cause of pelvic floor dysfunction. It can also be hereditary or provoked by a chronic bad cough, surgery or weight gain. Losing estrogen during peri- and postmenopause has an impact, too. A report from the Menopause Foundation of Canada states that 23 percent of postmenopausal women struggle with incontinence. After 65, almost 24 percent of adults wake up two or more times per night to pee.

In my case, central sensitization was at least partially at play, and Guitar told me it’s a common issue for women seeking pelvic floor physiotherapy. Central sensitization occurs when the nervous system’s fight-or-flight response becomes unbalanced with the rest-and-digest response. “It often happens due to chronic stress, prolonged periods of poor sleep or as a result of an injury,” she told me. “The brain perceives there could be a threat, so it starts sending more messages along the nerves in the body involved in fight or flight—called ‘sympathetic nerves’—as opposed to the nerves involved in rest and digest—called ‘parasympathetic nerves.’ These activations keep the body on high alert.” You then live in a constant state of hypersensitivity and high tension, which can lead to grinding or clenching of the teeth; tightness in the neck or shoulders; and pain with tampon use, pelvic exams or intercourse, along with feeling like you need to pee all the time.

The version of the Central Sensitization Inventory the clinic had me complete is a nine-point questionnaire where each response scores a number of points (between 0 and 4). The highest score is 36, while a score of 20 or more indicates that the body is likely in a state of central sensitization. I scored 23. Since my body was experiencing central sensitization—possibly due to my cervical cancer diagnosis and treatment, though I find I’m almost always in an anxious, high-stress state—Guitar said it was important to practice diaphragmatic breathing to stimulate my rest-and-digest response. “The diaphragm works closely with the pelvic floor,” Guitar says. “When we take a deep, diaphragmatic inhale, that helps to relax our pelvic floor muscles. It also stimulates the vagus nerve, which tells the brain that we’re safe.”

To do a proper diaphragmatic breath, lay down and place an item like your cellphone on your lower rib cage. When you breathe in, the phone should move upward, not your upper chest. “I call it belly surfing,” she says.

Over the course of three weeks, I spent several minutes each day doing diaphragmatic breathing while sitting, resting in a supported child’s pose and rotating through “cat-cow” stretches. During these sessions, I focused on the sensation in my pelvic floor and what it felt like to release. “Creating that body awareness is really important,” says Guitar. Now, when I take some time to focus on diaphragmatic breathing and the feeling of release in my pelvis, my entire body starts to uncoil.

Guitar also told me that sleep is another part of the puzzle for regulating the nervous system. “If you have a poor night of sleep and stub your toe, you’re going to get ‘warning’ messages that it hurts more than you would have yesterday,” she says. That’s because your nerve responses will be out of balance. Practicing mindfulness and taking part in restorative movement like walking, stretching and yoga instead of cortisol-spiking workouts like CrossFit and HIIT can also be key.

But steps for reducing central sensitization aren’t all that I took away from my time with Guitar. She also gave me crucial information about how my lifestyle and habits have impacted my bladder. The first knowledge bomb she dropped: Restricting your water intake can make you pee more often. Without really noticing, I’d stopped drinking water because I didn’t want to add even more trips to the bathroom. That’s a no-no because water acts to dilute our urine. Since I wasn’t hydrating properly, other items I consumed—like caffeine, carbonated drinks, alcohol, spicy foods and acidic fruits like lemons and tomatoes—were irritating my bladder, prompting the urge to void.

To figure out your ideal water intake, Guitar recommends drinking, in ounces, half your body weight in pounds. So, if you weigh 150 pounds, you should drink 75 ounces (around 9.5 cups) of water each day.

Once I was consistently drinking enough water, Guitar asked me to track how often I was urinating and how long my stream lasted. She helped me realize that one of the reasons I pee every 60 to 75 minutes is because I can; I’ve worked from home for years and if I have a tiny urge, there’s nothing to keep me from relieving myself. That’s a problem. “A good, healthy pee happens every two to four hours and the stream should last about eight to 10 Mississippi seconds,” Guitar told me. That’s a long time. If you’re frequently peeing for only three or four seconds, which I was, that means you’re either emptying your bladder before it’s full or your bladder has shrunk. “The bladder is a muscle, which means it’s capable of changing its size and capacity like any other muscle in the body based on how it’s used,” says Guitar. “If I’m peeing all the time, my bladder is going to get smaller because it’s going to say, ‘I don’t need to hold more than this. You pee every hour anyway.’”

To retrain the bladder, Guitar recommends tracking your bathroom breaks for a couple of days and figuring out how often you typically go. Then, over a series of weeks, increase the amount of time between pees—try adding five minutes every three days. After three weeks, your bladder capacity should have grown so you can hold your pee for an average of 95 minutes instead of just 60, for example.

There’s one more tip Guitar gave me that changed the way I go to the bathroom, and it’s to buy a Squatty Potty or any stool that brings your feet up seven to nine inches when you sit on the toilet. The reason? To reduce straining during urination and bowel movements. (Did you know you’re supposed to pee without pushing? Because I didn’t.) “In North America, we’ve designed our toilets to be at 90-degree angles where it’s like we’re sitting in a chair, feet flat on the ground,” she says. “That’s not the ideal physiological position to empty our bowel or bladder.” Instead, sitting with the knees higher than the hips (a sort of modified squat) allows the pelvic floor to relax, which makes peeing and pooping easier. “Having a bowel movement or going pee should be a completely passive process.” Mind blown.

After gaining all this knowledge from Guitar, then adding positive behaviours into my life and altering some of my habits, I decided not to complete any Kegel Throne sessions at Urospot. Though HIFEM stimulation can help to strengthen the pelvic floor once someone experiencing central sensitization has learned to fully relax, my doctor told me that the treatment has a few contraindications, including those who have or recently had cancer, as the treatment increases blood flow. I was told that the Kegel Throne is safe for me because my cervical cancer was found at a very early stage and has been treated, but I still have a lot of anxiety about it and would prefer to get a few years past my diagnosis before I reconsider. That said, I did sit on the chair for five minutes just to try it. For me, it felt like mildly uncomfortable tapping right in the centre of my crotch.

Here I am, a few months on, and I haven’t experienced any leaks lately. At my last appointment, my central sensitization score moved down more than 10 percent (a win!), and I continue to practice diaphragmatic breathing whenever I feel stressed. I’ve also been drinking more water and touting the benefits of the Squatty Potty to anyone who will listen. I still pee a bit more frequently than I’d like, so I’m working on adding time between bathroom breaks and trying to avoid peeing “just in case.” I feel like I’m on the right track and am grateful for what I learned from Craven and Guitar. This type of therapy can be expensive ($2,400), especially if you don’t have insurance. But every woman deserves to prioritize her pelvic health and there are many ways to improve the situation and protect yourself. Start by talking to your doctor—and maybe give diaphragm breathing a try.

Next: How to Have a Smooth Trip to the Loo

Originally Published in Best Health Canada