Do you feel like you have to pee all the time?  How about a pressure feeling on the bladder?  Assuming there is no burning or blood in the urine, it probably is not an infection.  If you are a woman, it is a good possibility you are dealing with a uterus that is falling/sliding backwards and down between the bladder and bowel putting pressure on the bladder.  Normally the uterus should be laying above the bladder and not trying to squeeze in between the bladder and bowel.

This is a terribly common condition that shows up because of a weakness in the pelvic floor muscles.  The most common reason for this weakness is childbirth.  Carrying a child inside you stretches out your muscles a great deal.  Men can also have a pelvic floor weakness, but it is more common in women because of the whole birthing thing.  Common causes are:
some types of prostate surgery
neurological problems
Parkinson’s disease
urinary retention
persistent straining to empty the bladder or bowel with or without constipation
persistent heavy lifting
a chronic cough (from smoking, chronic bronchitis or asthma)
being overweight
lack of regular exercise

Of greater concern for most folks, rather than the bladder pressure, is actual urinary leakage or even fecal incontinence.  The ultimate concern is an actual prolapse of the uterus or colon; not a pleasant thought.  But the bottom line (no pun intended) is the weakness of the muscles of the pelvic floor.

The first approach to correcting the weakness of the pelvic floor muscles (the muscles between the tailbone and the pubic bone in the front of the pelvis) was published in 1948 by Dr. Arnold Kegel.  His exercises became known as Kegel exercises and the pelvic floor muscles as a group are often referred to as the Kegel muscles.  You can best experience the function of these muscles if you try to stop your urine flow mid-stream or try to prevent yourself from passing gas.  These are the Kegel muscles in action.

The now classic approach to solving pelvic floor weakness and the resulting incontinence and prolapse is to engage a program of Kegel exercises several times a week.  It usually takes 8 to 12 weeks to see results.  This exercise program is then kept up for the rest of your life.  There are two difficulties with this approach.  The exercises are difficult to do correctly and Kegel exercises are often not enough.

The pelvic floor muscles are a basket of muscles in the lower pelvis that closely interact with our core stabilizer muscles of the lower abdominal region.  Proper pelvic muscle tension requires proper spinal posture.  If the pelvis is tipped forward (sway back) or backward (tail tucked under – the typical posture when we sit and slouch), the pelvic muscles do not contract properly and get weak.  Similarly, the proper function of the pelvic floor muscles requires proper functioning of the nerves of the low back.  Put in simple terms, if you low back is out or you have poor posture, you will have weakening of your pelvic floor.

Last week one of my patients forwarded a video to me of this 70-year-old English grandmother demonstrating simple pelvic floor exercises you do while laying in bed.  The person creating the video had taken the granny to her Pilates teacher who was completely blown away by how strong the old gal was.  What particularly impressed me were some of the benefits of doing these exercises beyond pelvic muscle tone.  Her whole core is very strong, which stabilized the low back and eliminated her previous back issues.  The increased circulation from doing the exercises also thickened her vaginal lining to like it was 20 years earlier.  Usually women use HRT – hormone replacement therapy to achieve this result, but the exercise made this unnecessary.

What other options are available? A huge adult diaper industry has sprung up over the last 20 years and is making loads of money for the manufacturers.  Unfortunately, diapers are not environment friendly.  We don’t really need landfills full of dirty diapers.  Surgery is also an option in which a sling of mesh is screwed into the front and back of the pelvis to hold up the organs.  This works sometimes, but the couple patients of mine that have had this done have not been happy with the issues of ongoing pain from the sling.

Exercises are the best option from what I have seen, and the four sets of exercises the grandma was doing looks like a very doable program as you simply do them as you are getting ready to go to sleep.  So check out the videos and consider strengthening your pelvic floor, even if you don’t have any issues yet.  Deep pelvic core stability can only benefit you and save you problems of many sorts down the road.

Take care,