Is it just me? Do the commercials on TV and print ads for urinary incontinence get on other women’s nerves? Based on what multiple marketing campaigns in the incontinence care industry would have you believe, if you use certain incontinence pads and undergarments, you will feel sexy, savvy, strong, and empowered, even if you are peeing in your pants. Suggesting women feel sexy or empowered because they are using an absorbent product to trap leakage flies in the face of common sense. As a pelvic organ prolapse (POP) patient advocate who talks out loud about all types of incontinence with women of all ages nearly every day, I find commercials and print ads that suggest incontinence and being sexy are synonymous ludicrous. And as a woman, I find this message insulting to my intelligence.
According to Euromonitor International, global retail sales of adult incontinence products reached nearly $10 billion in 2019 and are expected to exceed $14 billion by 2024. I am certainly in favor of women boldly embracing sexual empowerment, right alongside vaginal health empowerment. But absorbent products, as helpful as they are to the millions of women who use them, are a bandage to cover up a faulty system in need of repair. Shame on marketers who sexualize incontinence to increase market grab rather than focus on awareness and de-stigmatization of common incontinence health manifestations in women. If incontinence product marketers want to reach the hearts of those utilizing their products, they would more likely expand brand loyalty by educating women about how common urinary incontinence is, the types that can occur, and the reasons it may occur.
I have experienced multiple stigmatizing women’s health symptoms at this point in my life. Urine retention. Stress urinary incontinence. Overactive bladder. Chronic constipation. An unsettling episode of fecal incontinence at the airport prior to heading off to Nepal related to my nonprofit efforts. While I never felt highly stigmatized by these experiences, I had never given much thought to talking out loud about them prior to becoming a POP patient advocate and realizing how incapacitating the shroud of silence is to women’s health awareness.
One of the perks of sharing stigmatizing aspects of POP is I am approached from time to time to test nonsurgical programs, treatments, and devices developed to address POP symptoms, including urinary incontinence. I nearly always enthusiastically agree to play guinea pig. My intent is to evaluate new tools developed to strengthen and optimize core and pelvic floor structure and function, to provide insights to the women Association for Pelvic Organ Prolapse Support guides and supports, and of course, to enhance my personal health “maintenance for life” ritual. I have a drawer full of devices I have tested over the years. Until recently I felt they all fell a tad short of optimal. That is until I was introduced to leva, a biofeedback app based pelvic floor strengthening device developed by Renovia.
First let’s review some basics to clarify the source of the pelvic floor issues we women commonly navigate. The levator ani (pelvic floor) muscle group is a support structure that sits below the pelvic organs (bladder, uterus, and rectum), and helps maintain their position within the pelvic cavity along with support structures that suspend them from above. The bowl-shaped pelvic floor muscle has 3 individual arms which can become weakened or damaged as a result of childbirth or menopause, and/or lifestyle, behaviors, or co-existing health conditions. Multiple structures that enable urination, defecation, and sexual function pass through this muscle structure, and that is where aspects of women’s vaginal and pelvic wellness start to break down, literally.
To flesh out my backdrop, I had a hysterectomy and 1 ovary removed in 1994. In 2008 I had surgery to address 3 of the 5 types of pelvic organ prolapse, cystocele (bladder), rectocele (rectum), and enterocele (intestines), and was grade 3 severity. Additionally, a sling was inserted to prevent incontinence onset post POP repair (grade 3 usually masks urinary incontinence, crimping the urethra like a bent hose). Polypropylene mesh was used for cystocele and rectocele repairs; I am a transvaginal mesh success story. For a decade post-surgery, I had no leakage issues. But as often occurs with time, age and lifestyle may impact health ballast regardless the treatments or procedures we utilize in our efforts to remain in an optimized state of health. Post-surgery, despite my successful surgical repairs and a decades-long fitness regimen, I started experiencing minor urinary incontinence issues. Gastroesophageal reflux disease (GERD) became a facet of daily navigation and included a persistent, aggressive cough which most certainly trashed my pelvic floor strength and integrity. When I coughed, I could place my hand on my introitus (tissue surrounding the vaginal opening), and literally feel the tissues blasting downward every time my GERD hack occurred.
And then I had a conversation about leva with urogynecologist Samantha Pulliam, Chief Medical Officer at Renovia. Here are the basics.
Renovia’s leva device is an FDA cleared pelvic floor muscle trainer with biofeedback visualization technology that enables patients to view the real-time strength of their contractions in a digital application on their phone. The intent is to target the muscles predominately responsible for maintaining continence by rehabilitating and strengthening weak pelvic floor muscles to treat stress, mixed, and mild to moderate urge incontinence (including overactive bladder) in women. Patients can complete training in the privacy of their home in less than 5 minutes, twice a day. This device enables patients to track, review, and share their data with clinicians (leva is prescribed for patients by physicians).
After my fact-finding queries were satiated, I began my 12-week baseline regimen on November 23, 2020. Starting any new fitness program has a learning curve. After the usual stumbling to figure out the system day 1, I found the device very user friendly, prompting me through the next steps as is the norm with most apps these days. I wondered if the GERD symptoms of reflux and abdominal bloat would impact my training. They did not. My GERD was particularly bad that first day, my introitus felt “open” from the repetitive coughing, and my overactive bladder urge was pronounced.
What I discovered in the first 2 weeks of training truly surprised me. Turns out I had developed a habit of keeping both core and floor muscles simultaneously contracted nearly all the time in an attempt to maintain core/floor strength. I did not recognize that I was walking around in a state of pelvic floor lockdown, reducing my pelvic floor strength (to be fully functional, it is pivotal to fully relax pelvic floor muscles prior to contracting them, which leva instructs you to do during the exercising phase). Interestingly, I quickly recognized a reduction in overactive bladder urge once I learned to fully relax my pelvic floor, and leakage was radically reduced so quickly it was shocking. Another quick perk - urine hesitancy also quickly fell by the wayside. I did not realize the daily habits I had established were disabling my pelvic and vaginal health. As I relaxed into the program, contracting the core and floor separately became easy-peasy. While intent of testing leva was related to urinary incontinence, I was curious if there would be additional value regarding other pelvic floor related issues. There was.
Concerns I wanted to address:
Minor urine leakage when I coughed or sneezed.
Minor urine leakage sitting up to get out of bed in the morning.
High stress days = overactive bladder running amuck.
Weak urine stream.
Urination hesitancy.
Loss of sensation in anal sphincter.
Fecal urgency.
Improvements:
12/7/20, 2 weeks
Stronger urine stream.
Could relax pelvic floor completely.
OAB urge radically reduced.
Reduced cough/sneeze leakage.
Less frequent leakage getting out of bed.
No urination hesitancy.
Could relax pelvic floor completely.
Could contract core/floor as separate units.
12/23/20, 4 weeks
Much more cognizant of body tensing (in all areas, not just the pelvic floor).
Radical reduction in OAB symptoms.
Anal sensation and contraction improved; no longer needed to run to assure getting to the bathroom in time.
As I moved further into my test period, not only did bladder issues and symptoms continue to improve, but leva biofeedback additionally helped me understand the live action state of my core and pelvic floor, as well as how I reacted to external or internal stimuli. I no longer needed to make 2 bathroom stops during 3-hour road trips; I rarely need to stop at all. Daily bathroom runs radically reduced in number and instead of getting up 3 times a night to pee, 1 overnight trip did the trick. The repetitive urinary urge when working at my desk long hours stopped. When I decide to take a break and get up after several hours at the keyboard, I recognize that I have the urge to pee, but I can walk to the bathroom; no need to rush. And most significantly, leva not only helped me recognize I had a tight pelvic floor, the protocol also helped me understand how to completely relax my pelvic floor muscles prior to a contraction. There isn’t a single device I have ever tested that effectively included this step in their program. The live action visual leva provides on the app to both relax and contract the pelvic floor are unique and priceless; it is doubtful the end result would have been as optimized without it.
What I found most priceless about leva was the customer support that comes with this system. One on one tutoring and guidance regarding targeted questions is priceless and rare in apps or technology of any kind these days. To be able to literally speak with someone on the phone - priceless! As I eased my way into the program comfort zone, getting the answers I needed along the way when I was not sure if I was using the app correctly, I could see as well as feel my pelvic floor strength increasing week by week. Numbers don’t lie. While I wandered into the program with a pretty strong pelvic floor, the result of my maintenance protocol (based on lift numbers in first image), I watched them go up and up along the flow (note the dates and numbers on both app images). What I found particularly priceless was the days I didn’t do very good number wise with the program echoed how I felt physically on weaker days. I find it doubtful that any woman’s pelvic floor strength is top-notch every single day.
As a grassroots women’s vaginal and intimate health activist, I am frustrated at the insufficient focus on the biggest secret in women’s health, pelvic organ prolapse, a significant root of incontinence concerns. And as APOPS founder, I feel it is critical we address diverse vaginal, pelvic, and intimate health needs of women mid-teens through end of life in an open, de-stigmatizing way. Many women newly diagnosed with pelvic organ prolapse are not yet ready to jump to the page of surgery, and that is a good thing. It is pivotal women understand vaginal and pelvic floor health and maintenance basics prior to taking the leap to surgery. We are creatures of habit provoked by hectic lifestyles, and rarely recognize poor pelvic floor habits unless we are informed by a clinician after the damage is done. Our routines enable us to navigate our day-to-day craziness, subconsciously committing us to rituals that frame nearly every waking and many of our sleeping hours. It is imperative women educate themselves about their female anatomy as well as pelvic organ prolapse, likely the most common female health malady. Women must understand the value of both strengthening and relaxing the pelvic floor, and experiment with diverse non-surgical treatments until they find the right fit for their needs. If/when women move forward with surgery, maintaining pelvic floor function is critical to optimize vaginal health long term. We continue to brush our teeth after we have them cleaned at the dentist; why wouldn’t we want to maintain the integrity of our urinary, defecatory, and sexual health systems?
Disclaimer:
Renovia, the company that developed the leva device, does not claim or have studies validating benefits beyond treating urinary incontinence. The information shared in this article is the experience of Sherrie Palm, who has no monetary or other conflicts of interest to disclose.
#APOPS #womenshealthempowerment #EveryVoiceMatters