Leaky Bladder, Pelvic Floor, UTIs, & Constipation: Dr. Rena Malik Gives Solutions To Get Control

Key wellness strategies & self-care takeaways (pelvic floor, bladder, constipation, UTIs)

1) Reframe pelvic floor problems: common, but not “normal”

Pelvic floor issues can affect urinary function, bowel movements/constipation, pain, and sexual function.

Common symptoms like leaking, urgency, frequency, constipation, and pain are often fixable and manageable—don’t assume you must “suffer in silence.”

2) Know the main symptoms to take action

Urinary

• Urgency (“gotta go”)
• Frequency (going more often than usual)
• Leakage
  • Stress incontinence: leaking with cough/sneeze/heavy lifting/exercise
  • Urge incontinence: leaking when you can’t make it to the bathroom
• Difficulty emptying bladder
• Pain with urination, especially if UTI testing is negative

Pelvic/vaginal/sexual

• Pelvic pain, pain in vagina, or pain with sex
• Pain with orgasm
• Related pain can include hip/back pain

Bowel

• Constipation or trouble evacuating
• Possible connection: pelvic floor muscles not relaxing properly can worsen constipation

3) Get evaluated holistically (not just “urine only”)

Consider seeing a urologist/pelvic surgeon/urogynecologist/female pelvic medicine specialist and/or a pelvic floor physical therapist.

A good clinician should consider connections between:

• urinary symptoms
• constipation
• neurologic factors (e.g., spine/back injury)
• sexual function

Quality of life matters, including issues like sleep disruption, falling risk, and emotional impact.

4) Pelvic floor training: strengthen or relax—depending on what you have

Pelvic floor muscles can be:

• Weak (often after childbirth/strain/certain jobs/conditions)
• Too tight/tense (common in some younger, highly active people; athletes/gymnasts; breath-holding with exertion)

Important guidance

Don’t assume Kegels are right for everyone:

• If the pelvic floor is tight, Kegels can make symptoms worse.

Proper assessment can be done clinically (e.g., an exam to check whether muscles are weak vs tense).

If you’re doing Kegels (for weakness)

• Use the “stop pee / hold a fart” idea to identify the correct muscles (not as a daily practice).
• Start lying down for control.
• Typical progression mentioned:
  • 5 seconds squeeze / 5 seconds relax, repeat 10–15
  • progress once/day → twice/day
  • later progress to sitting → standing
• Best practice: work with a pelvic floor PT to ensure correct technique and progression.

If pelvic floor is tight (focus on elongation/relaxation)

Better strategies include stretching/relaxing options such as:

• Happy Baby pose
• Child’s pose
• Deep low squat

General principle: stretch/elongate rather than “crush” with more contraction.

5) Lifestyle moves that help bladder symptoms (especially overactive bladder)

Track patterns

• Use an OAB diary (drink/when you pee/how much/urgency/frequency).
• It can be therapeutic, not just diagnostic.

Avoid bladder irritants

• Smoking
• Alcohol and caffeine
  • can increase urgency/frequency by affecting bladder sensitivity and acting as mild diuretics
  • suggested approach: experiment (e.g., half-calf/half-caffeine) to identify your personal triggers

Manage body weight (if relevant)

• If overweight, losing ~8% body weight may significantly improve urinary issues.

6) Constipation support (and how it links to urinary issues)

• Increase fiber
• Increase fluid alongside fiber
• Increase movement (walking helps stool mobility)

Helpful constipation foods:

• Dates
• Kiwis

A practical recipe-style strategy mentioned (for some people):

• applesauce + prune/prune juice + a bit of fiber (e.g., a brand fiber) and take a spoonful

7) UTIs: prevention + when to worry

Recurrent UTI definition (as stated)

• 2 in 6 months or 3 in 1 year

Prevention strategies

• Hydration: drinking 2–3 liters/day can reduce UTI risk (as cited)
• Cranberry (with product quality notes):
  • choose concentrated cranberry/supplement made from the berry fruit (not low-juice “cocktails”)
  • look for 36 mg proanthocyanidins (PACs)

When symptoms overlap with UTI

Pain/burning can occur with a tight pelvic floor even when cultures are negative—often described as “UTI-like” pain with recurrent negative tests.

Check for other causes

If recurrent UTIs continue, clinicians should rule out:

• stones (kidney stones)
• post-procedure issues (e.g., after sling surgery)
• incomplete bladder emptying

8) Overactive bladder “night peeing” guidance

Typical guidance given:

• Younger than ~55: generally 0 times/night
• 55–65: usually about once/night

For sleep protection:

• reduce nighttime fluids if needed (e.g., stop a bedside glass and avoid large late drinks)

9) Incontinence during exercise: options (not just suffering)

Over-the-counter tools (mentioned)

• Tampon-like urethral support (pressure on urethra)

In-office options

• Pessary options fitted in-office (different shapes/sizes; can support/lift and reduce leakage)

Procedures (briefly discussed)

• Bulking agents: injected cushion to add resistance at the urethra
• Slings: support under urethra (mesh or patient tissue approaches mentioned)
• Office procedures / minimal downtime described

10) Difficulty emptying: practical techniques

• Some people need maneuvers to fully empty.

Example strategies mentioned:

• Sit/lean forward with legs spread to relax and help flow
• If not fully emptied: stand up, walk around, and try again
• For women with incomplete emptying: may require medical evaluation (and in some cases splinting techniques are described clinically)

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Presenters / sources

• Dr. Rena Malik (board-certified urologist; female pelvic medicine and reconstructive surgery; sexual health expert)
• Mel (host; “your buddy Mel”)