Bladder weakness, according to a poll by TENA and Harris Interactive.
The saddest fact is an alarming percentage of women, 43 percent, have done nothing to alleviate their symptoms, says Dr. Lauri Romanzi, a New York City-based pelvic health expert.
"More important, too few of these women know how to do the Kegel exercise," she says.
Q. OK. Kegel exercises. I think I know what this is.
A. Developed by Dr. Arnold Kegel, it is a way of contracting and relaxing the pelvic floor muscles. We teach Kegel exercise as part of our pelvic fitness spa in New York.
Q. Women don't talk about Kegeling because it's so, what, personal?
A. It's ridiculous. Men talk about the pathetic condition of erectile dysfunction without being embarrassed. Should pelvic fitness be a humiliating topic? We should be comfortable understanding our bodies and knowing what the resources are and how to get in shape. The idea that Kegel fitness is hush-hush doesn't make sense. Besides, if you Kegel you will have a better orgasm.
Q. Bladder incontinence is a midlife problem?
A. Yes, usually. There are different types, of course, ranging from "exert and squirt" to a sling. Some overactive bladder symptoms are not the type we do a surgical procedure for, of course. Symptoms such as hearing water running, putting your hands in water. But all of these are nicely treated with Kegel exercises.
Q. What about medications? The "gotta go" pills.
A. All of these medications get into the blood stream and reduce the bladder's Pavlovian trigger response. Very often, studies show, if you do the Kegel with the medications, the result is more effective, as much as a 70 to 80 percent improvement.
Q. Sounds as if women from a young age should be concerned about keeping pelvic floor muscles strong.
A. You lose these muscles by ignoring them and most women don't have a clue the muscles are there. You know, one-third of women expect to live their lives as menopausal creatures. They are aware that fitness is part of health, but they are not aware about fitness of the pelvic floor. They only hear about the pelvic floor when they are pregnant. Kegel is the dental floss of pelvic health.
Q. So when should you Kegel?
A. The average woman should do two sets of focused contractions every day, holding the contraction for five counts and doing 10 contractions.
Q. OK. How do I learn to Kegel?
A. There are pelvic floor physical therapy centers or there is a free DVD. Here's how to get the DVD and learn more about your pelvic floor. Go to tena.us/Women/exercise-area/core-wellness-program.