The Mel Robbins PodcastLeaky Bladder, Pelvic Floor, UTIs, & Constipation: Dr. Rena Malik Gives Solutions To Get Control
CHAPTERS
- 0:00 – 5:01
Why pelvic floor symptoms are common—but not “normal”
Mel introduces the topic through her own experience and Dr. Rena Malik frames a key theme: many bladder/bowel symptoms are widespread but still treatable. They define what healthy bladder function looks like and why people shouldn’t normalize ongoing leakage, urgency, or constipation.
- •Pelvic floor problems are common yet often correctable
- •Normal bladder function: hold, delay appropriately, empty fully, no bothersome urgency/leakage
- •Reframing symptoms reduces isolation and self-blame
- •Empowerment through understanding options and seeking care
- 5:01 – 8:46
Mel’s traumatic birth story and the hidden quality-of-life cost of leakage
Mel describes a forceps/vacuum delivery with significant trauma and how it led to years of stress incontinence and avoidance of activities. The chapter underscores how shame and fear delay treatment, sometimes for decades.
- •Birth trauma and subsequent chronic leakage
- •Behavior changes: avoiding running, hiking, dancing; relying on pads
- •Shame and embarrassment prevent early intervention
- •Delaying care can worsen severity and limit conservative options
- 8:46 – 10:55
Recognizing pelvic floor problems: urinary, bowel, and pain symptoms
Dr. Malik lays out common symptom patterns that can point to pelvic floor dysfunction, spanning bladder control, bowel function, and sexual/pelvic pain. She also clarifies the difference between stress vs urge incontinence and when to involve specialists.
- •Urgency/frequency, stress vs urge incontinence, incomplete emptying
- •Pain with urination when cultures are negative can be pelvic floor related
- •Constipation and outlet issues can reflect failure to relax pelvic muscles
- •Seek evaluation (urologist/urogynecologist/pelvic floor experts) especially if pain or bothered
- 10:55 – 14:17
Why these issues are underdiagnosed: prevalence, interconnected systems, and the shame spiral
They discuss how many people experience prolapse and leakage, yet remain untreated because symptoms are minimized. Dr. Malik explains how constipation, neurologic issues, and urinary symptoms interact—and how shame leads to social withdrawal and depression.
- •High prevalence: leakage affects up to ~1/3 of women; prolapse up to ~40%
- •Urogynecology should address urinary + bowel + neurologic + sexual health holistically
- •Constipation can worsen urgency/frequency and UTI risk by pressure effects
- •Incontinence impacts social life, mental health, and finances (pads/diapers)
- 14:17 – 17:30
Pelvic floor anatomy made simple: the ‘bowl of muscles’ that supports organs
Dr. Malik explains the pelvic floor as layered muscles forming part of the core, attaching to pelvic bones and tailbone, and supporting bladder/uterus/rectum. They cover how clinicians assess function and why these muscles affect continence, stability, orgasm, and lymphatic flow.
- •Pelvic floor is part of the core, not just abs
- •Supports organs and controls urinary/anal sphincters
- •Activates with movement; contributes to stability and sexual function
- •Clinical assessment can gauge strength vs tension (vaginal or rectal exam)
- 17:30 – 20:23
Why pelvic floor muscles stop working: childbirth strain, chronic pressure, and other risks
The conversation shifts to what weak pelvic floors look like and why weakness happens. Dr. Malik lists key risk factors and introduces the idea that symptoms are usually not dangerous—but they can be highly disruptive and should be addressed.
- •Major contributors: pregnancy load + vaginal delivery trauma
- •Other risks: standing jobs, chronic cough, neurologic/genetic conditions
- •Weakness often presents as stress incontinence (cough/sneeze/exercise leakage)
- •Reassurance: not typically dangerous, but quality-of-life matters
- 20:23 – 23:16
Kegels 101: doing them correctly, progressing safely, and self-testing
Dr. Malik explains that most people perform Kegels incorrectly and outlines a practical progression plan starting lying down. She offers ways to locate the correct muscles (without turning every bathroom trip into a workout) and emphasizes pelvic floor physical therapy as a ‘trainer’ for this muscle group.
- •Correct cue: squeeze ‘up and in’—without tightening belly or glutes
- •Progression: lying down → sitting → standing; 5s squeeze/5s relax; 10–15 reps
- •Self-check: finger in vagina to feel squeeze/relax; brief ‘stop the stream’ only to identify muscles
- •Pelvic floor physical therapy improves technique and outcomes
- 23:16 – 25:52
Leakage in young women and athletes: tight pelvic floors, breathing mechanics, and training mistakes
They address why leakage isn’t only a postpartum issue: tension can limit pelvic floor range of motion and cause leaking during impact activities. Dr. Malik links breath-holding during lifts to pelvic floor strain and explains how proper exhale-on-exertion supports stability.
- •Young/active women may leak due to an overly tight pelvic floor, not weakness
- •High-impact activities (trampoline, gymnastics) can expose limited muscle ‘give’
- •Breath-holding increases pelvic pressure; exhale during exertion helps pelvic floor stabilize
- •Symptoms vary—individual assessment matters
- 25:52 – 28:05
When Kegels make it worse: tight pelvic floor, pain, ‘UTI-like’ symptoms, and relaxation poses
Dr. Malik cautions that pain can signal pelvic floor tension, where strengthening exercises may worsen symptoms. She shares relaxation-focused strategies and explains how tight pelvic floors can mimic recurrent UTIs despite negative cultures.
- •Pain warrants evaluation before exercises; Kegels can worsen tension
- •Tight pelvic floor can cause painful urination without infection (negative cultures)
- •Relaxation options: happy baby, child’s pose, deep squat
- •Yoga/Pilates can support pelvic floor function beyond Kegels
- 28:05 – 30:42
When leakage becomes a problem: sleep disruption, fall risk, and incomplete emptying signs
They distinguish ‘incidental’ leaks from life-impacting symptoms—especially nocturia and frequent bathroom trips. Mel describes needing positional changes to empty fully; Dr. Malik explains maneuvers like splinting and why clinicians take quality-of-life seriously.
- •Quality-of-life thresholds: nocturia, urgency that disrupts work/life, frequent infections
- •Nocturia increases fall/hip fracture risk, especially in older adults
- •Incomplete emptying can require positional maneuvers; splinting may help some people
- •Medical care shouldn’t dismiss non-life-threatening symptoms
- 30:42 – 33:25
Treatment options for stress incontinence: devices, pessaries, bulking injections, and slings
Dr. Malik lays out a stepwise menu—from over-the-counter inserts to fitted pessaries and minimally invasive procedures. Mel shares how a sling procedure dramatically improved her life after years of fear and avoidance.
- •OTC support devices (tampon-like) can reduce exercise-related leakage
- •Pessary fitting: silicone support that lifts organs and may support urethra
- •Bulking agents: in-office urethral injections to add resistance without ‘burning bridges’
- •Slings (mesh or tissue) as a supportive backboard; Mel’s personal success story
- 33:25 – 36:57
Overactive bladder (OAB): signs, nighttime urination norms, and bladder irritants
They define overactive bladder symptoms and distinguish them from high fluid intake effects. Dr. Malik explains typical nighttime urination expectations by age and how caffeine/alcohol act as bladder irritants and mild diuretics.
- •OAB signs: >8 voids/day, strong urgency, nocturia
- •Consider fluid intake context before labeling frequency as abnormal
- •Nocturia norms: typically none <~55; about once/night after ~55 (varies)
- •Caffeine and alcohol increase bladder sensitivity/spasm and can worsen urgency
- 36:57 – 38:00
Constipation strategies that also protect bladder health
Dr. Malik offers practical constipation interventions and notes that bowel health affects urinary symptoms. Diet, movement, hydration, and specific foods are emphasized alongside awareness of constipating staples.
- •Increase fiber + increase fluids; move/walk to stimulate motility
- •Foods that may help: dates, kiwis; optional prune/applesauce/bran mixture
- •Constipating foods: cheeses and meats; return to high-fiber patterns after ‘off’ weekends
- •Constipation can worsen urinary frequency/urgency and UTI susceptibility
- 38:00 – 44:16
UTIs: symptoms, prevention (hydration + cranberry), sex-related risk, and male red flags
Dr. Malik explains typical UTI symptoms, why they hurt, and when infections are considered ‘recurrent.’ They cover prevention via hydration, evidence-based cranberry supplement criteria, the constipation connection, and why UTIs in men warrant earlier evaluation.
- •Symptoms: dysuria, lower abdominal pain, urgency/frequency; sometimes back/kidney pain
- •Recurrent UTI definition: 2 in 6 months or 3 in a year
- •Prevention: 2–3L water/day can reduce UTIs ~46%; choose cranberry supplements with 36 mg PACs (not sugary cocktails)
- •Sex can mechanically introduce bacteria; options include fluids, targeted cranberry, or post-coital low-dose antibiotics; men with UTIs should see urology
- 44:16 – 48:23
Men’s urination issues: sitting vs standing, double-voiding, prostate enlargement, and dribble
They clarify the ‘men should sit to pee’ claim: sitting can relax the pelvic floor and sometimes improves emptying. Dr. Malik explains why aging prostates obstruct flow (straw analogy), how clinicians measure post-void residual, and what post-void dribble can mean.
- •Sitting may help relaxation/flow; not mandatory—comfort and effectiveness matter
- •Double-voiding technique can reduce retained urine
- •Enlarged prostate is common and narrows the urethra, causing weak stream/nocturia
- •Post-void dribble is common; causes include prostate issues, weak stream, or rarer strictures
- 48:23 – 50:58
DIY tools for OAB and the next-level treatment arsenal (including nerve stimulation and Botox)
Dr. Malik lists practical steps listeners can try before medications: tracking, avoiding irritants, managing constipation, smoking cessation, and weight loss when relevant. She then outlines advanced options such as tibial nerve stimulation (acupuncture-like), bladder Botox, and other third-line therapies.
- •Use an OAB diary to identify triggers and share with clinicians
- •Lifestyle levers: bladder irritants, fluid timing, smoking cessation, constipation management
- •Weight loss (~8% if overweight) can significantly improve urinary symptoms
- •Advanced treatments: tibial nerve stimulation, bladder Botox, and other procedural options
- 50:58 – 55:53
What to watch in urine and the most important next step: ask for help
They close with practical guidance on urine appearance and a clear call to action: don’t suffer in silence. Dr. Malik emphasizes persistence in finding appropriate help, and Mel reinforces the message that addressing pelvic health improves long-term vitality and dignity.
- •Urine color target: ‘lemonade yellow’; avoid extremes of clear or dark yellow
- •Red flags: blood in urine; unusually foamy urine; cloudy/stinky without symptoms usually just hydrate
- •If you’re struggling, ask for help and seek the right specialist if needed
- •You’re worth the time and care; treatment can be life-changing
