Welcome to OBGYN Champs, the show where no question is off limits. Join host Morgan Allen and board-certified OB/GYN Dr. Suny Caminero, MD, as they tackle the topics women are often too embarrassed, afraid, or unsure to ask about. From hormones, menopause, and sexual wellness to pregnancy, pelvic health, cosmetic gynecology, and everything in between, each episode offers honest conversations, expert advice, and practical insights to help women confidently take control of their health.
Whether you’re in your 20s, navigating motherhood, approaching menopause, or simply looking for trustworthy answers, OBGYN Champs is your place for real talk, myth-busting, and empowering education. Tune in, ask your questions, and join the conversation because your health deserves to be talked about.
Dr. Suny Caminero, MD, OB/GYN
Founder of Cosmetic Gynecology Florida
Website Address: https://cosmeticgynecologyfl.com/
Can urinary incontinence happen for women at any age?
Dr. Suny Caminero:
Some teenagers do, but they’re not having the same type of urinary incontinence as somebody who’s pregnant or postpartum or just aging. They have it because of pressure or exercise intensity. Their pelvic floor isn’t as strong either. And when their pelvic floor isn’t as strong, you will see a young woman cough, sneeze, laugh, and kind of clasp their legs because of their incontinence.
My daughter has done it so many times where she’ll say, “Don’t make me laugh. I’m going to pee,” at 17 or 18. And then they go, “Wow, this is really happening to a young woman.” But it can happen because of pelvic floor weakness, essentially.
The pelvic floor is like a hammock. Your structure has muscles with an opening right in the middle, where the vaginal tract and the rectal tract are. That opening can expand, and if you have a lot of pressure, you can lose some of the strength of the muscle supporting the bladder and the urethra, which is a little tube that comes out of the bladder that lets you pee.
When you lose that strength, any pressure makes your muscles tighten up, and pee just comes out. So it’s also not uncommon for a teenager to have it. It’s not as bad because teenagers, you know, you exercise with the pelvic floor and you’re back to normal. For postpartum women, for example, it’s a different story, particularly if they have had a C-section or vaginal delivery.
Vaginal deliveries are definitely worse because now those muscles have stretched, and they are stretched to the point that they’re not actually really going to come back.
Can a tear from childbirth affect your urinary continence?
Dr. Suny Caminero:
A tear actually does not affect urinary leakage. A tear affects mostly the rectal area, not the urethra. It’s very uncommon to have a tear that goes to the bladder. You can have a tear in the area where you pee a little bit, but those are tiny little tears, nothing that will really cause an issue for the most part. Most of the tears, like a serious one, for example, are more at the bottom of the vagina, and that can affect the rectum more than it does the bladder.
Urinary incontinence during pregnancy comes from the pressure of that pregnancy. The pelvic floor holds it all the time. So there’s a lot of pressure. Everyone who’s been pregnant knows that at the end, you’re just walking funny like there’s a bowling ball between your legs.
Those muscles are just incredible because they’re holding all that pressure. Let’s say that you have a C-section. All those muscles were under that pressure throughout the pregnancy, right up to the end. And because of that, you can have urinary leakage. And I’m a perfect example. I have three C-sections, and I had urinary leakage with every single one postpartum. It wasn’t terrible, but it was annoying because you didn’t know when it would happen. And just doing little things will give you a little tiny drip at that time, and then you feel uncomfortable.
Now you’re thinking, “Do I have an odor or do I not have an odor?” It’s just annoying when that happens. But that can happen with a C-section. With a vaginal delivery, it’s much worse, given that the pelvic floor muscles have stretched to that degree to deliver a baby. The bigger the baby, the worse it is.
It also has to do with pelvic size. Some women have a much bigger pelvis, not because they’re necessarily bigger women, but because their pelvis is just wider. And for them, those are the women that come in, and I deliver an hour later, and they just come out, and you’re like, “Well, that’s very lucky.”
Versus some, it’s like, “I was in labor for 12 hours, and I pushed for five hours.” And if you push for that long, those muscles really are getting hit, for sure.
How do you know if you have a bigger pelvis or not?
Dr. Suny Caminero:
You really don’t know. They used to do X-rays on women to find out whether the baby could come out vaginally, but none of that actually worked. You really didn’t know until the time of delivery because the pelvis itself is almost floating. Ligaments in the pelvis allow that because high progesterone in pregnancy weakens them, and women know some of them get that pain in the pubic bone.
That allows for that pelvis to really stretch. We don’t know if it’s going to stretch a lot or not stretch; everybody is different. There’s no way of measuring that, and so you won’t know until the time to have a baby whether that pelvis is going to open up for that size, your size pelvis for your size baby.
There are different pelvises. Some pelvises are narrower, and some families have wider ones. Some pelvises are more like male-type pelvises. If I remember correctly, there are about five different pelvic shapes. And you really don’t know based on a person’s size. You have no idea based on a woman’s size whether she has a narrower or wider pelvis.
Can Kegels help with urinary incontinence after giving birth?
Dr. Suny Caminero:
Kegels do help, but most of us don’t know how to do them. There are so many things that we’re taught about how to do Kegels, but it is really hard to know if you’re exercising the right muscle.
It really would be a great thing if postpartum women had a system where they had physical therapy and pelvic floor physical therapy after delivery. In Europe, they do. In the U.S., we don’t. I would have taken that at the time that I delivered because it would have saved me three months of urinary incontinence.
You can do it in the U.S., but you have to go outside your insurance to get it. Sometimes insurance may pay for it; sometimes they may not. You have to be an advocate for yourself, and if you’re having that issue, which most women do after delivery, doing pelvic floor physical therapy sessions to get back to recovering is a fantastic idea, a fantastic idea, and to stop that urinary leakage.
What solutions do you provide to stop urinary leakage?
Dr. Suny Caminero:
Physical therapy works for young women most of the time. It’s just pretty incredible and amazing. Physical therapy does a lot, not only to fix it, but also to maintain it. If you have a weak pelvic floor, right, and you fix it, but then you don’t maintain it, that pelvic floor can become weak again.
It’s like you go to the gym, right? You go to the gym, you exercise, you’re now building your muscles. And then all of a sudden, you decide not to do it for a year or so. You lose all your gains. The pelvic floor is similar to that. You have to incorporate it into an exercise routine to keep your pelvic floor strong, so that will work.
If you have had a large baby or multiple babies, physical therapy may not work. Those muscles have stretched so much, and the pelvic floor is so weak that there’s really no number of exercises that can improve them. Women do feel like they’re like, “I’m doing this, and I’m doing the exercise, and I’m doing physical therapy. I don’t even feel my muscles move.” They don’t even feel that it’s engaging. For those women, sometimes they need surgery to bring those muscles back together and strengthen the pelvic floor.
There are different types of urinary leakage. For the most part, postpartum women have more of what we call stress urinary incontinence, meaning that a stressor or a maneuver like jumping on a trampoline, running, coughing, sneezing, something like that causes that pressure or causes a leak.
As we age, you get more urge urinary incontinence, that if I see a bathroom, it comes out before I even get there. Or you’re waking up at night two or three times a night to pee and then going to pee, and there’s just a little bit that comes out. Those bladder nerves are really irritating the bladder, making you feel like you have to pee.
What treatments work for stress urinary incontinence and urge urinary incontinence?
Dr. Suny Caminero:
For stress urinary incontinence, the most common solution is physical therapy. They can also teach you how to do Kegels and other pelvic floor exercises.
They can also teach you how to incorporate it into your physical exercise, like your gym routine. Incorporate that into that routine, so it’s not like you’re adding something else for your daily thing.
And they can also teach you ergonomics on how to do things when you’re lifting heavy things or pushing things so that you protect that pelvic floor. There are all these games that you can buy with things that you can put in the vagina. There are so many options you can put in the vagina, and you actually play these games on an app, and it’s just contracting your pelvic floor as you’re playing these games, which is pretty cool, right? So that’s an easy way to, like, “Okay, I’m watching TV. Let me just put this in and do some games and contract my pelvic floor to strengthen that pelvic floor muscle.”
We also have a chair in the office, and it’s a magnetic energy chair. You sit on it, and it goes right through your pelvic floor and increases—gives you like 12,000 muscle contractions in a 30-minute period. And it’s super strong. It’s a contraction. It’s not painful, but it’s stronger than you could ever do on your own. So for users who do a series of treatments, after the third time, you notice the urinary leakage going away. It’s pretty cool.
And then if it’s pretty severe, then that is when surgery comes in, when that doesn’t work. And you can tell, once you’ve done a lot of treatments for urinary incontinence, you can tell who’s going to respond to the chair, who’s going to respond to physical therapy, who actually needs surgery right off the bat to help out. So the person can tell themselves—make the decision themselves.
Morgan Allen:
And based on the exam, the history, and the symptoms, can you tell whether any of this is going to work for someone?
Dr. Suny Caminero:
I can definitely tell. And based on the exam, is your bladder prolapse what we call a grade three or four? Is it coming out of your vagina already? Only surgery will fix that. Or the rectal prolapse or the uterine prolapse, depending on the type of prolapse, it will tell me whether surgery is needed, or we can do something that is not surgical.
We used to use a lot of mesh for prolapse repair, but we don’t do much of that anymore because it caused a lot of complications. We’ve also done other things, like sling procedures, that work really well. And those have actually fallen out of favor as well, because we have found other ways of helping with urinary leakage.
The other one that I wanted to mention is that the CO2 laser works really well if you have a mild prolapse. That was amazing. It works really well too. There are so many therapies.
When it comes to urge urinary incontinence, often that is more related to aging, typically, although it can happen before, but often more related to aging. For them, vaginal estrogen works incredibly well to restore that tissue to a healthy state.
And also the EMSella chair works really, really well for that pelvic floor. Biofeedback physical therapy works really great for that. That doesn’t really need surgery, although some women are so bad that they need Botox in the bladder, and then Botox in the bladder will help that significantly.
How does Botox affect urinary incontinence?
Dr. Suny Caminero:
You know what’s interesting? That’s how I started doing Botox for women. I started doing Botox for the bladder and for the vagina, for vaginismus. And then my patients would say, “Can you do it to my face?” And I’m like, “I can learn how to do that.” So then I started doing—well, thanks for anyway. But that’s how I first started, was doing Botox for urge urinary or for urinary urgency and for urinary incontinence.
It works because the muscles are over-responding. And then you paralyze the muscle. Now you’re not having that urgency anymore.
Is urge urinary incontinence caused by psychological factors?
Dr. Suny Caminero:
It is very physical. So if there is anything that’s irritating the vagina or the bladder, you’ll have the urgency. So the nerves cause the urgency. The nerves hit the muscle, and then it just kind of spasms, like a seizure of the muscle. And so you have that, “I gotta go, gotta go.”
If you don’t fix what’s causing that issue, it gets worse over time. And then women will start to go to the bathroom so frequently, right? Like every 30 minutes or every hour, because they’re afraid that they’re going to pee on themselves. Now the bladder loses the ability to hold volume, to hold a lot of urine.
And so now you’re not holding, let’s say, 300 cc’s, 300 mL. Let’s say that you’re not holding 300, and now you’re holding 50 or 100. And the minute the bladder feels that there’s a little bit of urine in it, the body contracts so much that muscle—the minute it feels that there’s a little bit of urine in it, it’s like, “And then you’re like, I gotta go pee again.”
So you have to almost do this bladder diary to retrain your bladder into knowing, “Okay, it’s just my bladder acting up right now. I really don’t have much urine in there. I’m going to have to just talk to my bladder and tell it to stop or ignore it,” allowing it to expand again so that it can actually accommodate higher volume, like normal volume, so that you don’t have to keep going to the bathroom every 30 minutes or every hour.
Some women aren’t sleeping at all because they’re getting up so frequently at night to go to the bathroom. And imagine how much that’s affecting their lives, right? Like, if I don’t sleep for one night, I’m terrible the next day, right?
And that’s for the urge incontinence. The stress incontinence, you really don’t get up at night to pee at all. That’s more like if you jump on a hard surface—we call it the trampoline test. If you can’t jump on a trampoline without peeing and you have stress urinary incontinence, or if you’re running, there are some activities that will cause urinary leakage no matter what.
Like our weightlifters, for example, when they’re lifting that heavy of a weight, it’s so much pressure down on your pelvic floor. The pressure has to go somewhere. So they do have some urinary leakage because of lifting that heavy weight.
Very common for workers of, like, the male system, UPS system, that are carrying heavy bags, carrying heavy weights often. They often get a weak pelvic floor too.
So for them, that’s not the night thing. That’s more like, “I lift heavy, and pee comes out,” or, “I bend down and get up,” and that change in pressure caused a leak.
Can men get urinary incontinence?
Dr. Suny Caminero:
Men get more of a retention issue with their prostate. It’s more of a prostate issue as they age. Their prostate starts to get larger, and so it blocks the ability to pee. They end up having to pee very frequently to try to empty their bladder.
What is your message for women dealing with urinary incontinence?
Dr. Suny Caminero:
I don’t want women to feel like they have to live with urinary incontinence. And I don’t want women to think that they have to have surgery every time, because it isn’t surgical every time. So that does scare people, and you don’t always have to have surgery.
So many things can happen with urinary incontinence, whether it’s urgency that keeps you from getting sleep at night. And we need to fix that because, for health purposes, it is not healthy not to sleep at night.
So let’s fix that. Let’s not live with that. And then one of my biggest pet peeves is just the diaper thing, the women having to be on diapers when you could have really prevented it completely.
And there’s a whole market right now on women’s diapers. There’s a whole market on underwear to catch up, and it just doesn’t—just go to the store, just go where the baby aisle is, and then see how many diapers are for babies and how many diapers are for adults.
That alone will tell you the problem and how much that industry is benefiting from people peeing on themselves. And it’s just—just fix it.
