Loss of Bladder Control
Q: Lately I have experienced an increase in leaking a little urine when I laugh or cough. It started after having my third child and was only a problem on steep downhills if I was walking fast. It's embarrassing and at 47 I feel I'm too young for this. What is happening and any suggestions?

A: Perimenopausal women can have fluctuations in their estrogen levels, even if they are still having periods. Low estrogen levels, even only part of the month, can cause the tissues around the urethra and vagina to weaken leading to what is known as stress incontinence, e.g., the loss of a small amount of urine when running, laughing, coughing, or sneezing. You can help this condition by doing Kegel exercises to strengthen the pelvic floor muscles. You can support estrogen balance with phytoestrogen-containing herbs such as black cohosh, wild yam, and licorice root. Sometimes the best solution is a prescription for vaginal estrogen cream or suppositories that can be used intermittently to revitalize the tissues. Vaginal estrogen does not carry the same risk as estrogen taken orally. Discuss options with your gynecologist or naturopathic physician. No need to suffer in silence with this condition.
— Dr. Arianna Staruch

Warming Up to the Cold Weather
Q: I have been told many times to warm up before and stretch after exercise but as the weather gets cold it seems impossible. What is the best routine to warm up before walking during these cold winter months?

A: We know how hard it is to stay motivated when it is dark, damp, and foggy outside during these winter months. However, it is very important to stick to a routine of exercise, especially during the holiday
“eating” season. So here are some key points to remember when walking during the winter:
• Always remember to plan your route where you can start and stop in a warm place. If you plan on walking for 45 minutes but fear you might only be able to endure 30, try 3 to 15 minute laps near your house so if you’re too cold you can escape to the comforting heat of home after just two laps.
• Dress appropriately for winter with light-weight gloves, a rain jacket or wind-breaker, and a hat. Try not to leave skin uncovered and exposed to the environment.
• Do your warmups in a warm place. Make sure to engage all the muscles in a variety of dynamic movements. Try to mimic everyday bending, twisting, reaching, and lifting to warm up, like pretending to unload the dishwasher and place dishes in a high cupboard. In other words, reach down by your feet and stretch to reach up over your head. Take a few steps while incorporating a deep lunge. The goal is to make sure all your muscles are warm and activated, not just stretched before heading out into the cold.
• At the end of your walk get back inside before you begin your cool down stretches. Go through your normal after-workout stretching routine to make your body more limber and to prevent post-exercise muscle stiffness. Most important, have fun and be safe during this holiday season.
— Dr. Jacob May

Keeping Your Child Warm
Q: How do I know when I am out walking with my child in her stroller that she is warm enough?

A: There are a few things to consider when out walking with your child. First if your child is two or younger, they are usually not as physically active while in the stroller, so take that into account and not only bundle them up but also throw a blanket on them. For babies, many companies make great chinchilla-type jumpers. If your child is older and is able to play in the stroller then putting on extra layers should do the trick. Most strollers today, especially jogging strollers, come equipped with rain guards that seal the child in the stroller. I would use these not only when it is raining but any time there is medium to strong winds. The most important areas of the body to keep bundled are the head, ears, chest, neck, toes, and fingers. Play it smart, remember that your child isn’t exercising with you, so they need extra layers and protection to keep the elements out. Listen to your child, if they are crying or complaining about the cold then get them out of it. If their cheeks, forehead, or chest are cold to the touch then either wrap them up more or get out of the cold.
— Dr. Lindsey Nelson

This Issue’s Experts
Lindsey Nelson, ND, is a naturopathic primary care physician and can be reached at 503-279-0205 or by email at: lindsey@clearh2o.org.

Jacob May, DC, brings careful thought and analytical thinking blended with a
holistic approach to medicine. To contactDr. May, call 503-279-0205 or email jacob@clearh2o.org.

Arianna Staruch, ND, is a naturopathic
physician focused on women’s health issues. To contact Dr. Staruch call 503-279-0205 or email arianna@clearh2o.org.