Urotherapy explained: A conversation with our urotherapist
Sylvia Böhler
November 2, 2026
7 min
Pelvic floor and bladder problems can affect both women and men at different stages of life. At our gynaecological clinic, urotherapist Sylvia Böhler primarily supports women – for example, following pregnancy and childbirth, or with symptoms associated with ageing. In this interview, she explains when it is advisable to seek help and why nobody should simply have to put up with these symptoms.
Ms Böhler, could you tell us: what exactly does a urotherapist do – and what fascinates you about your work?
A urotherapist is an expert in conditions and functional disorders relating to the bladder, bowel and pelvic floor. The focus is on conservative treatment. In addition to various treatment options, this also includes personalised counselling and training, as well as behavioural therapy approaches. Urotherapists work, for example, in urology practices and clinics, in gynaecology and paediatrics, in rehabilitation clinics or paraplegia centres.
As I work in a gynaecology clinic, I mainly support women – for example, with involuntary urine leakage, frequent or strong urges to urinate, and difficulties with pelvic floor function. I find it particularly fascinating how different needs can be depending on the stage of life. Pregnancy and childbirth place particular demands on the pelvic floor. However, symptoms can also arise during the menopause or as we get older.
What I like about my work is that we can take very practical steps to improve quality of life. Often, it’s not just about treating a single symptom, but also about regaining confidence in one’s own body.
2. Why are so many people reluctant to talk about bladder and pelvic floor problems?
Because these are very intimate issues. Urination and bowel movements are seen as private matters, and involuntary urine leakage or a loss of control over the bladder or bowel in particular are often associated with shame. Many people affected fear that others might react with a lack of understanding or rejection. Some also worry about how the problems might affect their attractiveness or self-image.
On top of that, many feel they are alone with their problem. Among women, for example, we often hear the idea that ‘that’s just how it is after giving birth’ or ‘it’s part of getting older’. Such beliefs can mean that symptoms go unaddressed for a long time. Out of fear of unpleasant or embarrassing situations, some people even withdraw from their social lives.
Yet bladder, bowel and pelvic floor problems are part of our everyday medical practice. Nobody needs to feel ashamed about them and, above all, you don’t simply have to put up with them. Many symptoms can be significantly alleviated or even resolved with the right treatment.
It’s also important to note that bladder and pelvic floor problems aren’t just a women’s issue. Men can be affected too, for example following certain operations, due to medical conditions, or as they get older.
Sylvia Böhler, urotherapist
‘Our pelvic floor supports and sustains us throughout our lives and deserves just as much attention as the other muscles in our body.’
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3. Which symptoms do you encounter most frequently?
At the gynaecology clinic, I particularly often see women with urinary incontinence, a strong or frequent urge to urinate, and pelvic organ prolapse. Postnatal conditions also form an important part of my work. These conditions can vary greatly in severity and affect women at different stages of their lives.
4. Is there a particular moment from your work that has stayed with you?
I particularly remember one patient who worked as a teacher and had to go to the toilet 14 to 16 times a day. Often, she could only pass small amounts of urine. Initially, many signs pointed to an urge incontinence problem. However, the examination revealed that a prolapsed bladder was the cause: the bladder could not empty completely and consequently filled up again quickly.
As the patient wanted to avoid further surgery if possible, based on her previous experiences, we fitted her with a so-called pessary to support the bladder. By her very next appointment, she reported that she only needed to go to the toilet eight to ten times a day. She was very relieved by this improvement and by the fact that she could avoid further surgery for the time being.
Moments like these show me just how much the right treatment can improve everyday life and quality of life.
5. When should you seek professional help?
You should seek professional help at the latest when symptoms start to affect your quality of life or when your bladder begins to dictate your daily routine. This applies at every stage of life. After pregnancy and childbirth, the body naturally needs time to recover. Nevertheless, symptoms such as persistent urine leakage or a strong urge to urinate should not simply be put up with. The same applies to symptoms that only arise later in life.
No one needs to wait until the distress becomes overwhelming. Waiting too long can unnecessarily worsen the situation. The sooner symptoms are addressed, the sooner we can work together to find out what support is appropriate.
A healthy pelvic floor requires not only strength, but also awareness, coordination and the ability to relax again.
Tips for a strong pelvic floor
Pay attention to your posture: Stand upright and distribute your weight evenly between both legs. When sitting, make a conscious effort to sit on both sitting bones and keep your back straight.
Lift and carry correctly: Bend your knees, keep the load close to your body and, as you stand up, breathe out and engage your pelvic floor.
Reduce pressure: When coughing or sneezing, turn your upper body slightly to one side and cough or sneeze into the crook of your arm.
Keep active: Incorporate pelvic floor-friendly activities such as swimming, cycling, walking, aqua aerobics, Pilates or yoga into your daily routine.
Monitor your toilet habits: Pay attention to how often you go to the toilet and the volume of your stools. Frequent toilet visits just to be on the safe side should be avoided where possible.
6. How does a urotherapeutic treatment session work at your practice?
We begin with a detailed consultation in a confidential setting. I’m interested in finding out what symptoms you’re experiencing, when they occur and how they affect your daily life. Any previous medical conditions, pregnancies, births, operations, as well as your drinking and toilet habits, can also be important factors.
This is often followed by a log-keeping phase: over several days, the patient records how much she drinks, how often she goes to the toilet and whether she experiences any urine leakage. This provides us with important insights into where we can focus our treatment.
Another important aspect is gaining a better understanding of one’s own anatomy and the function of the bladder and pelvic floor. Depending on the situation, the treatment may include, for example, fluid and toilet training, advice on suitable aids, or further educational sessions. If necessary, we also consult a doctor and a specialist physiotherapist.
During subsequent follow-up appointments, we assess what has improved and how the measures can be successfully integrated into everyday life. It is important to me that every patient understands what is happening in their own body and why we recommend certain steps.
7. What can you do yourself for your pelvic floor in everyday life?
An important first step is to become aware of your own pelvic floor. This isn’t about tensing it as often or as strongly as possible. A healthy pelvic floor must be able to both tense and relax.
There are also things you can do in everyday life: maintaining good posture, lifting and carrying objects correctly, and breathing properly can all help relieve pressure on the pelvic floor. When coughing or sneezing, for example, it helps to turn your upper body slightly to one side. Regular exercise and pelvic floor-friendly sports such as swimming, cycling, walking, Pilates or yoga are also recommended.
It’s also worth taking a look at your own habits: How often do I go to the toilet? Do I go often just to be on the safe side? Do I drink less for fear of needing to urinate? Behaviours like these can affect bladder function.
Particularly after pregnancy and childbirth, physical activity should be gradually built up again. If you are experiencing symptoms, I recommend seeking advice before starting an exercise programme on your own.
Bladder and pelvic floor problems are not exclusively a women’s issue. Men also have a pelvic floor and can be affected, for example following certain operations or as they get older.
8. Which myth about the pelvic floor do you come across most often?
There are several. One common myth is that only women have a pelvic floor. That is, of course, not true: men also have a pelvic floor and can develop problems, for example, following surgery, illness or as they get older.
The idea that you can train your pelvic floor by interrupting the flow of urine whilst passing water also persists. However, you should definitely avoid doing this.
And finally, it is not true that the stronger and more frequently you contract your pelvic floor, the better. A healthy pelvic floor requires not only strength, but also awareness, coordination and the ability to relax again.
Another important point: incontinence does not have to be simply accepted, either after childbirth or in old age. Even though symptoms may occur more frequently during these stages of life, there are ways to treat or alleviate them specifically.
9. If you could share one message with our readers – what would it be?
Our pelvic floor supports and sustains us throughout our lives and deserves just as much attention as the other muscles in our body. Especially during pregnancy and a vaginal birth, it is subjected to enormous strain and performs amazingly well.
That’s why it’s important to me that you take any discomfort seriously and talk about it. No one should have to organise their daily life around these symptoms out of shame, or give up things they enjoy. Even if symptoms occur more frequently after childbirth or as we get older, that doesn’t mean you simply have to put up with them. The first step is to talk about it and seek advice.
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