What Can Physical Therapy do for:

Urinary Incontinence:

This can be a little leakage when a person coughs or sneezes or a lot of leakage with the urge to urinate.  Stress incontinence is often seen in young women during pregnancy and after delivery and also in postmenopausal women. By working on strength and coordination, the bladder can be controlled to only empty when the time is right.

Urinary Frequency:

This is characterized by urinating more than 7 times in a 24 hour period and may be accompanied by urinary leakage. If a person is urinating frequently enough that it is interrupting their daily lives, physical therapy can provide urgency suppression techniques  and  a progressive bladder training program to increase the amount of urine the bladder is able to hold and thus increase the duration between emptying episodes.

Urinary Urgency:

“Key in the door syndrome” falls into this category and is explained by the strong urge to empty your bladder just as you get to the door and begin fumbling with your keys.  If you find yourself knocking over women and children to get to the bathroom you have urgency of urination. Physical therapy works to improve the communication between the bladder, brain, and pelvic floor muscles to calm the bladder and allow a resumption of normal bladder contraction frequency.

Urinary Retention/ Hesitancy:

Incomplete emptying of the bladder can be corrected by training and coordination of the pelvic floor muscles and stimulating the nerves that are responsible for contracting the bladder.  Toilet posture training is an important part and taught by your physical therapist.  Bladder retention may be a neurological deficit, muscular in-coordination, or an actual physical obstruction.  

Pelvic Organ Prolapse:

The descent of the pelvic organs including the bladder, uterus, and rectum causes pressure and movement in the vaginal walls. This occurs as ligaments that support the organs become stretched out and the pelvic floor musculature is weakened. This often begins during delivery (frequently asymptomatic at this stage) and if untreated results in surgery later in life. Physical therapy should be performed by every woman with pelvic organ prolapse whether surgery is performed or not.  Physical therapy will increase strength and power of the pelvic floor muscles to increase support of the organs. In addition, protective techniques are taughtto be applied to daily activities to protect a surgical procedure (to decrease chance of surgical failure), decrease feelings of pressure and discomfort, and prevent additional organ descent.

What's Up Down There? : Commitment

What's Up Down There? : Commitment: One of the number one issues that I hear about from my patients who need to strengthen their pelvic floor muscles is that they have trouble ...

Stop the Leak!

 

It is true! It is possible to regain full control of your bladder without using medications or having surgery. A little leakage with a cough or sneeze or on the way to the bathroom with a full bladder is thought of as normal to many. Although this is extremely common in women of all ages it is not something that should just be tolerated as part of life or aging.

Physical therapy for urinary incontinence and over active bladder restores the strength and coordination in the pelvic floor muscles so the bladder begins to do what you tell it to instead of your bladder running your life.


The muscles in your pelvic floor, that surround the bladder and anus, speak to the bladder to let it know when is the appropriate time to empty and when it is time to store urine. This communication is easily disrupted if strength is lost or damage (such as a vaginal delivery or pelvic surgery) occurs.

Physical therapy will include education on this very important communication process, a variety of kegels to increase pelvic floor power, urgency suppression techniques, and a look at how the diet might affect the bladder.

Who should do Kegels

This is a common question that I hear from patients. Most women and  men can benefit from pelvic floor strengthening by performing Kegel exercises.

 Women should begin pelvic floor strengthening when they are pregnant with their first child and continue to include it as part of their normal exercise program. Pregnancy and delivery are very hard on the pelvic floor muscles and structures and it is important that adequate strength is maintained to stave off pelvic organ prolapse and incontinence. Most of the women I treat for these two issues are under the age of 40. 

That being said, as women age their chance of developing bladder control problems ( including urgency, frequency, and incontinence) rises and it is vitally important that post menopausal  women pay attention to the strength of their pelvic floor muscles and work to build and maintain it.
It is possible for women of any age to have what many refer to as a “weak bladder” This may include leaking a little when you laugh, cough, or sneeze, urinary frequency where you urinate more than 9-10 times a day or urinary urgency where you are unable to  put off going to the restroom once you have the urge to urinate. Anybody experiencing these symptoms can benefit from pelvic floor strengthening and should speak to the physician about starting a strengthening program.

Men can also benefit from improving the strength of their bladder control muscles. Because of the different design, men are less likely to develop incontinence without an underlying pathology. Incontinence after prostate cancer requiring prostatectomy is very common and kegal exercises can make a significant improvement in urinary leakage.  Studies also show men suffering from erectile dysfunction due to venous compromise can correct the dysfunction by participating in a pelvic floor exercise program.

It is important that if you have bladder or urinary problems, or pain, you should speak to your doctor about initiating a  pelvic floor strengthening program. You may require more specific instruction and need to see a women’s health physical therapist.  Pelvic floor strengthening should also include a rest component. So if you begin with 5 second hold, a 10 second rest period should be placed after every hold. 

The Two Exercises Every Women Should Do ( as featured on Oprah.com )

Women's health physical therapists swear these pelvic
workouts help forestall all kinds of female-specific problems.
One's a classic, and the other will forever change how you
look at your watch.

By Corrie Pikul


If you have never felt pelvic pain, a "little spritz" (thank you, Whoopi
Goldberg, for that phrase), or organ prolapse, you probably want to
keep it that way. The best strategy for shaping up "down there"? Yep,
that old standby, the Kegel. We know you've heard this before, but
that's because experts agree that Kegels are the most effective
exercise to improve the muscle tone of the pelvic floor. "After the age
of 35, we lose 5 percent of our muscle mass every 10 years," says
women's health physical therapist Kristi Latham. This reduction
occurs in muscles everywhere in the body—including those in our most
private regions. Here's a full pelvic workout, including Kegels and
"pelvic clocks."

Keep in mind: Just like you wouldn't run sprints with a sprained ankle,
you shouldn't do these exercises if you have a painful pelvic condition
(like vaginismus) without first checking with a women's health physical
therapist.





A Kegel Refresher Course
These wonder clenches can increase sexual arousal, improve your
ability to reach orgasm, help you master control of your bladder and,
says Latham, support your pelvic organs in avoiding dreaded conditions
like prolapse.Fitness instructor: Kristi Latham, PT, CLT, is the pelvic health and
lymphedema program director at Metro SportsMed Physical Therapy
in Brooklyn, New York.

Warm-up: When you're just starting out, it's best to lie down so that
you can concentrate solely on your pelvic floor.

The exercise: Squeeze the muscles around your vagina and anus.
These are the muscles you use to prevent gas from passing, stop the
flow of urine and the muscles that contract during orgasm. Think about
trying to pull the muscles up and in (if your pelvic floor is weak, you will
only faintly feel this contraction). You'll know you're doing these
exercises correctly if you feel the muscles tightening but don't have
movement in your abs or buttocks. Isolate your pelvic floor so if somebody
looked at you while you were doing the exercise, they wouldn't
think you were moving at all.

The routine: For healthy women without symptoms of pelvic floor
impairment, do the following three times per week: 5-second squeeze
followed by a 10-second rest period, 10 times, 3 times per day (30
total). With practice, you should be able to do them while sitting at your
desk or driving.

Advanced:
• Endurance training: Increase hold time and decrease rest time:
10-second squeeze followed by a 3-second rest period.
• Sprints: Add in what Latham calls "quick flicks": Squeeze and
relax 5 times, as fast as you can, followed by a 5-second rest
period. Do 30 per day, 3 times per week (as above).
• Form drills: Try any of the above routines while standing up.
Note: You've probably heard that you should practice Kegels by
stopping the flow of urine while going to the bathroom. Using Kegels
to frequently stop or slow the flow of urine can cause backflow, which
creates infection, and can also disrupt your pelvic muscle coordination.
Most WHPTs discourage practicing Kegels while urinating. Latham
suggests paying attention to how your muscles feel just after urination,
then follow up later with a Kegel to feel the difference between relaxed
and contracted.

Pelvic Clocks





These exercises can improve circulation to the pelvic organs; decrease
tightness, stiffness or congestion from prolonged sitting or standing;
increase pelvic flexibility; improve balance and—not enough for you?—
help you gain a better awareness of spinal stability.
Fitness instructor: Gail Wetzler, PT, EDO, is the owner of Wetzler Integrative
Physical Therapy Center in Newport Beach, California, and
instructor of pelvic physical health courses for the American Society
of Physical Therapists.

Warm-up: Lie on your back to be sure that the back side of the pelvis
has a full range of movement. Bend your knees and keep your feet flat
on the floor. Keep your spine in a neutral position. Imagine that there is
a clock on your lower abdomen, where 12 o'clock is at the bellybutton,
6 o'clock is at the top of the pubic bone and your hip bones are at 9
and 3.

The exercise: Bring the bellybutton down to the spine. This will make
the "clock" tilt, down at the 12 position (bellybutton) and up at the 6
(pubic bone). Move your hip and pubic bones to rotate your clock to
the side so that 3 o'clock hip is lower. Move around the clock, tilting
the pelvis until the 6 o'clock position is lowest. Continue around the
clock, hitting every number, until the 12 position is again the lowest
position. Repeat two or three times, then reverse to repeat the cycle in
the opposite direction, two or three times.

The routine: For healthy women without symptoms of pelvic floor
impairment, the clocks should be done once per day to keep the pelvic
girdle in shape. Those experiencing movement restrictions can try
these two times per day (a.m. and p.m.).

Advanced: Vary up the routine each day: Try going from 1 o'clock to
neutral, then 2 o'clock to neutral, and continuing like that around the
clock. Wetzler suggests repeating one movement, such as 4 o'clock
to 5 o'clock, five to six times "to really feel the pelvic activity."