Pelvic floor physical therapy can support urinary continence
By Deborah Jeanne Sergeant
If you have never heard of pelvic floor physical therapy for improving urinary continence, you’re not alone.
“People do not know much about pelvic floor physical therapy,” said Schweta Singh, physical therapist at Robert Berkley Physical Therapy in Oswego. “Many don’t know what it is.”
Urinary incontinence can result after surgery, trauma to the area’s tissues, bladder irritation, childbirth or prolonged bedrest and deconditioning. But it doesn’t have to be a lifelong problem. Whether urge incontinence (always feeling the need to urinate), stress incontinence (leaking when lifting objects, sneezing or laughing) or a combination of those, pelvic floor physical therapy can help.
Patients can often see improvement within two to three weeks if they follow their provider’s protocol for home exercises between visits. Their number of accidents goes down and they’re not rushing to the bathroom anymore. They can cough and sneeze without needing to excuse themselves.
At this point, “They realize that if they continue therapy, they’ll be OK,” Singh said.
In about four to six weeks, many achieve significant results, although some take longer.
Singh said that some women continually use the bathroom “just in case” and inadvertently train their bladders to need emptying at half full. But waiting to urinate is not the best idea in all cases.
“You can try to wait a little bit longer between when you first have the urge, like waiting five minutes and eventually waiting longer,” she said. “There’s a fine line between not voiding that often. They need a normal pattern.”
Another common misconception is that advanced age means urinary incontinence is inevitable. But Singh has seen patients in their 80s improve.
After taking a patient’s medical history, a physical therapist can better understand how and why the patient is experiencing incontinence. A therapist may look at posture and breathing and if any specific action causes leakage, such as rising
from a chair.
An exam also includes assessing muscle strength and, if the patient assents, an internal exam of the pelvic muscles, which can help better understand what’s going on.
Patients should avoid bladder irritants, such as caffeine, processed foods and cigarettes.
The results of pelvic floor physical therapy last, especially if the patient performs any exercises prescribed a few times a week to maintain their progress.
Some people believe that performing Kegel exercises is the answer. However, Tania Gardner doctorate in physical therapy working in Pelvic Rehabilitation at Upstate Physical Medicine and Rehabilitation, said that many different things can cause leaks beyond weak pelvic floor muscles.
“Sometimes the leakage is a result of pelvic floor muscle weakness, having pelvic floor muscles that are too tight, or muscles that aren’t coordinated, not doing the right job at the right time,” she said. “Pelvic floor physical therapists can assess how a patient’s pelvic floor muscles are working and develop a treatment plan to improve muscle function. They also provide education on healthy bladder and bowel habits as well as strategies to reduce urine leakage. If the physical therapist suspects the urinary incontinence is due to something other than pelvic floor dysfunction, the patient will be referred back to his or her physician for further evaluation.”
Some people have urge incontinence, where they feel the need to urinate frequently and instantly. Others have stress incontinence, where straining to do something else like picking up a heavy box or sneezing can cause leaks. Still others experience both types.
Therapists may use manual therapy, biofeedback and exercise to improve muscle function. Instead of assuming surgery is the first way to treat incontinence, physical therapy can offer conservative management of urinary leaks.
Jeanne Cioci, physical therapist at Apollo Physical Therapy in Oswego, who is certified in pelvic floor physical therapy through the American Physical Therapy Association, views the process as a progression from gaining control of urinary contractions to achieving control regardless of activity.
In addition, “there’s a lot of education for patients about the pelvic floor,” Cioci said. “It involves bladder habits, normal functioning, the fluid intake and behavioral changes.”
Cioci added that proactively addressing pelvic floor issues before surgery or childbirth can lead to a better outcome with urinary continence after surgery.
Once a patient has reached a status of urinary control, they can often maintain the positive results through home exercises.
“Like any body part, if you get it better and ignore it, you have potential to have it return,” she said. “You should still do some of the exercise some of the time. I tell patients that right now, you’re in the thick of training doing these exercises every day. If you’re not leaking, you can back it down. Do some every day or do it every other day. You still need to keep the brain-nerve-muscle connection and keep the muscle engaged.”
New York is an open-access state for physical therapy, meaning that most health insurance that covers physical therapy will not require a physician’s referral to cover a limited number of visits.