Incontinence

It’s estimated that at least 1 in 3 women have incontinence, or urinary leakage. While leakage may be common among women, it should never be considered “normal” or acceptable. In fact in most cases it is totally curable. While some people may think of incontinence as affecting mostly the “older” population, research has shown all ages including young athletes can have incontinence.

Stress incontinence is the involuntary loss of urine during exertion, such as lifting objects or while sneezing, coughing or running. This is contributed by weakness of the pelvic floor muscles in addition to the surrounding connective tissue.

Urge incontinence is the involuntary loss of urine associated with the “gotta go” feelings and urges to get to the bathroom immediately. Some describe this with certain activities such as turning the key in their door, walking by a bathroom or with the sound of running water. While the frequent desire to urinate often may seem like a good idea to prevent leakage, going to the bathroom too often during the day will “tell” the bladder not to hold as much urine, giving you the signal to go more often. Incorporating bladder re-training tips, urgency strategies and retraining the pelvic floor muscles to respond better will help control the symptoms and return to normal bathroom habits without the fear of leakage.

During the first appointment at Indy Women PT a complete medical history will be taken along with a review of current symptoms. After taking the history, the physical therapist will then perform a thorough external and internal musculoskeletal examination. You are welcome to bring a second person with you into the examination room during the examination and subsequent treatments. We will discuss the physical findings and together will set up a plan of care with your personal goals in mind.

Evaluation and treatment may include:

  • Postural assessment including muscle strength testing
  • An internal exam will include a gloved finger with lubricant inserted either vaginally or rectally to assess for muscle tone, strength and any pain
  • Biofeedback to help cue isolation of the pelvic floor muscles or as a tool to help the muscles learn to relax again
  • Manual therapy both internal and external to address any pain issues or help improve pelvic floor muscle strength if there is weakness
  • Electrical stimulation to help isolate and promote strengthening the pelvic floor muscles. It can also assist with deferring urgency
  • Education regarding safe exercises and precautions with POP
  • Bladder re-training techniques, urgency strategies and appropriate strengthening or relaxation exercises of the pelvic floor muscles.

Pelvic Organ Prolapse

Pelvic Organ Prolapse is very common in women. Research shows prolapse can occur in 50% of women that have had children. Pelvic Organ Prolapse, or POP, is when the pelvic organs drop from their anatomical position and pushes against the walls of your vagina. Organs affected include the bladder, uterus and rectum, with the bladder being the most common. This can be caused by weak pelvic floor muscles or over stretching the ligaments that support the abdominal organs. While childbirth can play a big factor in developing POP, other causes can include obesity, work related lifting and chronic constipation.

Symptoms

Some women have POP and do not realize they even have it. Some women have symptoms of heaviness or a feeling something is falling out of their vagina. In some cases you may notice a protrusion or feel tissue coming out of the opening of the vagina. This may happen after strenuous activities or after being on your feet for most of the day.

Other symptoms can include:

  • Pressure in the pelvis or low back
  • Urinary urgency or frequency
  • Post-micturition dribbling-This is a feeling of not being able to empty your bladder, or after rising from the toilet you have an involuntary loss of urine
  • Straining during bowel movement or inability to empty your bowels
  • Uncomfortable or painful intercourse

Indy Women PT can evaluate for and treat the symptoms of POP. The goal is to alleviate some of the symptoms of POP while preventing it from worsening. While we cannot change the prolapse itself, we can teach strengthening exercises to help alleviate the symptoms of heaviness, along with providing lifestyle interventions to prevent it from worsening.

While surgery sometimes is recommended with pelvic organ prolapse (POP), or incontinence, physical therapy may in fact help to prevent the need for surgery. In one study 79% of patients receiving pelvic floor muscle training for stress incontinence improved sufficiently to avoid surgery. For those that do require surgery, pre-operative physical therapy has been shown to significantly improve the physical outcomes and quality of life after surgery for POP and or incontinence.

To help promote these outcomes we offer an evaluation along with education for those patients who have either undergone surgery, or are scheduled to have surgery. We will perform an internal exam to check for pelvic floor muscle strength and offer individualized exercises as appropriate. We also discuss healthy bladder and bowel habits, pelvic floor muscle bracing along with appropriate breathing techniques and voiding/defecation techniques without straining. These suggestions can help maintain a healthy pelvic floor while ensuring the benefits of surgery.