Pelvic Floor Therapy Can Alleviate Urinary Incontinence

There are several options to deal with the condition

By Deborah Jeanne Sergeant

If you leak urine, pelvic floor physical therapy can help you ditch pads and rushing to the bathroom throughout the day.

While it would seem like medication or surgery are the only ways to solve urinary incontinence, physical therapy provides a different approach that solves the common yet not normal issue.

Sarah Capodagli, doctor of physical therapy with CorrEra Physical Therapy in Williamsville, said that urinary incontinence affects men and women of all ages—not just post-partum and post-menopausal women.

“I would say overall, women might know more about physical therapy for urinary incontinence but sometimes the extent they know about treating it is Kegel exercises,” she said.

Kegel exercises—consciously working the muscles that control urine flow to strengthen them—are not always the answer. Many do not know how to perform them correctly and engage the wrong muscles. For people with tight bladder control muscles, these exercises worsen the problem.

Some people hold stress in their shoulders. Others hold stress in their pelvic floor, which can interfere with continence.

That is why it is important to learn the patient’s health history.

Professionals typically look at the body mechanics, posture, and breathing patterns. All of this affects continence. The physical therapist also discusses behaviors such as avoiding constipation, lifting mechanics and movements in daily living such as getting in and out of a car.

Ironically, many people reduce drinking fluids to help control their incontinence. That tends to worsen the problem. Most providers recommend drinking throughout the day and to reduce accidents, stopping three hours before bedtime.

Since constipation is sometimes related to urinary incontinence, Capodagli encourages patients to have easy, consistent bowel movements by eating enough fiber and drinking enough water.

Providers also discuss when the person experiences leaks. Stress incontinence is caused by sneezing, laughing, lifting objects and other types of movement. Urge incontinence occurs frequently throughout the day when the patient feels an intense need to urinate. Physical therapy can help with both types of incontinence.

“They learn how to relax them and learn how to mechanically relax them.

That can help,” said physician Jacquelyn Gonka-Griffo, who completed a fellowship in Female Pelvic Medicine and Reconstructive Surgery. She practices at Western New York Urology Associates in Cheektowaga.

She added that for many people with incontinence, their bladder control muscles are either too lax or too tight. They may be out of synch with when they want to hold their bladder and when they want to release urine. Learning stretching exercises in the office that they can perform at home may be the key to conquering incontinence.

“A lot of these patients are in significant discomfort and this is the only thing that can help,” Gonka-Griffo said. “A lot of patients have urinary incontinence with interstitial cystitis, a term that’s been brought into the urology world for those with unexplained bladder pain or discomfort.

Some are put on diets where they can’t eat anything acidic and they’re told there’s nothing else they can do. Pelvic floor physical therapy can treat general pelvic pain, overactive bladder, fecal incontinence and organ prolapse.”

By the second visit for pelvic floor physical therapy, some patients may need an internal exam, performed through the vagina for women and through the rectum for men. This can help the physical therapist know how the muscles are engaging.

Rehabilitative ultrasound is another tool therapists use. Similar to pregnancy ultrasound, it gives physical therapists a better idea of how the pelvic floor muscle is working.

When someone learns how to perform a bicep curl, she can watch her reflection in the mirror to monitor her movement. Since pelvic floor muscles are inside, the ultrasound gives a peak at what they’re doing.
Within a few weeks, most patients see improvement in continence and those effects last.

“They may still have exercises they need to do when done with therapy, but my goal is to teach them how to correctly use their body, so they don’t need to see me again,” said Mary Roberts, doctor of physical therapy with Buffalo Rehab Group in Williamsville.

Of course, those who seek treatment sooner tend to see quicker results.

Roberts wants anyone struggling with urinary incontinence to know that it’s never too late to see improvement.

“The big thing is that you don’t have to live with it, even if it’s only happening occasionally,” she said. “It’s easier to treat it if it’s going on a couple months than people who let it go on years and years. It’s usually a longer road to get there. Don’t be afraid to talk about it; people don’t talk about it. And ask your doctor and advocate for yourself.”

Roberts added that few physicians refer people to pelvic floor physical therapy. As with any type of physical therapy, patients can go directly to a physical therapist without a referral and most forms of health insurance will cover it.