Pelvic Floor Retraining for Incontinence & Pelvic Pain
What is the pelvic floor and what is its role?
The pelvic floor is made up of muscles, bony structures, fascia, ligaments, and blood and nerve innervations, which have 3 functions:
1. Support: provide support for the pelvic organs, bladder, uterus, and colon within the pelvis.
2. Sphincter: assist in stopping and starting the flow of urine, gas, and bowel movements.
3. Sexual: aid in sexual appreciation.
What is Incontinence?
Involuntary loss/leakage of urine, gas, or feces; a dysfunction in the voiding process
Are there different types of incontinence?
Urinary or Fecal Incontinence
- Stress-loss of urine during coughing, laughing, sneezing, or walking, etc.
- Urge-urine loss that occurs with strong desire to urinate (urgency) with a few seconds to minutes warning the bladder contracts when you do not want it to.
- Mixed-combination of both stress and urge incontinence.
- Overactive Bladder increased urinary urgency, frequency of urination, and urge-related
- Pelvic Relaxation (Pelvic Organ Prolapse) symptoms include post voiding dribble, falling out feeling, incomplete voiding. Childbirth is usually #1 risk factor, but chronic constipation/heavy lifting also risk factors
Can men have incontinence, too?
Yes, they can have the above types of incontinence, as well as incontinence related to prostate surgeries, interstitial cystitis, prostatitis, BPH, and muscle coordination dysfunction.
Can physical therapy help constipation?
Yes, pelvic floor relaxation, massage, and education are all forms of treatment for normal voiding.
What other related diagnosis can physical therapy treat?
Sexual dysfunction (painful intercourse/ejaculation, penile fracture, erectile dysfunction). Treatment may be focused on relaxation or strengthening the pelvic floor muscles and correct muscle coordination.
Do I need to see a specialist before coming to physical therapy?
An obstetrician/gynecologist can refer women directly to physical therapy if the incontinence or pelvic pain is related to gynecology, pre/post-partum issues or pelvic organ prolapse.
An urologist can also refer men or women to therapy. An urodynamic evaluation will be performed to measure bladder filling, storage, and emptying. Other tests may include: post-void residual, cystometry, EMG, cystography, video urgodynamics, MRI.
A PCP can refer a person to therapy; however, further work-up is beneficial to have a more specific diagnose.
What are "Kegal" exercises and are there different types of exercises?
Kegal exercises= pelvic floor contractions: The physical therapist will work with a patient to isolate the correct muscles to work on relaxation, strength, and endurance and correct coordination for correct function of the pelvic floor. Key words used are "pulling up and in," "squeeze as if you are holding back from voiding." There are two different muscle fibers that are for separate functions; therefore there are two different exercises.
to assist with holding back urine when you cannot get to the bathroom in time
Slow twitch muscles: "holding"
To strengthen and increase endurance during increased intrabdominal pressure (sneezing, coughing, laughing, and lifting)
Why do "Kegals" (pelvic floor retraining) during pregnancy and post- labor?
Strengthen pelvic floor for more efficient pushing during contractions.
Prevent incontinence during pregnancy (due to pressure of baby pressing down).
Prevent urinary/bowel incontinence after labor.
What are the goals for treatment?
- Provide patient with a better understanding of the pelvic floor and its function.
- Strengthen pelvic floor muscles with "kegel" exercises to decrease incontinence.
- Gain control of bladder function with the assistance of biofeedback and electrical stimulation.
- Retrain the bladder with normal voiding patterns.
- Decrease pelvic pain to resume functional lifestyles.
- Increase self-esteem and confidence to be independent in the community without leakage.
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