Pelvic Floor Therapy
Urinary incontinence is a condition experienced by thousands of women. There are two major types — stress incontinence and urge incontinence — and some women may have a combination of the two.
How does a physical therapist decide how to treat incontinence?
The therapist may begin by having the patient keep a “bladder diary” for about a week, writing down how often she went to the toilet as well as any accidents and what triggered them. Therapists will use a exercises and bladder retraining techniques to help reach specific goals and reduce accidents. The therapist will work with each patient to establish specific goals for the number of times and amount of urine to be voided throughout the day and night, based on the patient’s age and specific condition.
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Pelvic Floor Therapy
Stress incontinence involves an involuntary loss of urine that occurs with activities that increase abdominal pressure, such as laughing, coughing, sneezing or heavy lifting. It is the most common type of urinary incontinence in women. Risk factors for developing stress incontinence include multiple pregnancies, smoking, obesity and female gender.
Urge incontinence can be a sign of an irritable bladder and can be made worse by rushing to go to the toilet at an unscheduled time. If the urge — and resisting the urge — to go at an unscheduled time is an issue, a patient can be instructed in ways to relax, including deep breathing and pelvic floor muscle exercises.
What is bladder retraining, and how does it help?
Bladder retraining is based on the notion that the patient can control her bladder rather than the other way around.
- A plan will be devised combining scheduled toilet visits and behavior modification. Regular, scheduled toileting will help keep the patient dry and reduce the need to delay voiding or resist the urge.
- Fluid management, diet management and weight loss all affect incontinence. The patient may benefit from dietary changes such as reduced caffeine to eliminate bladder irritants and increased fiber to avoid constipation. The bladder usually takes three to four hours to fill before signaling the need to urinate. A person can normally override the urge to urinate, but continence is a learned behavior and some patients may need retraining of the brain/bladder signals.
In urge control training, the patient may be instructed to:
- Stop all activity and sit or stand still.
- Use pelvic floor muscle exercises as instructed by the therapist.
- Relax the rest of the body — do not panic — and concentrate on suppressing the urge sensation.
- Walk to distract attention from the urge until it subsides.
What kind of exercises can help prevent incontinence?
Pelvic floor muscle exercises, known as Kegel exercises, are easy to do and can be done lying down, standing or sitting, without anyone else noticing. Many women do Kegels before, during and after pregnancy to strengthen the muscles that support the bladder.
- To learn how to do a Kegel, stop or slow the flow of urine while urinating, and notice which muscles that action involves. To do a Kegel, contract those same muscles for three seconds and then relax them.
- The therapist may also recommend the use of vaginal cones or weights to assist in strengthening the pelvic floor muscles, and will provide instructions on how to use and where to purchase them.
Night Time Voiding Techniques
- Avoid fluids two to three hours before bedtime to decrease the need to get up in the night.
- Increase fluids during the day/afternoon.
- If leg edema is present, elevate legs for one hour before bedtime or wear compression stockings during the day.
- Use urge reduction techniques before going to sleep.
How can biofeedback help relieve incontinence?
Biofeedback techniques may assist in the use of Kegel exercises to strengthen affected muscles. Sensors are placed outside or within the vagina to monitor muscle activity and provide the patient with visual or auditory feedback to guide her efforts.
The therapist will work with each patient to establish specific goals for the number of times and amount of urine to be voided throughout the day and night, based on the patient’s age and specific condition.