Pelvic Floor Therapy Can Alleviate Urinary Incontinence

There are several options to deal with this condition

By Deborah Jeanne Sergeant

If you leak urine, pelvic floor physical therapy can help you ditch pads and stop 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.

Elizabeth Loycano

Elizabeth Loycano, doctor of physical therapy with Finger Lakes Health, said that urinary incontinence affects men and women of all ages — not just post-partum and post-menopausal women.

“People engaging in contact sports, gymnastics and basketball can experience it,” she said. “Things like surgeries like for prostate, hysterectomy or diverticulitis or anything with the abdomen or pelvis can affect the pelvic floor muscles and that can lead to incontinence.”

After taking down the patient’s health history, Loycano looks at the body mechanics, posture, and breathing patterns. All of this affects continence.

She also discusses behaviors such as avoiding constipation, lifting mechanics, and movements in daily living such as getting in and out of a car.

“I ask people to drink less soda, coffee and tea and more water,” Loycano said.

Jen Morin

Ironically, many people reduce drinking fluids to help control their incontinence. However, 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, Loycano encourages patients to have easy, consistent bowel movements by eating enough fiber and using a footstool while eliminating so their bodies are in a better posture for effective elimination.

She also discusses 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.

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.

While many people are aware of Kegel exercises—consciously working the muscles that control urine flow to strengthen them—these are not always the answer. For people with tight bladder control muscles, this worsens the problem. Some people hold stress in their shoulders. Others hold stress in their pelvic floor, which can interfere with continence. Learning stretching exercises in the office that they can perform at home may be the key to conquering incontinence.

By the second visit, 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.

Jen Morin, physical therapist, certified pelvic rehabilitation specialist and co-owner of Evolve Physical Therapy in Pittsford, said that rehabilitative ultrasound is another tool therapists use.

“It’s like a pregnant woman would receive on her belly only we’re using it to look at how their pelvic floor muscles move,” Morin said. “It gives us a better idea at how that muscle is working and it’s a visual for the patient as to how their 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.

“We’re trying to isolate that pelvic floor muscle and we don’t want people to ‘cheat’ by using their other muscles,” Morin said.

Within a few weeks, most patients see improvement in continence. Of course, those who seek treatment sooner tend to see quicker results.

“It’s never too late to be seen. Even someone in their 90s can see improvements,” Morin said. “A lot of times it’s learning how our bodies are supposed to work and how they’re currently working. After the first visit, most patients say, ‘Oh, that wasn’t so bad. I don’t know why I didn’t seek this sooner.’”

Morin said that few physicians refer people to pelvic floor physical therapy.

However, 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.