It’s National Bladder Health Week and we want to dedicate this blog post to our favorite (and only) urine collecting organ! The bladder is a vessel that sits on the pelvic floor and its primary function is to collect and hold our urine. It is made out of a hollow muscle called the detrusor which stretches to allow urine to collect and contracts when it is time to urinate. Just like any other muscle in the body, it can become injured or dysfunctional when things go awry. So, in honor of National Bladder Health week, I want to highlight some of the most common bladder ailments that we encounter on a regular basis, as well as discuss how pelvic floor physical therapy can help.
Incontinence. An all too common issue that many of us deal with on a daily basis. Research has shown that anywhere from 8.5%-38% of the population experience urinary incontinence1 . However, incontinence tends to be more common among the female population; women experience urinary incontinence 75% more than men2 .
Stress urinary incontinence is the most common type of incontinence. It is characterized by urine leaks that occur with an increase in intra-abdominal pressure, such as a sneeze, laugh, cough, or vigorous activity like running or jumping. If the pelvic floor muscles are not able to contract strongly enough to resist this increase in pressure, then the result may be a leak.
How we can help:
It is important to make sure that the pelvic floor and pelvic girdle muscles have the proper strength, endurance, and control to ensure optimal muscle function. A pelvic floor physical therapist can work with you to prescribe a tailored program of strengthening exercises (beyond the ubiquitous kegel) and neuromuscular re-education of both the pelvic floor/girdle and core musculature to train these muscles how to contract appropriately and eliminate incontinence. Biofeedback is one of the many tools that a physical therapist may choose to employ to enhance a treatment program.
*As we have discussed in previous blog posts, not every person with incontinence needs to be doing pelvic floor up training/strengthening. So, check with a qualified physical therapist to determine the appropriate treatment plan for you. This post is a great example of someone who is experiencing stress incontinence, but would not be appropriate for a strengthening program.
**Pregnancy is a factor that creates many changes in a woman’s body, including increased intra abdominal pressure, increasing weight of the fetus, and hormonal changes. All of these changes put stress on the pelvic floor and increase the risk for incontinence. Over half of pregnant women have reported varying degrees of stress urinary incontinence. If you are experiencing any bladder symptoms, check with your OBGYN and a physical therapist to determine the best course of action.
Urge urinary incontinence occurs when we feel a strong urge to urinate and are unable to delay the urge long enough to get to a toilet in time. Such a strong urge to urinate can be created by tight tissues near the bladder or other various triggers. One example of a common trigger is when we get our key in the door, it has even been named it ‘key in the door syndrome’!
How we can help:
There is often both a behavioral and musculoskeletal issue happening for people dealing with this symptom. Tight pelvic floor muscles can irritate the urinary tract which can cause urinary urge that is disproportionate to the amount of urine that is actually in the bladder. Working with a PT to normalize the pelvic floor tone and make behavior modifications can be a huge factor in overcoming this issue.
Prolapse. The bladder is supported in the bony pelvis by connective tissue and the pelvic floor muscles. When one or both of these structures are unable to support the bladder, it becomes hypermobile, allowing itself to fall backwards, into the vaginal wall. When this happens, the angle where the urethra meets the bladder changes, and it becomes more difficult for the pelvic muscles to compress the urethra to stop the flow of urine. When this occurs, a person may be asymptomatic or may experience symptoms ranging from a heaviness in the pelvis to urinary incontinence.
How we can help:
A physical therapist can give instruction on a pelvic floor/pelvic girdle muscle strengthening/neuromuscular re-education program to increase support for the bladder, as well as how to use these muscles appropriately to avoid excess pressure on the pelvic floor and reduce symptoms. A person may also need to use a pessary or have surgery to correct for the degree of pelvic organ prolapse. Check out this blog post for more information.
Urgency/Frequency. Urgency is the sudden need to urinate that (as mentioned above) may cause urine to leak on the way to the bathroom. Frequency occurs when we are feeling the urge to urinate more than what is considered the norm. Normal is about 6-8 times per day or once every 2 to 5 hours. We want to strive for not waking up in the middle of the night to urinate; however, during pregnancy or menopause, one time in the middle of the night is considered “normal”. (Similar to urge urinary incontinence, urgency and frequency are often a combination of both pelvic floor muscle overactivity and behavioral factors).
How can we help:
The urge drill is one technique to retrain the bladder to reduce urgency, frequency, and urge urinary incontinence. When you feel a sudden, urgent need to go to the bathroom, do not run to the toilet. Rushing will activate your fight or flight system and increase the urge. To help control the urge, first stop and be still, as this quiets your nervous system. Then try doing 5 quick pelvic floor contractions or pelvic floor drops (relaxations). This sends a signal to your bladder to stop trying to get the urine out. When the urge is under control, slowly and purposefully walk to the bathroom to empty your bladder. Timed voiding schedules may also be necessary for those experiencing urgency and frequency.
Pain. Bladder pain (aka painful bladder syndrome (PBS) or interstitial cystitis (IC)) is a condition that can be caused by various mechanisms that presents with a range of symptoms. Different treatment plans will be successful for different people, however a very common finding in people with bladder pain is a tightening of the muscles and connective tissue in the surrounding area. Painful organs can cause painful muscles and tissues in the surrounding areas which then restrict blood flow and oxygen to that area. This further irritates the tissues and nerves causing further bladder discomfort (a perpetual cycle). Stay tuned for an upcoming post dedicated to PBS/IC.
How we can help:
A skilled pelvic floor physical therapist can help to decrease the tone of the involved muscles and tissues allowing improved mobility, blood and oxygen flow, and aid in the healing process. Here is a link for more information on PBS/IC support.
**This blog is intended to give a brief overview of some of the physical therapy treatment options for musculoskeletal factors contributing to bladder dysfunction. If any of these issues are affecting you, there is hope! Let’s seize the moment of National Bladder Health Week to get on the path of recovery! Contact your physician or physical therapist today to determine the right treatment plan for you!
Finally, check out this blog post for ideas on how to locate a pelvic floor specialist in your area!
References:
1Ashton-Miller JA, Howard D, and DeLancey JOL. The functional anatomy of the female pelvic floor stress continence control system. Scand J Urol Nephrol Suppl 2001;207:1-7.
2Pages IH, Jahr S, Schaufele MK, et al. Comparative analysis of biofeedback and physical therapy for treatment of urinary stress incontinence in women. Am J Phys Med Rehabil 2001;80:494-502.
3Price N, Dawood R, and Jackson SR. Pelvic floor exercise for urinary incontinence: A systematic literature review. Maturitas 2010;67:309-315.
FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.
Comments
I’d love to read an article here about IC/PBS