Using physical therapy to treat pelvic floor disorders

For many women, a leaky bladder along with urinary urgency and frequency are part of everyday life.

According to the National Institutes of Health, approximately 25 percent of women in the United States are suffering from symptoms like these, indicative of a pelvic floor disorder.

Pelvic floor disorders are a broad category, and can encompass a number of different conditions or symptoms that affect the pelvis, bladder, uterus and vagina. While they can affect anyone, women are diagnosed with pelvic floor disorders at much higher rates than men, due in large part to gender-specific risk factors like menopause and childbirth.

Fortunately, as the number of pelvic floor diagnoses has increased, so have treatment options. Medication, urethral injections, bladder slings and surgery can all offer relief from pelvic floor disorders. So, too, can physical therapy.

How physical therapy can improve your pelvic floor function

At first, it might sound surprising to hear that physical therapy may be useful for reducing symptoms like bladder leakage, urinary frequency and urgency, and varying degrees of pelvic pain. However, physical therapy is a practice focused on restoring mobility and function to every area of your body—and that includes your pelvic region, too.

“We treat a variety of conditions related to pelvic floor dysfunction, including stress urinary incontinence (leakage with coughing and sneezing), overactive bladder, fecal incontinence, pelvic organ prolapse and pelvic pain,” says Maureen Fleagle, a physical therapist with the Bryn Mawr Rehab Outpatient Network in Wynnewood, part of Main Line Health. “Once a patient has consulted their doctor and received an accurate diagnosis, they are often referred to physical therapy as an attempt to treat symptoms without surgical intervention.”

Utilizing techniques such as biofeedback, diaphragmatic breathing, mindfulness, pelvic floor strengthening and education about lifestyle behaviors, physical therapists specially trained in pelvic floor rehabilitation work with patients to reduce or manage the symptoms of pelvic floor disorders . Below, Fleagle discusses a few of the components that may be included in a patient's treatment session.

Education about diet and bladder irritants

“Our rehabilitation program involves—first and foremost—a complete examination, including a comprehensive patient history and objective exam. The initial visit often covers a significant amount of patient education,” says Fleagle. “We speak to patients seeking treatment for bladder issues about how their diet can impact their symptoms, and the importance of keeping bladder irritants to a minimum.”

Many women are surprised to learn that what they eat and drink can have an impact on an overactive bladder. However, common bladder irritants like caffeine, carbonated beverages and acidic foods can all trigger those frequent bathroom breaks.

Quite often, women will reduce their fluid intake if they are experiencing urinary frequency, urgency and leaking. However, as part of patient instruction, it is highly recommended to drink adequate fluid throughout the day, mostly water, to ensure healthy bladder function.

Bladder re-training to help correct learned behaviors

Just like your body needs time to adapt to a new fitness routine or follow a new diet, your bladder will need time to adapt and ‘re-learn’ new behaviors, too. This is called bladder re-training, and it’s an important component of pelvic floor rehabilitation.

“Many of us have learned bladder habits over the years that encourage us to use the bathroom when it’s convenient for us rather than when we need to,” says Fleagle.

She points to a common example: ‘just in case’ bathroom runs.

This refers to emptying the bladder prior to running errands, even if you've just recently used the bathroom. By adopting this and other lifestyle habits, the bladder becomes accustomed to frequent breaks and will start to signal that it needs to be emptied, even if it is not full.

In other instances, women may be ignoring bathroom cues or unable to use the bathroom as frequently as needed. This is especially prevalent in certain professions or when a person has an aversion to using public toilets.

While the number of times someone will need to use the bathroom each day can vary, Fleagle says that an average of every three to four hours is normal for pre-menopausal women, while every two to three hours is normal for post-menopausal women.

Of course, bladder re-training isn’t easy—particularly if you’ve been able to ignore or misconstrue bathroom cues for several years. That’s why patients referred to pelvic floor rehabilitation are given a bladder diary and instructed to keep a three day account of fluid intake, voids throughout the day, leaking episodes and urgency. This information will be kept by the patient and reviewed with the therapist on a weekly basis.

If overactive bladder symptoms are the issue, urge suppression techniques are taught and utilized to keep symptoms to a minimum. These are lifestyle adjustment tools and can be practiced throughout the person's lifetime.

In most instances, education about pelvic floor issues along with an adjustment to learned behavior patterns is enough for many women to see an improvement in their symptoms.

Relaxation and mindfulness

Managing conditions like an overactive bladder or urinary leakage can often be as much of a mental act as it is physical. That’s why mindfulness techniques can help.

To help combat the 'fight or flight' response many patients experience when they have the urge to use the restroom, she and her colleagues teach mindfulness and relaxation techniques like mindful breathing and hand warming to quiet the nervous system. If patients often find themselves running to the bathroom, they might work with their therapist on an ‘urge suppression strategy’ which helps them reach the bathroom without leaking.

Pelvic floor strengthening using biofeedback

Another component of a pelvic floor rehabilitation program can be strengthening, if it is indicated necessary following an assessment by the therapist.

Before beginning any strengthening exercises, your physical therapist will typically complete a manual assessment using his or her finger to evaluate pelvic muscle, tone and strength. Based on the results of this assessment, your therapist will devise a therapy plan that may include exercises that focus on strengthening the pelvic floor muscles, if necessary.

Another technique your therapist may use is biofeedback. Biofeedback is a helpful tool for added information regarding the patient's pelvic floor including resting tone, ability to contract and relax, and how long a patient can sustain a contraction. Oftentimes, this tool is utilized as part of the visit with the patient lying down and progressing to sit then a standing posture.

If you’ve ever been confused as to whether or not you’re doing 'Kegels' correctly, this can be a helpful tool.

“If you tell two people to contract their pelvic floor, one might squeeze their thighs while another might pull their belly in,” says Fleagle. “Biofeedback gives the therapist and patient useful information, and patients often leave their visit feeling more confident and motivated to take a more active role in their therapy program.”

Seeing results

After about four to six weeks, Fleagle says that most women see results and an improvement in their symptoms. As with any exercise program, it’s important to continue your program at home. Stopping the home program when physical therapy is completed can result in a return of the original symptoms. Therefore, patients are encouraged to continue a lifelong commitment towards a healthier lifestyle.

For women and men suffering from ongoing conditions like urinary or fecal incontinence, pelvic organ prolapse or pelvic pain syndrome, our pelvic floor rehabilitation program provides comprehensive evaluations, diagnostic testing and therapy. Bryn Mawr Rehab has physical therapists who are certified pelvic floor therapists located in the Philadelphia suburbs of Collegeville, Media, Paoli and Wynnewood, who help patients reach their goals step by step.

To schedule an appointment with a Bryn Mawr Rehab clinician for outpatient physical, occupational and speech therapy services, call 484.596.5000.