Written by Rebecca Ironside, PT. Rebecca is also a published Author of Fiction.
I met a woman named Eva* at the Pelvic Floor clinic. She came for physical therapy to address urinary leakage, which she has endured for over ten years. I had to glance at her date of birth to make sure of her age. Eva is 85 years old, and she looks spectacular. “What is your secret to looking so young and vibrant?” I asked her. “Maybe it is having good friends. Wonderful children and grandchildren. Or maybe it is just my good Danish genes,” she replied.
Eva told me that she began leaking urine several years ago, but her condition is getting worse. She told me that she cannot go to the beach anymore at Point Pleasant, which is her favorite thing to do. In her medical history, I learned that Eva had had three pregnancies with vaginal births. She does not drink enough water, mostly in fear of losing even more urine. Based on her age and prior history of childbearing, I was working under the assumption that Eva had weakness in her pelvic floor muscles. Maybe a little prolapse of the bladder.
“A lot of young women come here with complaints of pain with sex,” I told her. Eva’s eyes opened wide. “Do you mean to tell me that there is treatment for that? I had two husbands and sex was awful with both of them. The pain was unbearable. I never understood what the big fuss about sex was all about.”
Here was a woman in her eighties who had lived with pelvic floor dysfunction her entire life. The painful intercourse made sense, given how much tension she was holding in her musculature. I devised a treatment program for Eva to allow the muscles of her pelvic floor to elongate. She was given a home program of self-stretching, diaphragmatic breathing exercises, and an activity known as the pelvic floor drop, which is the opposite of the famed Kegels we have all read about in McCall’s Magazine.
Eva has returned several times to our clinic. She has far less urinary leakage, is drinking more water (she has retrained her bladder to accommodate this), and practices yoga and deep breathing. She is planning a month-long trip to Florida, wherein she will be able to go to the beach in a bathing suit encasing her lithe body without fear.
I learned something wonderful during my treatment of Eva. I rejoice in living in a time when help is now possible for these things that have plagued women for centuries. I also learned that it is never too late to change. Eva is 85. And if she responded so readily to this therapy, then anything is possible.
*The name and some personal details of this patient have been changed, according to the laws of the Health Care Portability and Accountability Act. But the symptoms of Eva and the outcome of her treatment are true. Pelvic Floor Physical Therapy works!
What the Research Says: Effectiveness of Early Pelvic Floor Rehabilitation Treatment for Post-Prostatectomy Incontinence
A prospective study by Filocamo and colleagues in 2005 investigated the effectiveness of early pelvic floor muscle training (PFMT) after radical retropubic prostatectomy (RRP). After catheter removal, 300 men were randomized equally into either a structured PFMT group or a control group that did not receive exercise. Incontinence was assessed by the 1-hour and 24-hour pad test, as well as the ICS-Male questionnaire.
By 6 months, almost 95% of the PFMT group achieved continence as compared to 65% of the control group. The authors concluded that an early supportive rehabilitation program like PFMT significantly decreases continence recovery time.
Filocamo M, Marzi VL, Del Popolo G, Cecconi F, Marzocco M, Tosto A, Nicita G. Effectiveness of Early Pelvic Floor Rehabilitation Treatment for Post-Prostatectomy Incontinence. European Urology. 2005 Jun:48(5)734-8.
Patient: 42-year-old female
Chief Complaint: Urine leakage with urgency after vaginal delivery of 2nd child + emergency hysterectomy; 6 night voids
Past Medical/Surgical History: Repair of prolapse the following year + Oxybutynin with 50% decrease in symptoms; history of low back pain, irritable bowel syndrome
Physical Therapy Treatment: proper voiding techniques; lower body stretches; prolapse management; posture and breathing exercises; abdominal scar release
Results: 0 urine leakage with 1.5 hour urinary intervals, 0 night voids, 0 Oxybutynin in 12 visits!
(Constipation in Children. (2013).Retrieved June 9, 2014 from http://digestive.niddk.nih.gov/ddiseases/pubs/constipationchild/#common Urinary Incontinence in Children. (2012). Retrieved June 9, 2014 from http://kidney.niddk.nih.gov/kudiseases/pubs/uichildren/index.aspx)
Written by Michelle Dela Rosa, PT.
Another study from Japan showed that almost half of their 784 elderly participants reported nocturia 2 times or more per night. These individuals were at greater risk for fracture and mortality. (Nakagawa et al, J Urology. 2010 October; 184(4): 1413-18.)
Simple advice like decreasing caffeine, alcohol, or any fluid near bedtime may help improve nocturia. Physical therapists can help patients with other behavioral strategies and techniques after a thorough evaluation. Other factors to consider include: sleep disorders, diabetes, poor bladder storage, kidney dysfunction, or cardiac issues.
Written by Michelle Dela Rosa, PT.
1000 healthy, young women (age 16-30 in Melbourne, Australia were surveyed about continence. 6.2% of women reported urinary leakage with stress, 4.5% with urge, and 1.9% with both stress and urge. Women were also more prone to UI if they reported a history of bedwetting beyond 5 years of age.
Written by Michelle Dela Rosa, PT.
(Hung HC et al., “Effect of pelvic-floor muscle strengthening on bladder neck mobility: a clinical trial”. Phys Ther. 2011 Jul; 91(7): 1030-8.)
These results demonstrate the need to screen patients with IC for pelvic floor dysfunction and painful muscle trigger points, and refer them to specialists like physical therapists who are skilled in treating pelvic pain.
Urinary incontinence exists at higher levels in patients with Type I or II diabetes than in those without diabetes, according to new research. Another article from the National Association for Incontinence (NAFC) website states that 50% of men and women with diabetes have incontinence. It describes how sugar can get into the urine and irritate the bladder. This creates urinary urgency, frequency, and incontinence, symptoms that could be mistaken for a urinary tract infection.
The article also notes that persistent bacteria in the bladder can lead to symptoms of overactive bladder (OAB), which results in the neurologic dysfunction of incomplete bladder emptying. Consequently, the patient becomes more susceptible to urinary incontinence and infections.
In addition, fluid retention can be associated with other conditions of the diabetic patient. Extra fluid in the legs can be moved into the patient’s system when lying down. This often leads to urinary frequency at night, which interrupts sleep and puts patients at risk for falls.
Some easy solutions include having the patient do ankle “pumps” (bending the foot back and forth) before bedtime to move fluids out of the legs earlier. If a diuretic is being taken, altering the dose or timing may also help. The literature suggests that physicians should screen for incontinence in diabetic patients, as they may not share this information by themselves.
Elser D, Diabetes and Urinary Incontinence. Quality Care. 2011 Nov
Phelan S et al., Clinical Research in Diabetes and Incontinence: What We Know and Need to Know. J Urol. 2009 Dec