Urinary frequency and leakage- how can pelvic floor physical therapy help?

Well I usually get an e-mail from an unhappy baldder patient that is something like this:  Dear Karen: I have to pee all the time.  Before I leave the house, once I get to where I am going, then once before I leave, and again when I get home.  I don’t understand I barely drink any water, but sometimes the urge is so strong and only a few drops come out.  Can you help me?

This is the email I get at least once a week.  Women are distressed all over the country because their bladder has taken over their lives. They always have to pee.  They are in fear that they are going to leak, and wear pads or liners- some have leaked in the past, others have not. 

How Does the Bladder work?

The Bladder is a small sack just behind and slightly above your pubic bone and empties via the urethra that is right in front of your vaginal opening. 

In the happy bladder world:

In order to pee and properly empty the bladder: the bladder muscles contract and the pelvic floor muscles relax, that way the urine goes from an area of high pressure to an area of low pressure.

In order to store urine, ie if you cannot find a bathroom: the pelvic floor contracts and the bladder stretches to accommodate the urine until a more opportune moment is present.  So the valve is closed until it can open once you sit at a toilet.

Well that is not what is going on with my people!

They don’t know if their pelvic floors are relaxing/ contracting, and good luck figuring out what their bladder is doing!

Some medical reasons why you may be experiencing this:

• interstitial cystitis, painful bladder syndrome, post operative bladder sling

• Benign Prostatic Hypertrophy (BPH), chronic prostatits

• Overactive Pelvic Floor muscles

• UTI- red flag: =you don’t need a PT, call your provider, you need antibiotics, and if this urinary symptom is new you may want to call your provider to drop off a urine sample

So if you do have a medical diagnosis from 1 and 2- then your provider may recommend a medical intervention along with pelvic floor physical therapy!

What can Pelvic Floor Physical Therapy do? 

1. We will tell you to drink your water, don’t dehydrate yourself

2. Seriously some of what I do is potty training . . .get it? PT . . . We need to go over proper toileting ergonomics.  What is the best position for you to SIT on the toilet to optimize pelvic floor relaxation, opening the valve . . .

3. A continuation of #2, you MUST sit, not HOVER on the toilet.  Try squatting- can you really relax your muscles?  ‘Enough said

4. Lengthen the tissues and muscles to give the bladder more space to stretch and accommodate for urine storage

5. Bladder retraining to help you slowly build time between voids.  Know it is scary to not pee right before you leave the house.  But what if the place you are going to is only 8 minutes away? Can we start small? And leave an extra set of clothes in the car just in case?

I promise I will never make you do something you are uncomfortable with, I will nudge you in that direction though and we can start with baby steps. Soon you will have no problems driving Houston to Austin with NO STOPS! Make an appointment today!