Missed Opportunity to Educate

Misinformation can be dangerous. With all due respect to author Dr. Jen Gunter, I found her most recent piece in The New York Times (link to article) lacking and misleading. In her recent article, “Is Incontinence Inevitable?” (1/14/20), she completely missed the opportunity to promote the benefits of pelvic floor physical therapy when it was handed to her on a silver platter.

The following questions was posed to her by a reader: “Dr. Gunter, I am a postmenopausal 63-year-old woman. I am wondering if the fate of all women my age and older is to wear pads for leakage. I understand your specialty is gynecology and not urology but thought you could weigh in on any advances in this area as the two specialties are related.”

Dr. Gunter proceeded to explain the difference between stress and urge incontinence and to cite several commonly known statistics about incontinence. She then offered several tips to her readers, the second of which was to limit fluid intake. According to her, the notion of drinking eight cups of water per day “is a myth.” I have found this to be completely not true. Anecdotally, patients who drink greater quantities of non-irritating, flat water fare better than patients who drink smaller quantities of poor-quality irritants (ex. caffeine, carbonated beverages, and artificial sweeteners). The solution isn’t to restrict fluids; it is to drink larger amounts of high-quality fluids to allow the bladder to fill and empty in a healthier manner.

She then encouraged readers to participate in Kegel exercises, both endurance and quick flicks exercises. The problem with this is that approximately 50% of people who attempt to perform Kegel exercises do not perform them properly and engage in substitution patterns. In other words, people use the wrong muscles, such as the buttocks or inner thigh muscles, rather than the pelvic floor muscles. The best way for people to learn how to correctly engage the pelvic floor muscles is with a physical therapist who can introduce the learner to the muscles by touching them through internal manual cuing.

While Dr. Gunter answered the question correctly, that incontinence is NOT inevitable, she neglected to mention a very important piece to the puzzle in addressing the issue. The fact that the words “physical therapy” did not appear once in the article was, in my opinion, an oversight on Dr. Gunter’s part. Pelvic floor physical therapy has helped many women improve their continence in a safe, conservative, and evidence-based manner. If you or anyone that you know stands to benefit from our services, please contact us at Revitalize Physical Therapy. It would be an honor and privilege to help you!