Bladder/Urologic Archives - Revitalize Physical Therapy

When you think of bathroom training, you probably think of your little one learning to use the potty for the first time, but it’s for adults too – especially those with urinary incontinence.

It may sound silly, but at some point, if you have urinary incontinence, your body needs to be retrained on proper voiding habits and mechanics. And just what do we mean when we talk about urinary incontinence? You may be familiar with the feeling of a little urine leaking after a cough (known as stress incontinence), as one in three women can relate, but there are other kinds of urinary incontinence as well. There is regular leaking throughout the day (overflow incontinence) due to your bladder not releasing urine when it should, and accidentally urinating before you’re able to get to the restroom in time because the urge is too strong, often described as “key in door” because people tend to leak on their way to the bathroom (urge incontinence). You can even have mixed incontinence, which is a combination of stress and urge incontinence.

Ultimately, the goals of bladder retraining include urinating less frequently, urinating larger and healthier volumes of urine, and increased volitional control over voiding.

Part of bladder retraining is starting a bladder retraining diary that captures what life is like for you on a day-to-day basis with urinary incontinence. It may feel weird to do, but it is a legitimate way to help. You may use your bladder retraining diary to keep track of urges and leaks. You can record what times you go to the bathroom, how much you urinate (no need to measure fluid ounces, as using “Mississippi seconds” to time length of void suffices to gauge how empty or full your bladder is), and the type of fluids you’re drinking. Bladder irritants cause your bladder to contract even if it isn’t yet full, and this leads to incontinent episodes. The top three biggest offenders are caffeine, alcohol, and carbonated beverages. You may even choose to abstain from said food or drink. You may feel disheartened when you are first keeping track of what’s going on, but the idea isn’t to feel bad when accidents or setbacks are recorded in your diary, rather to use the diary in your detective work to help create patterns which will help you solve the problem.

As for how you’ll actually retrain your bladder, you’ll start by extending the time you wait to urinate by 15 minute intervals. (People who don’t have urinary incontinence generally go to the bathroom six to eight times per day and zero to one time at night.)

Kegels, or performing a pelvic floor muscle contraction, are a great bladder suppression technique. In other words, when you turn the pelvic floor muscles on while performing a Kegel, a message is sent to the bladder to turn off, which allows it to fill up for longer before needing to void.

Speaking of Kegels, your pelvic floor physical therapist can demonstrate exactly how to perform Kegels properly. Don’t be embarrassed to ask us for a demonstration! They can be difficult to master, and helping you resolve urinary incontinence is what we are here for! The other reason why it’s best to check with a pelvic floor PT prior to initiating a Kegel strengthening program is because KEGELS AREN’T FOR EVERYONE. If a person has a history of overactivity, or tightness of the pelvic floor, Kegels exercises are contraindicated as they can exacerbate the problem. Some signs that may indicate overactivity or tightness of the pelvic floor muscles include pelvic pain, urinary frequency, and constipation, to name a few.

Urinary incontinence can feel embarrassing, but you shouldn’t let that embarrassment keep you from speaking to your doctor or physical therapist about your symptoms. If you are determined to retrain your bladder, recognize, though, that it is a commitment. It may take as long as 12 weeks to see improvement. You may want to carefully choose a calm time in your life to embark on this journey, versus a time when you know it may be tougher to remain compliant. Still, it’s worth it because urinary incontinence can hold you back from enjoying all the things you love to do: seeing movies at the theater, taking long car trips, and traveling. It’s time to show your bladder who’s boss! I encourage you to talk to your doctor and physical therapist (or contact me for a free consultation) so you can get back to living life leak-free!

If you’ve been diagnosed with pelvic floor dysfunction, you may be wondering what you can expect from your first pelvic floor physical therapy appointment. You may already know about physical therapy for other parts of the body, but pelvic floor physical therapy is different. You are entrusting us with a very private part of your body. It’s understandable, therefore, to feel confused and concerned. Knowing some of what to expect at your first pelvic floor physical therapy appointment, though, can go a long way toward easing your mind:

You will be there for a while. Pelvic floor physical therapy is not a quick visit, and that’s especially true for your first pelvic floor physical therapy appointment. How long can you expect your first pelvic floor physical therapy appointment to take? First sessions are typically an hour, and subsequent appointments are usually 45 to 60 minutes.

Even though the session is long, you will have to change clothes fast! Physical therapy day is not the day to wear a complicated jumpsuit. Although your therapist should be patient while you change, you don’t want to spend too much time struggling with buttons or zippers. You need that time for your session.

You will be expected to talk about your symptoms, medicines and medical history at your first pelvic floor therapy appointment. The night before, it’s a good idea to write down a summary of what brings you to pelvic floor physical therapy. Have you noticed urinary frequency? An increase of pain? Are you leaking? How long has this been going on? Don’t feel embarrassed. We need to know, just like any healthcare provider needs to know about your symptoms. Don’t be surprised if your pelvic floor physical therapist asks you about your sexual activity either! We’re not doing it to be nosy or judgmental. If your therapist is asking, she needs to know. It’s in order for them to understand your symptoms so that they can best help you. There is no wrong answer. Just answer truthfully.

You will be asked for paperwork and IDs. This is why it’s a good idea to prepare the night before! You should have your driver’s license, health insurance card and a prescription from the doctor who is referring you to pelvic floor physical therapy (should that be required).

You may feel strange at first, and that’s ok. No matter how lovely your therapist is, having that part of your body explored by someone you don’t know could feel odd. Don’t be afraid to speak up in the session for anything you need that will make you feel more comfortable, whether that is an extra pillow or a fan. (We don’t want to treat your pelvic floor only to hurt your neck with improper support!) Over time, you may find you feel less strange during pelvic floor therapy appointments as they become more routine.

There will be an external exam as well as an internal one. The external exam may involve your back and hips, among other areas. In addition to an internal vaginal exam, your physical therapist may ask to do a rectal exam. Remember, though, you always have the right to refuse any part of an exam, whether at a physical therapist’s office or anywhere else. This is as true for your first pelvic floor physical exam as it is for your 31st: Just because you approve an internal exam, for example, during the first appointment doesn’t mean you can’t refuse it later on. You are always in control, and you should always let your therapist know if you are in pain during a session!

You may have homework. You may need to do exercises and work with a dilator. Remember: You are a partner with your therapist in getting better – it’s not just him or her doing the work alone! Added bonus: patients who do their homework get better faster.

You won’t be cured after the first session. You may have wanted this problem over with yesterday, but you must understand that physical therapy is a process. It’s not the same as taking a painkiller. That being said, the average time spent in physical therapy is 6 to 12 sessions.

I hope this guide has helped. Going to your first pelvic floor physical therapy appointment is a brave, powerful step that can help put you on the path of a more comfortable life without drugs or surgery. You may question sometimes whether to keep going, especially during weeks when you have a setback, but know that it and you are always worth the effort. If you are in the New York area, feel free to contact me for a free phone consultation, so I can further encourage you about starting pelvic floor physical therapy.

Category: Bladder/Urologic

Mind Over Bladder

What Should I Expect at My First Pelvic Floor Physical Therapy Appointment?