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An Ounce of PT Prevention

No one wants to deal with urinary incontinence (UI), or involuntary loss of urine. Unfortunately, an estimated 25-45% of women will experience UI at some point during their lives. As if that were not bad enough, it has been hypothesized that women who experience UI are at risk of developing uncomplicated urinary tract infections (UTIs). I am sure you would agree that this is a rather unwanted two for one deal. The reason for this is that dysfunctional voiding can disrupt the normal flow of urine through the urethra, which can result in bacteria travelling back to the bladder and creating infection.

Past research has focused on and proven that pelvic floor physical therapy can help reduce UI symptoms…but does pelvic floor PT help with UTI prevention?

I am not the only one who has pondered this question. Lucky for us, Dr. Kate Divine and Dr. Lisa McVey have asked themselves the same question and kindly performed research to help answer it. They conducted a single-subject case study with a 50-year-old schoolteacher who presented with a ten-year history of UI, UTIs, urinary urgency/frequency, and pelvic pain. Her conservative pelvic floor physical therapy treatment plan included bladder retraining, biofeedback, electrical stimulation, patient education, and exercises. After six sessions, the patient had achieved all her goals. When the researchers checked in with her three months later, she had not experienced any UTIs (compared to pre-treatment, when she typically experienced them every 1-2 months) or UI symptoms.

Obviously, additional research is warranted to explore if the same results occur across the board, because a sample size of one is rather small. It would also be interesting to see if the positive results continue beyond three months. But this is a huge first step. The research is extremely promising, especially because resistance to UTI antibiotics is on the rise. The fact that physical therapy, a conservative and non-pharmacologic approach, may be of help further reinforces my strong belief in “an ounce of prevention is worth more than a pound of cure.”

If you are someone you know stands to benefit from pelvic floor physical therapy to address either UI or recurrent UTIs, please contact us! It would be an honor to serve as your healing agents.

Divine, Kate PT, DPT, WCS; McVey, Lisa PT, DPT Physical Therapy Management in Recurrent Urinary Tract Infections: A Case Report, Journal of Women’s Health Physical Therapy: January/March 2021 – Volume 45 – Issue 1 – p 27-33 doi: 10.1097/JWH.0000000000000189

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“Can We Please Pull Over For a Rest Stop?”

Everyone has that friend who, when travelling together, is always asking to pull over for a rest stop, chalking it up to their “small bladder.” You know exactly who I’m talking about. Well, believe it or not, it might not be their fault. It could just be their PIEZO2 gene doing exactly what it was designed to do.

When it comes to the age old question of nature vs. nurture, nature seems to be stealing the spotlight once again. Scientists have discovered that genetics play a major role in previously unidentified territory. 

But first, a bit of background. The kidneys filter and send excess water to the circulatory system while sending waste to the bladder through the ureters in the form of urine. The bladder wall, which contains the detrusor muscle, is lined with smooth muscle which fills like a balloon. The bladder’s stretch receptors send messages to the brain when activated by the full bladder telling you “it’s time to go.” This is a type of interoception, or awareness of what is happening within the body.  

Researchers at the National Institutes of Health led by Dr. Ardem Patapoutian discovered that the PIEZO2 gene is involved with at least two different types of cells associated with bladder filling sensation. It contains instructions which make proteins that are activated when the detrusor muscle cells are stretched. Individuals born with a deficiency in this gene may have difficulty sensing when their bladder is full. In fact, in 2015, researchers realized that many individuals who demonstrated a mutation in this gene reported pediatric toileting issues, frequent urinary tract infections, and other urinary issues of various sorts (ex. three participants reported voiding only 1-2x/day. Normal urinary patterns involve voiding approximately 6x/day).

The implications of this study reinforce what pelvic floor therapists routinely address, including the value in keeping a bladder diary. Tracking fluid intake and urine output is often an enlightening, eye-opening experience for most people. It is normal to void every 2.5-3 hours. Keeping track of how frequently you urinate could reveal urinary frequency, or on the opposite end if the spectrum, urinary retention. Individuals with the mutated gene stand to benefit from forcing themselves to void at scheduled intervals rather than relying on their desensitized receptors.

Anyone who experiences urinary dysfunction (ex. urinary frequency, retention, incontinence, and or urgency) stands to benefit from pelvic floor physical therapy. Aside from addressing food and fluid intake, urination patterns, and avoidance of bladder irritants, pelvic floor physical therapy can address any underlying musculoskeletal dysfunction which may be contributing to urinary dysfunction. If you or someone that you know is nodding their head silently while reading this blog, please contact us at Revitalize Physical Therapy. It would be an honor to help you along your healing journey.