Physical Therapists are the musculoskeletal experts of the medicine world. We are passionate and proficient with disorders of the skeletal and muscle systems of the human body. There is an area of our bodies that often gets overlooked in a complete rehabilitation program – The Pelvic Floor. It is composed of a series of muscles, nerves, ligaments, and joints that house important organs, and has the ability to carry and birth our children.
Just like any other muscle system, our pelvic floor muscles can become weak or tight, or activate improperly. These impairments can manifest as incontinence, heavy feelings during menstruation or post-partum, or pain. There are also many causes of a pelvic floor dysfunction- not limited to- childbearing/birth, chronic coughing/smoking/asthma, obesity, repetitive lifting, high impact exercises, surgery, cardiovascular issues, diabetes, low back pain, and normal aging1. Physical therapists treat this area just like any other set of muscles – with a thorough history, complete physical examination, and specific interventions to treat your impairments.
Why haven’t you heard about this before? Because no one wants to talk about it…So let’s talk about it!
- Urinary Incontinence (UI) affects over 200 million people worldwide7.
- 47-49% of college age female athletes and non-athletes have signs/symptoms of Stress Urinary Incontinence2 (SUI).
- UI prevalence and severity increased with age3.
- There is a clear association with increased BMI/obesity and the prevalence of urinary frequency and incontinence4,5. Weight loss has a positive effect on incontinence; a RCT (randomized control trial) demonstrated a 60% improvement in weekly UI episodes6.
- Women who attended pelvic floor rehab with a skilled PT were 4 times more likely to be continent 15 years after treatment than their home exercises counterparts.
- High success rates (up to 90% of women treated) have been identified with SUI , UI and mixed urinary incontinence (MUI) that performed short duration, weekly sessions of skilled PT7.
- A healthy adult voids approximately 4-8 times a day, 0- 1 time at night is considered normal (up to 2 times at night per age >65 is still considered normal).
- The length of urination/micturition should be 8-10 seconds long.
- The bladder continuously fills (15 drops/minute; slowing at night) and can normally hold 400 mL of urine before micturition (urination) occurs.
The Dos and Don’ts of Healthy Bladder Habits.
Do not “hover” over the toilet. By contracting your glutes, adductors, and pelvic floor muscles you are not allowing the passive activity of micturition to occur. DO relax! Take your time, this is a passive activity; don’t feel like you have to rush. Urination should last 6-8 seconds.
Do not run or rush to the restroom. DO stop what you’re doing, perform a few quick Kegels, then walk to the restroom – you control the urge!
Do not only consume irritants to the bladder. These include caffeinated or artificially sweetened beverages, acidic foods/drinks, nicotine, alcohol, processed foods. If you must have your coffee in the am, keep a bottle of water close by and alternate between the two. DO drink water thorough the day. We should be consuming between 6-8, 8oz glasses of fluid/water (48-64 oz/day). Try drinking a standard water bottle between breakfast and lunch, another from lunch to leaving work, and another on your way home.
Do not hold your urine all day! (I’m talking to you teachers, nurses, medical professionals, busy bodies!) DO try to void between 4-8 times throughout the day. By storing your urine you are adding to the irritants in the bladder (stored urine is also an irritant) and placing excess pressure on your probably already weak pelvic floor muscles.
Do not urinate at night because you woke up. DO go back to sleep and only urinate as the need arises.
- Majzun C, Mize L, Huge B, et al. Pelvic health physical therapy level 1 course manual. Section on Women’s Health of the American Physical Therapy Association. 2013; 49-51.
- Figuers CC, Boyle KL, et al. Pelvic floor muscle activity and urinary incontinence in weight-bearing female athletes vs. non-athletes. JWHPT. 2008; 32:7-11.
- Wagg A, Majumdar A, Toozs-Hobsob P, Patel AK, Chapple CR, Current and future trends in the management of overactive bladder. Int Urogynecol J. 2007; 18:81-94.
- Elia G, Dye TD, Scariati PD. Body mass index and urinary symptoms in women. Int Urogyecol J. 2001; 12: 366-369.
- Dwyer PL, Lee ETC, Hoy DM. Obesity and urinary incontinence in women. Br J Ostet Gynacecol. 1998;5:91-96.
- Subak LL, Whitcomb E, Saxton J, Vittinghoff E, Brown JJ. Weight loss: a novel and effective treatment for urinary incontinence. J Urol. 2005;174(1):190-195.
- Knorst M, Resende T, Santos T, Goldim J. The effect of outpatient physical therapy intervention on pelvic floor muscles in women with urinary incontinence. Braz J Phys Ther. 2013;17(5)442-449.