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Pelvic Floor Therapy… More than Kegels

Written by: Dr. Elizabeth Braley, PT, DPT, OCS, CSCS

After writing about the prevalence of incontinence issues I thought I should address more specifically what pelvic floor therapy involves. Unfortunately, some people think if they do enough Kegels (pelvic floor contraction) their pelvic pain or leakage will resolve. In fact, a study found 40% of women had ineffective effort with pelvic floor contraction. Even worse 25% of them displayed urinary incontinence promoting techniques instead of appropriate use of the muscles.

The therapist may have you work on breathing because the diaphragm and pelvic floor muscles work together to manage pressure in your mid-section. We may also address issues with the hips, pelvis or spine that could be contributing to your pain.

We may start by having you do a bladder diary to get a baseline for your fluid intake, bathroom habits and get a sense of how often you are having leakage if you are having incontinence. Most people are surprised to learn drinking more WATER can help decrease leakage. If you are dehydrated the urine irritates the bladder more which could cause urgency issues. However, consuming too many bladder irritants can increase bladder pain and leakage. Irritants include; caffeine, coffee, soda, chocolate, sugar, spicy foods, acidic foods like citrus and some fruits. Constipation can put a lot of stress on the pelvic floor so managing constipation can also help decrease the stress on the pelvic control.

Sometimes it is necessary to discuss potty habits. Are you “power peeing” “hovering” or going just in case? Those things can be problematic. Also important to note is that Kegel exercises should not be done while urinating. Some people are triggered by things like walking by the bathroom or hearing running water. We can work together to train you (and your bladder) to not need to go as often. Controversy, if you feel the urge to have a bowl movement you should go and not try to hold it to avoid constipation.

In some cases, only if the patient is consenting, we may perform internal work. Being able to look at the area, see how it contracts and how it relaxes can be very helpful. Some people’s pelvic floors are tight and weak, others have difficulty with coordinating the contractions needed to hold urine during activities like coughing, laughing and jumping. Looking at the pelvic floor can help determine if manual stretches are needed and ensure that the muscle contractions are being done correctly.

There are so many ways pelvic floor therapists can help both men and women with urinary incontinence and pelvic pain. Don’t be shy, we can help!

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