Rehab program targets incontinence, pelvic pain

Therapy strengthens pelvic floor muscles

Physical therapy can help women experiencing incontinence and pelvic pain avoid surgery or other medical interventions, says Cynthia Neville, PT, director of women’s health for Progressive Steps Rehab’s northeast Florida division, based in Jacksonville. Neville started the treatment program five years ago.

"Physical therapists are uniquely qualified to evaluate and treat these patients," she says. "Not only can we rehab the pelvic floor muscles, but we also can assess the muscular skeletal system, the spine, and abdominal and back muscles, which play a great role in pelvic pain."

When pelvic floor muscles become weak during pregnancy and vaginal childbirth, it can lead to incontinence and muscle pain in the abdomen, buttocks, thighs, and pelvic area, Neville says.

In the past, she says, patients who complained have been told by their physicians, "What do you expect? You just had a baby."

At Progressive Steps, women are treated with electrical stimulation and biofeedback — to get the muscles functioning properly again — and behavioral therapy. For simple stress incontinence, patients usually come for a total of six visits, once a week. For more serious problems, such as overactive or unstable bladders, patients may require nine to 12 treatments.

Anyone who has had a baby is at risk for incontinence, Neville says. She’s treated women as young as in their 20s, but the most common age of patients in the incontinency program is 40 to 60.

"The onset of menopause is associated with an increase incidence of incontinence because estrogen plays a significant role in maintaining bladder control," Neville says.

When patients are referred to the incontinence and pelvic pain program, a therapist asks them about their symptoms and performs a pelvic floor muscle examination to assess strength of the vaginal muscles.

Treatment typically involves a biofeedback assessment during which an electrode probe, similar in size and shape to a tampon, is inserted into the vagina. The electrode transforms the electric activities of pelvic muscles into signals that patient can watch on a computer screen, as they contract the muscles.

"As patients contract the pelvic floor muscles, they can watch the graph rise and see how strongly they are holding it and for how long," Neville says.

The images make exercising those muscles easier, she says. "These are internal muscles. You can’t see them. You can’t watch them, and after childbirth, you often can’t feel them."

The treatment also is effective in treating bowel control problems and constipation.

Ultrasound and biofeedback used

For pelvic pain, therapists massage the pelvic floor with ultrasound to break up scar tissue and help the patients learn to strengthen the pelvic floor muscles using the biofeedback device.

For the behavioral portion of the incontinence program, patients are asked to keep a track of their intake of fluids and foods and to keep a voiding diary.

"Often their habits and their diets are influencing bladder control," Neville says.

For example, a woman who drinks a lot of coffee in the morning may have problems making it to the bathroom in time. The coffee may be irritating the bladder, and in combination with weak pelvic floor muscles, may cause urinary leakage, she says.