You Have the Power to Manage a Pelvic Floor Disorder
- Urinary incontinence, which affects 1 in 8 women, is the most common female pelvic floor disorder.
- Usually a first-line treatment, physical therapy for a pelvic floor disorder involves special exercises that retrain, strengthen and rebuild pelvic floor muscles.
- In combination with diet modification and other lifestyle changes, physical therapy can delay or even defer the need for surgery.
- Crozer-Keystone has a team of female physical therapists who are specially trained in rehabilitation for female pelvic floor disorders. Most programs last four to six weeks, but exercise regimens must continue to be followed in order to remain successful.
- If a patient is not interested in physical therapy or if it just isn’t the best treatment for her, medication or surgery are other options.
If you’re a woman with a pelvic floor disorder, you fully understand how much this problem can control your life. Do you make it a point to always know where public restrooms are? Do you avoid social gatherings, family outings or other favorite leisure activities for fear of having an “accident”? Do you leak urine when doing something as simple as coughing, sneezing or laughing, and “just live with it”?
These are extremely difficult questions to think about, but if you answered “yes” to any of them, it may be time to consider doing something about it.
According to Jose Maceda, M.D., chief of the Division of Female Pelvic Medicine and Reconstructive Surgery at Crozer-Chester Medical Center, urinary incontinence is the most common female pelvic floor disorder. Affecting 1 in 8 women, Maceda says that his patients usually report infrequent symptoms at first, but that they tend to worsen over time. “Patients compensate unconsciously until they realize how much their lifestyles are being restricted,” he says. “Once you add in the emotional impact, they become frustrated and may isolate themselves socially—they stop taking part in favorite activities such as sports, exercise, even playing with their kids.”
So now we know that the symptoms aren’t going to just go away on their own. But you may be able to control them without needing surgery.
“Physical therapy is a conservative measure that can help,” Maceda says. “There are therapists who are skilled at retraining, strengthening and rebuilding pelvic floor muscles. The key to remember is that they can be retrained.”
“Individuals experiencing urinary or fecal incontinence, pelvic pain and/or organ prolapse (a vaginal bulge that can be seen or felt, or the pressure of something falling from the vagina) are candidates for pelvic floor physical therapy,” says Carla DeWald, general manager of the Healthplex® Sports Club and administrative director of Rehabilitation Services for Springfield Hospital. Crozer-Keystone’s female physical therapists are specially trained in pelvic floor rehabilitation.
“The patients who are willing to attempt a more conservative form of treatment will opt for PT prior to surgery,” says Maureen Fleagle, CKHS senior therapist for Pelvic Floor Rehabilitation. “These patients are usually very compliant with the program as they know what alternatives they may be facing. Oftentimes, they are a little skeptical regarding what they will accomplish but the majority of patients are very pleased with the outcomes. This includes all the education in lifestyle adjustments as well as exercise for strengthening.”
Lifestyle adjustments include dietary changes and, possibly, “timed voiding.” “Certain foods, such as caffeine, can worsen the problem,” Maceda says. “They can cause bladder instability and increase the frequency of urination.” Timed voiding is essentially training the bladder by going to the bathroom on a set schedule.
Maceda adds that if a patient is not interested in physical therapy or if it just isn’t the best treatment for her, medication and surgery are other options to consider. “Surgery is done on an outpatient basis,” he says. “There is no hospital stay, and you are off your feet for a few days, with lifting restrictions for about a month. At that point we can introduce activity again.”
However, if patients are uncertain about an outpatient procedure or prefer a conservative approach first, Maceda usually suggests that his patients give pelvic floor physical therapy a try. But you need to be committed to the program. “Usually, you make weekly therapy visits for four to six weeks, with follow-up visits to discuss progress and make any needed lifestyle adjustments,” he says. “Treating urinary incontinence with lifestyle changes and exercise can delay or even defer surgery. More importantly, if you begin physical therapy before the problem gets bad, there is a good possibility that you will no longer need to use pads or modify your lifestyle. PT has no side effects and it’s not invasive. But you need to keep up with it and continue to exercise long after the therapy sessions are done. If you stick with it, you can enjoy the benefits indefinitely.”
For more information about pelvic floor disorders and treatment options available at the Crozer-Keystone Center for Pelvic Medicine, visit http://ckpelvicfloormedicine.crozer.org. For an appointment with Dr. Maceda or his associate, Laurie Kane, M.D., call (610) 338-1810. For more information about Crozer-Keystone’s physical therapy services for pelvic floor disorders, call (610) 328-8800.