Pelvic Floor Physical Therapy

[lalasmama]

Here's my TMI question of the day....

If you've done physical therapy for urine incontinence issues, how long was it until you started feeling "normal" again, ie, less leakage?

I'm only on my second session, and I have several issues I'm going for, but the urine leakage is first on the "to do" list, and bladder re-training started today. So, I'm wondering when others were back to normal.

:bag: I can't believe I just admitted on a public forum that I pee myself....

[brittone2]

This is not my area of expertise as a PT by any means.

My mom just completed PT for pelvic floor issues and incontinence and is doing well. I know it definitely took her a few weeks to get to where she was noticing a change. She probably did 3 months total of PT I'd say, but she didn't go every week. My mom was really excellent with doing her home program. I think she was seeing results prior to the 3 months though.

She's pretty thrilled with the results. She mentioned she was wearing a pantiliner before and now isn't using them at all.

Best of luck.

[SnuggleBuggles]

I never had incontinence or even the slightest leak. But, my midwives really wanted me to get PT because they worried the muscles were weak at my 2w postpartum check. They had noted it during well visits before I was even pregnant too. At one point in my life between the kids I had kegels of steel but slacked on doing my exercises. When i started PT she said that she was grading my strength at 1-2 on a scale of 5. By 1 month in I was up to a 4- she said it was very unusual to have such good progress and conceded that I knew what I was doing and had once been in shape. :) I still don't have the steel I used to have but still doing ok ( no leaks). I got the ok to stop coming to PT but she recommended a home electro stim kit. I never followed up with that because I hated it so much.

I don't know if that really helps but I thought at the least it'd be nice to know you weren't alone having the PT!

Beth

[anamika]

I have terrible issues with this - especially when coughing. How did/do you find a PT for these issues?
I live in a big metro so there's got to be someone around. I just don't know how to find one. What do I ask for?

What do the exercises involve? Do they need to do vaginal exams etc?
Thanks for any help!

[SnuggleBuggles]

I have terrible issues with this - especially when coughing. How did/do you find a PT for these issues?
I live in a big metro so there's got to be someone around. I just don't know how to find one. What do I ask for?

What do the exercises involve? Do they need to do vaginal exams etc?
Thanks for any help!

My midwives recommended someone- I would ask your OB or midwife. My person worked with a major PT group in my city, she just had the extra specialty in pelvic floor issues.

You need to be comfortable with lots of "internal work" by the PT. Most of the appointment involved her needing to feel the progress, know how to instruct me in doing it correctly, and just checking that everything was in good working order. She'd have me do kegels with her there and she would do things like provide resistance to make me work harder. So, basically it was kegels with assistance for most of the appointment. I didn't love it but it was very professional and as comfortable as possible.

Mostly it was kegels of various styles- hold for X seconds, elevators, lots of reps... But we also did some things like electric stimulation. As I mentioned before, I hated that. There was a probe that you place inside and it was attached on the other end to an electric device that would emit a little current. It made your muscles contract without you doing anything. So, it strengthened the muscles without you having to do kegels. I think you could also use the probe to practice kegels and the PT could see the results on a graph- how strong things were, how long...I guess part of the appointment was solo work.

I am glad I went and made sure I didn't wind up really getting those muscles out of shape. I was also really glad when it was done. It wasn't my favorite thing in the world but it really professional, clinical and as comfortable as can be.

Beth

[brittone2]

I have terrible issues with this - especially when coughing. How did/do you find a PT for these issues?
I live in a big metro so there's got to be someone around. I just don't know how to find one. What do I ask for?

What do the exercises involve? Do they need to do vaginal exams etc?
Thanks for any help!

Here's a link to finding a PT specializing in women's health issues:

http://www.womenshealthapta.org/plp/index.cfm

They often use a combo of biofeedback, sometimes internal electrical stim, sometimes internal vaginal weights, etc.

eta: there are PTs who do pelvic floor physical therapy who aren't listed on the above link. You could ask some care providers in your area if you can't find someone using the link above. You could also call physical therapy practices and ask if they have anyone who does pelvic floor PT. I'd start w/ the link above if you are in a metro area.

[Melbel]

After ruling out more serious issues, I had therapy for pelvic floor dysfunction (spasm and frequency of urination; constantly had the sensation of having to go but no leakage). The therapy was as described by PP and lasted for about a month or so. I was also relieved when it was over! FWIW, I was taught to do kegels using anal muscles rather than vaginal muscles for better strengthening of the pelvic floor (i.e. picture yourself in an elevator with your dream celebrity and trying to hold back gas; example given by my therapist). The therapsit was at the office of a gynecological urologist. Wishing you the best!

[lalasmama]

I have terrible issues with this - especially when coughing. How did/do you find a PT for these issues?
I live in a big metro so there's got to be someone around. I just don't know how to find one. What do I ask for?

What do the exercises involve? Do they need to do vaginal exams etc?
Thanks for any help!

My family practice doc referred me to my PT lady. I've seen her twice now, and she's fantastic. I go to a large Catholic-ran hospital system, so I really wasn't expecting them to have a PT specializing in women's health issues like this. They only have 1 or 2 at our local location, but may have more at the main hospital.

At the first visit she took a lot of history... I'm having some pelvic congestion/pain, so she asked about bladder and bowel habits, sexual history relating to the pain (not anything like numbers, just about how it affects my current sex life, and if/how it affected things in the past), along with general and gyn health stuff. After taking the history, she did an internal, fingers only, no pushing on the outside of my belly. She was able to hit a few "ouchy" points, and figured out that I have been having internal spasms causing some pelvic pain, along with some back pain. You know how some people say they keep their stress in their shoulders or back or neck? Ummm, yeah, guess where she said I keep mine! ;):rotflmao: While I could do a kegal, I wasn't able to relax all the way at the end of them, so she taught me how to do that, and that was my homework. Now, I'm getting them much better, and already noticing some improvement with some things.

At the second visit, she massaged the muscles going from the bottom of my pelvis (the bones you sit on), to my tail bone, as she hit a spot during the assessment that nearly made me jump. Turns out, I have an immobile tailbone (who woulda known!). She also started me on the bladder retraining... When the urge strikes, I'm not allowed to run to the bathroom. I have to sit in place, cross my legs, and start my "no accident" mantra while doing kegals. Thankfully, my coworkers had seen my "gotta go!" run enough times that they are good-naturedly ribbing me when I suddenly stop talking, start lamaze breathing and mumbling my mantra. .... So, I have the kegals to continue, and the bladder retraining for this week. She said she wanted to make the second visit nice since my first visit was kind of uncomfortable. The massage felt wonderful.

I'll be honest. I was quite concerned about starting the PT, because I dont' relish gyn exams (who does?!), and it seemed weird to allow anyone other than the gyn (or my SO) to be poking around down there. But my PT is very professional, and she totally takes my mind off what's going on. Her treatment rooms are away from the regular PT area, in a private room with a closing door (I remember my knee PT I only had a curtain around me, even if I was in my skivvies while they were taping my knees!). She's got family and wedding pictures around on the walls, so, while it still feels "clinical" it doesn't feel as sterile. She's also got sheets on the bed instead of paper, which is much appreciated.

I have 3 more months of therapy expected. While I wasn't thrilled at the idea, I also thought it was "normal" to have some of the issues I was having--the urine leakage, and what I thought was hemmrhoids (actually prolapsing my rectum!). I knew the pelvic pain wasn't "normal", which was what got me interested in the PT to start with. Anytime SO would "make a move", I would be aroused, but very uncomfortable down there. Activities wouldn't hurt, it wasn't like I was spasming down there or anything, but I would just feel pain with arousal. I asked my doctor about it, and she suggested PT. When she started asking about other issues (like the urine incontinence), that pretty much sealed her suggestion to get my butt (haha) to PT. I'm just so excited to know that we can fix my leaking, and fix my prolapsing, and make arousal more comfortable as well.... and for those kinds of things being fixed, I'm willing to endure whatever it takes, including women's health PT.

[anamika]

Thanks all! And for the link Beth.

[swissair81]

I also go to PT for pelvic issues. I go because of pain 'up there' and in my sacroiliac that travels, um, everywhere. I'm not hot on the poking either, but it's helping, so... Still not feeling normal yet & I've been at it for a month.

[jerseygirl07067]

I think it is great you are going for PT. I am a PT too, though that is not my area of specialty. That being said, I know a few PT friends who have gone to the course by Janet Hulme, PT, who is one of the PT gurus in this area.

This is an area I want to get into down the road in my career, a big part due to self interest. I have had issues since high school! I remember peeing myself at the end of a cross country meet when I had to sprint the last few hundred yards. And to this day, I do jumping jacks, or any type of jumping and it is not long before I start to leak.

I need to get treated myself, but have not done so. I keep putting it on the back burner. I have done some of the exercises for this problem but have not been diligent enough. I'll need to get on this more consistently, otherwise I'll wind up wearing Depends, lol.

[boltfam]

I went to my ob/gyn and found out I have a cystocele. My doc said it would need to be surgically fixed when DH and I are done having babies. Would PT help a cystocele?

[brittone2]

I went to my ob/gyn and found out I have a cystocele. My doc said it would need to be surgically fixed when DH and I are done having babies. Would PT help a cystocele?

It can help, but obviously the degree of relief you might get would depend on your individual situation. IME, many docs do not even offer pelvic floor PT as an option to patients, so it is something you might want to check on for yourself. My mom has a cystocele and is doing much better after completing a PT program. I would consider getting in touch with some of the contacts on the APTA website and get an evaluation to determine whether you are a good candidate for PT.

[boltfam]

It can help, but obviously the degree of relief you might get would depend on your individual situation. IME, many docs do not even offer pelvic floor PT as an option to patients, so it is something you might want to check on for yourself. My mom has a cystocele and is doing much better after completing a PT program. I would consider getting in touch with some of the contacts on the APTA website and get an evaluation to determine whether you are a good candidate for PT.


Thanks so much for your reply! Yeah, my doc never mentioned it - I just happened upon this thread right after my appointment, and it got me thinking. I will check the APTA website. I don't think there was anyone in my area on the site, but maybe they can refer someone?

BTW: I swear you're my go-to-girl on most things health-related. I always appreciate your willingness to help me out. :D

[brittone2]

Thanks so much for your reply! Yeah, my doc never mentioned it - I just happened upon this thread right after my appointment, and it got me thinking. I will check the APTA website. I don't think there was anyone in my area on the site, but maybe they can refer someone?

BTW: I swear you're my go-to-girl on most things health-related. I always appreciate your willingness to help me out. :D

there are PTs that take continuing ed seminars/classes to learn how to handle pelvic floor patients, etc. They won't all be listed on the APTA site. You could try calling around to a few outpatient places and asking if they know of anyone, or if you have any midwives in your area, IME they are a little more apt to refer out for pelvic floor PT than many OBs. There are a lot more PTs that do pelvic floor PT than there were 5+ years ago. Ideally I'd try to find someone who does a good bit of it, but just start calling outpatient PT practices and see if they offer it or have any idea who might in your area.

HTH! My mom had a great experience and is doing much better w/ her cystocele. I know hers was bulging into her vagina but I'm not sure what degree she was dealing with. I know her urogyn wanted her to have surgery and my mom no longer feels surgery is necessary in her case...she's very happy with the outcome.

FWIW, this is totally not an area of PT I have any personal experience with whatsoever, other than knowing there are some great PTs out there for pelvic floor stuff, and that many women aren't presented with it as an option even when it may help. My only experience is some minimal discussion when I was in grad school (it was kind of a new area of practice back then) and then my mom's personal experience with it. I have no idea how PTs in this area of practice decide what is too far advanced for PT to really provide any relief.

[boltfam]

there are PTs that take continuing ed seminars/classes to learn how to handle pelvic floor patients, etc. They won't all be listed on the APTA site. You could try calling around to a few outpatient places and asking if they know of anyone, or if you have any midwives in your area, IME they are a little more apt to refer out for pelvic floor PT than many OBs. There are a lot more PTs that do pelvic floor PT than there were 5+ years ago. Ideally I'd try to find someone who does a good bit of it, but just start calling outpatient PT practices and see if they offer it or have any idea who might in your area.

HTH! My mom had a great experience and is doing much better w/ her cystocele. I know hers was bulging into her vagina but I'm not sure what degree she was dealing with. I know her urogyn wanted her to have surgery and my mom no longer feels surgery is necessary in her case...she's very happy with the outcome.

FWIW, this is totally not an area of PT I have any personal experience with whatsoever, other than knowing there are some great PTs out there for pelvic floor stuff, and that many women aren't presented with it as an option even when it may help. My only experience is some minimal discussion when I was in grad school (it was kind of a new area of practice back then) and then my mom's personal experience with it. I have no idea how PTs in this area of practice decide what is too far advanced for PT to really provide any relief.

Yeah, I think mine is pretty advanced, but it's definately worth a call to area PTs and see if it can be helped with PT. My doc recommended waiting until I'm done having children before having the surgery, so even if it can just get me through until surgery, it would be helpful. Thanks again!

[amm40]

Anyone else do a couple kegels every time you scroll past this post? :waving4:

[lalasmama]

Anyone else do a couple kegels every time you scroll past this post? :waving4:

:rotflmao:

Yes I do!