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Regaining Control

The problem is called pelvic floor dysfunction, and it becomes more common as women age, affecting as many as 50 percent of women in their 50s and more than 75 percent in later years. It is also a very common issue for women postpartum as the pelvic floor muscles stretch for delivery, often causing injury to the area. For active women, it is the worst kind of loss of control. It’s embarrassing and something many women are reluctant to talk about.

In Lawrence General’s Rehabilitation Centers, however, pelvic floor dysfunction is a very comfortable and hopeful topic.

“For more than 75 percent of women with urinary incontinence, rehabilitation therapy significantly reduces or solves the problem—no surgery or medications needed,” says Suzanne Miller, PT. “And results can happen quickly, in four to six weeks.”

“Childbirth is a significant trauma for the pelvic floor muscles,” observes Renee Morin, PT. “So, we see a lot of women with urinary incontinence and/or pelvic pain post-childbirth. However, we also see younger women, in their 20s, who struggle with this, and we can help.”

The pelvic floor is an essential stabilizer of the body in conjunction with the lower back, hips, and abdominal muscles. These muscles are often forgotten and may be weak and overstretched or tight, depending on the situation, causing incontinence, pelvic pain, and/or bowel issues in women and men.

Education. For pelvic floor dysfunction, physical therapists do a thorough initial evaluation, with education beginning on day one. They use anatomic models to teach patients about the muscles in the pelvic floor that support the organs in the pelvis, and influence things like bladder, bowel, and even sexual function. Bladder irritants, water intake, and a bladder diary are integral topics that are covered in the first few visits.

“Pelvic floor dysfunction can have many different symptoms, from lack of control to nonspecific pelvic pain, and these symptoms can also be related to pain or problems in other areas of the body, such as the lower back. The causes also vary, and we have a variety of techniques to help patients relieve their symptoms,” says Miller.

Treatment. The team uses both strengthening and relaxation to help women address their symptoms. Biofeedback technology helps women isolate muscles deep in the pelvis that, when strengthened, facilitate better control. Behavioral modification, stretching, and focused breathing are also helpful to patients.

“It’s like turning on a light for some women,” says Morin. “They say, ‘I didn’t realize that muscle was there, or that I could exercise it!’”

Homework. Patients go home with exercises to help them strengthen and maintain the health of both the pelvic floor and their abdominal core, and quickly gain the confidence to re-engage in activities they thought they could no longer do.

“It’s such a basic need, to be able to control our bathroom habits or to enjoy a normal sex life,” observes Miller. “Once they know how, these patients can maintain their recovery by keeping up with the exercises.”

While medication and surgery are good options and may be needed in a percentage of patients, rehabilitation therapy is a less invasive and very successful alternative for many women. The team has some male patients, too, often with side effects from prostate surgery. Rehabilitation works for them as well, though in some cases the course of treatment may be longer.

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