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The latest literature review conducted by Mazur-Bialy et al. (2020) shows the most modern methods of pelvic floor physical therapy that can help with urinary incontinence.

Here at Femina PT, we pride ourselves in keeping up with the current best practices and latest techniques. Here’s a breakdown of the latest techniques and how we utilize them at the clinic.

What is urinary incontinence?

Urinary incontinence refers to the involuntary loss of urine, which can range from a few drops (also called light bladder leakage) to complete loss that wets the floor. There is actually more than one kind of urinary incontinence: the two most common types of urinary incontinence that affect women are stress incontinence and urge incontinence (also called overactive bladder, or OAB).

  • Stress Incontinence: urine leaking with physical activity- sneezing, coughing, laughing, lifting, pushing/pulling, jumping.
  • Urge Incontinence: urine leakage that is coupled with urgency to go- leaking while you’re in line for the toilet, leaking/urgency when you’re parking your car in the driveway, putting the key in the door, fumbling with your pants, etc.
  • Mixed UI: a combination of stress and urge symptoms

Pelvic Floor Physical Therapy and the Management of Urinary Incontinence: Current Best Practices

Pelvic Floor Muscle Training

Pelvic floor muscle training (PFMT) can help increase pelvic support and increase the function of the urethral sphincter, which is the little muscle that helps you stay leak free. Pelvic floor muscle training can be performed to increase strength, endurance, and muscle coordination.

Studies estimate that 30%–40% of women are unable to perform a pelvic floor muscle (PFM) contraction, or Kegel, correctly with verbal instruction alone. The correct voluntary PFM contraction despite the instruction and in the population of women with pelvic floor dysfunction, the rate is as high as 70% (Talasz, 2008; Tibaek, 2014).

At Femina PT, our therapists are experts in teaching a correct pelvic floor contraction and how to increase strength in a safe and effective way.

Manual Therapy

Pelvic Floor Dysfunction (PFD) can result in muscles that are too tight and weak, or with low tone and weak. Manual therapy techniques performed by a trained pelvic floor therapist can help treat the muscles and fascia that may be contributing to the pelvic floor dysfunction. Additionally, the fascia inside the pelvis is continuous with the fascia that lines the organs and the abdomen, diaphragm, area between the vaginal canal and the rectum, and the fascia of adductors. Manual therapy and fascial release of these areas can help the other areas as any disorders in hip, core muscles may affect the pelvic floor and vice versa. Additionally, it has been found that massage of the abdominal muscles and the muscles surrounding the bladder may improve bladder function (Mazur-Bialy, 2020). The therapists at Femina PT are trained in manual therapy techniques such as trigger points release, myofascial release, and visceral massage- techniques which may reduce urinary incontinence symptoms and pelvic pain.

Electrical Stimulation

Electrical stimulation is one of the most commonly used therapeutic methods in the treatment of urinary incontinence (Mazur-Bialy, 2020). Electrical stimulation is a noninvasive, passive treatment that induces muscle contraction in a muscle. In regards to the pelvic floor, electrical stimulation can be combined with pelvic floor physical therapy, which can further help the treatment of urinary and also fecal incontinence. At Femina, we have access to the Attain line of biofeedback and electrical stimulation products to help you gain control of your continence.

Other Interventions

Mazur-Bialy (2020) outline two other interventions that are helpful in the treatment of urinary incontinence: magnetic stimulation and whole-body vibration training.

What does pelvic floor therapy at Femina PT look like?

In addition to the methods described above, the treatment modalities you will receive in pelvic floor physical therapy depend on your body and the issues present.
Some of the modalities used at Femina Physical Therapy for the treatment of urinary incontinence can include (but are not limited to):

  • Bladder and bowel habits including lifestyle modifications like optimal fluid intake and constipation management
  • Therapeutic exercise to strengthen the pelvic floor
  • Biofeedback training with intravaginal sensors
  • Electrical stimulation using the InTone device
  • Manual therapy to treat connective tissue dysfunction and myofascial trigger points
  • Visceral mobilization (gentle massage techniques that loosen internal adhesions and restore movement to the organs including the intestine, bladder, uterus, and ovaries) to reduce intra-abdominal pressure, improve motility, and organ function
  • Internal pelvic manual therapy to treat sensitive tissues, muscle spasms, trigger points, and muscle guarding that can contribute to urgency, frequency, and leakage
  • Training in self treatment techniques including correct form for pelvic floor strengthening and abdominal lymphatic massage
  • Neuromuscular re-education and autogenic relaxation to reduce chronic muscle over-activity and improve parasympathetic nervous system function, including reducing bladder spasms

Contact one of our 4 Los Angeles area offices for more information.

Resources

Mazur-Bialy, A. I., Kołomańska-Bogucka, D., Nowakowski, C., & Tim, S. (2020). Urinary Incontinence in Women: Modern Methods of Physiotherapy as a Support for Surgical Treatment or Independent Therapy. Journal of Clinical Medicine, 9(4), 1211. doi:10.3390/jcm9041211

Jahromi, M.K.; Talebizadeh, M.; Mirzaei, M. The Effect of Pelvic Muscle Exercises on Urinary Incontinency and Self-Esteem of Elderly Females With Stress Urinary Incontinency, 2013. Glob. J. Health Sci. 2014, 7, 71–79. [CrossRef]

Talasz, H.; Himmer-Perschak, G.; Marth, E.; Fischer-Colbrie, J.; Hoefner, E.; Lechleitner, M. Evaluation of pelvic floor muscle function in a random group of adult women in Austria. Int. Urogynecol. J. Pelvic. Floor Dysfunct. 2008, 19, 131–135. [CrossRef]

Tibaek, S.; Dehlendorff, C. Pelvic floor muscle function in women with pelvic floor dysfunction: A retrospective chart review, 1992–2008. Int. Urogynecol. J. 2014, 25, 663–669. [CrossRef] [PubMed]

What Our Patients Have to Say

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Testimonial by P.M.

I was hopeful but frankly skeptical when the doctor treating me for Interstitial Cystitis recommended that I go to Heather for physical therapy. Medication and diet helped control my IC symptoms, but I had never heard of physical therapy being used to treat IC. The education and treatment I received from Heather was a revelation. She explained that the pain I experienced with IC had helped create a cycle of muscle guarding which affected the entire pelvic area. I had no idea of the amount of tension being held there. No wonder my husband and I had not been able to have sexual intercourse for years!

Read more: Testimonial by P.M.

Testimonial by R.M., Age 40

I can’t speak highly enough of the theapists at Femina Physical Therapy and how much they have helped me grow, discover, and love my body. I had had painful sex for my entire life, and didn’t know that there was anything that could be done about it. It was at the point where my husband and I were not having sex for MONTHs, because it was just too frustrating, and I hated feeling like I was the ONLY woman out there who had this problem, especially at my age. I finally brought it up to my doctor because I was turning 40 and my husband and I were barely having enough sex to conceive. And she brought up pelvic floor, PT. I didn’t even know this was a “thing”.

Read more: Testimonial by R.M., Age 40

Testimonial by T.H.

I started seeing Heather in October 2014. For more than two years, I had been suffering from painful urinary tract infection type symptoms after my bartholins gland surgery which included constant burning and urinary frequency sensation that led to more and more painful intercourse. I had made multiple visits to internist, obgyn and urologist's offices, went through a range of treatment with UTI and bladder frequency medication that included antibiotics, vesicare, estrogen cream, but nothing worked.

Read more: Testimonial by T.H.

Testimonial by R.M., Age 40

I can’t speak highly enough of the theapists at Femina Physical Therapy and how much they have helped me grow, discover, and love my body. I had had painful sex for my entire life, and didn’t know that there was anything that could be done about it. It was at the point where my husband and I were not having sex for MONTHs, because it was just too frustrating, and I hated feeling like I was the ONLY woman out there who had this problem, especially at my age. I finally brought it up to my doctor because I was turning 40 and my husband and I were barely having enough sex to conceive. And she brought up pelvic floor, PT. I didn’t even know this was a “thing”.

Read more: Testimonial by R.M., Age 40

Testimonial by Y.L. (mom of 2)

After having my second baby via C-section I searched for months to try to find help for my lower back pain and separated abdominal muscles. I finally came across Heather Jeffcoat via a mommy blog. I reached out to her via email and set my first appointment. My first appointment went amazing … she listened to what my symptoms, check my separation and explained to me in detail what the next steps would be. Not only did my abdominal separation go from 3 to about 1 -1/2 but my back has pain has significantly reduced. I’m personally recommending all my mommy friends to Heather!

Y.L. (mom of 2)

Testimonial by Alexandra B.

Heather is without exaggerating AMAZING! After years of trouble with a certain part of my body, in no time, she made everything change back to equilibrium and to what would be considered normal. She explains everything in detail and therefore gives you a better understanding of why things are the way they are, and how you can work towards turning things around. I would highly recommend Heather for any type of Physical Therapy. She has created her own "Method/Therapy" through years of studying (with some of the greatest practitioners), practice and breaking down the issues of her past patients, enabling her to fine tune her own system. I'm so thankful to have found her, and I'm especially grateful for the quick recovery I've achieved, after years of distress. If you cannot afford her, I recommend you purchase her book. Although it may not be Heather in person, it can still help you to get on the right path to recovery!

-- Alexandra B., 5/20/2015 via Yelp!

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