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Incontinence, Overactive Bladder, Pelvic Organ Prolapse, and Constipation

Bladder incontinence (urine leakage), fecal incontinence (stool leakage), and pelvic organ prolapse (dropped abdominal organs): all are common consequences of pregnancy and menopause. Unfortunately, many women don’t seek treatment because they believe their problem is unavoidable and untreatable—something they “just have to live with.” Fortunately, that’s not true.

The common denominator in these conditions is a weakened pelvic floor: the “sling” of muscles and tissues in the lower abdomen that supports, and holds in place, the bladder, uterus, and rectum. The sling can stretch, sag, and get injured during pregnancy and vaginal childbirth. It can further weaken from menopause, loss of estrogen, and aging.

Just like other muscle and soft tissue problems, pelvic floor dysfunction usually responds beautifully to physical therapy. Pelvic floor physical therapy may be just what the doctor ordered for incontinence and prolapse—as well as overactive bladder and constipation, which can also arise from pelvic floor problems.

About incontinence

There are several types of incontinence:

Urge incontinence—the loss of urine with a sudden, strong urge to urinate

Stress incontinence—the loss of urine with lifting, exercising, coughing, sneezing, crying, or laughing—in other words, anything that stresses the bladder, abdominal muscles, or pelvic muscles

Mixed incontinence—a combination of urge incontinence and stress incontinence

Fecal incontinence-—loss of control of bowel movements, resulting in stool leakage

About overactive bladder

In a subconscious effort to prevent urine or stool leakage, many incontinence sufferers clench their pelvic floor muscles. These muscles can tighten and fatigue, go into spasm, and develop tender points and trigger points (sore “knots” that refer pain elsewhere). Also, the bladder muscles may contract, triggering “gotta go” urges even when urine levels are low—sending sufferers to the bathroom many times a day. Sudden or frequent urges to urinate are symptoms of an overactive bladder.

Overactive bladder can arise for other reasons: bladder muscle or bladder nerve dysfunction, urinary tract infection, interstitial cystitis, bladder-irritating foods, kidney or bladder stones, bladder tumor, or neurological conditions. Sometimes doctors aren’t able to pinpoint a cause. 

About pelvic organ prolapse

Pelvic organ prolapse means that an abdominal organ—usually the uterus, bladder, or rectum—has dropped out of place. Sometimes the organ pushes into the vaginal walls; in extreme cases, it protrudes outside the vaginal opening. When the rectum pushes into the vagina, the resulting bulge is called a rectocele; when the bladder pushes into the vagina, the bulge is called a cystocele; when the uterus pushes into the vagina, it’s called a uterine prolapse.

In a subconscious effort to pull in their protrusion, many women clench their pelvic floor muscles. Here again, these muscles can tighten and fatigue, go into spasm, and develop tender points and trigger points.

Not surprisingly, the net result of prolapse can be pain during intercourse, frequent urination, incontinence, constipation, or pain in the lower back and pelvis.

About constipation

Constipation can also stem from pelvic floor dyssynergia (also called anismus), meaning incoordination of the pelvic floor muscles. Normally, anal and rectal muscles relax during a bowel movement. But in some people, they contract instead, causing straining, a feeling of incomplete emptying, and constipation. (Please note that there are many possible causes of constipation. Our focus is on musculoskeletal factors.)

How pelvic floor physical therapy can help

To treat incontinence, overactive bladder, prolapse, and constipation, Raquel and her staff employ any or all of these gentle, proven techniques, tailoring treatment to your diagnosis and needs.

Manual (hands-on) therapy such as soft-tissue massage, trigger-point release, and myofascial release. We work on your back, pelvis, abdomen, hips, and thighs—and, when you’re ready, inside your vagina.

Exercises to stabilize your core, improve your posture, and strengthen your abdomen, back, hips, and legs.

Biofeedback to teach you to isolate, relax, or strengthen your pelvic floor muscles, including the muscles that control urination.

Electrical stimulation (e-stim) to isolate and recruit the muscles that control urination.

(Note: Biofeedback and e-stim are not recommended for pregnant women.)

After a course of pelvic floor physical therapy, most women report that their symptoms are significantly or completely better.