Bladder Dysfunction

Pelvic floor muscles are crucial for urinary function, supporting the bladder, maintaining continence, and controlling urination. Typically, we don't think about our bladder unless there's a need to urinate. However, when these muscles malfunction, various symptoms can disrupt daily life, making the bladder a constant concern. While bladder issues are common, they're not a normal part of life, and pelvic floor physical therapy can effectively address these problems.

Healthy Bladder Function

• Typically, urinating 6-8 times in 24 hours is normal

• Urine leakage is not a normal occurrence

• A strong bladder urge shouldn't be overwhelmingly intense

• A usual urination duration is about 20 seconds

• Initiating urination should be effortless and swift

• The feeling of urgency should resolve post-voiding

• Drinking more fluids should increase urine volume, not frequency

• A healthy bladder holds between 300 – 600ml

• It's normal for individuals under 60 to wake once, and those over 60 twice, for nighttime urination

• Experiencing pain before, during, or after urinating is not normal

Symptoms

• Stress Incontinence: Urine leaking during coughing, laughing, sneezing, or exercise

• Urge Incontinence: Leaking en route to or before reaching the bathroom

• Mixed Incontinence: Combination of stress and urge incontinence

• Urinary Urgency: Feeling a strong need to urinate without having a full bladder

• Urinary Frequency: Needing to urinate often, without a full bladder

• Urinary Hesitancy: Difficulty starting urination, with a slow or deviated stream

• Urinary Urgency During Sexual Activity: A sudden need to urinate during sexual encounters

• Post-Activity Urinary Urgency/Frequency: Increased need or urgency to urinate following sexual activity or exercise

• Pain in Urethra or Bladder: Occurs before, during, or after urination

• Climacturia: Urine leaking during orgasm

Causes

• Frequent urinary tract and yeast infections

• Use of hormone-regulating medications like oral contraceptives, GnRH agonists (e.g., Lupron), and acne treatments

• Life stages and events such as childbirth, breastfeeding, and menopause

• Trauma from surgeries

• Injuries related to orthopedics, including accidents and impacts

• Biomechanical or structural issues like hip or sacroiliac joint dysfunction, piriformis syndrome, scoliosis, or discrepancies in leg length

• Dysfunction in the pelvic floor muscles

• Pelvic organ prolapse

• Issues with constipation and gastrointestinal distress or bloating

Diagnostic challenges

Pelvic floor dysfunction often presents symptoms similar to sexually transmitted, prostate, urinary tract, and bladder infections, causing confusion in diagnosis. People frequently suspect an infection, only to be surprised by normal test results. In women, bladder leakage has become so commonplace that it's often dismissed as normal, especially post-childbirth or attributed to aging, reducing the likelihood of seeking treatment. Additionally, many men are not informed about the high risk (up to 80%) of urinary incontinence after prostate surgery. An evaluation by a pelvic floor physical therapist is recommended to accurately identify and address the underlying causes, regardless of the individual's situation.

How we can help

At Healthy Pelvis PT, we specialize in helping those experiencing bladder dysfunction. An evaluation by our pelvic floor physical therapist can identify how pelvic floor dysfunction contributes to your symptoms. Bladder issues may arise from pelvic floor muscles that are overly tight, weak, or uncoordinated. Traditional advice like performing kegels for bladder health isn't always effective, especially if your pelvic floor muscles are too tight. In such cases, kegels might worsen your symptoms. Our physical therapists focus on proper rehabilitation, which often involves lengthening the pelvic floor muscles before strengthening them. We will review your medical history, symptoms, previous diagnoses, and the effectiveness of past treatments. Understanding the frustration that comes with these issues, we're committed to guiding you through effective recovery.

What to expect

At your initial appointment, we will start by taking your medical history, followed by a comprehensive musculoskeletal examination of your pelvic area. This will include assessing your posture, joint alignment, any muscle restrictions or trigger points, the health of your connective tissue, and muscular strength. An internal examination is often part of this process, but it's entirely optional and will only be conducted if you feel completely comfortable with it. This exam is much more relaxed and comfortable compared to a typical ob/gyn visit, and it provides essential information about your pelvic muscle tone, strength, and coordination. If impairments are found during the exam, the physical therapist can treat the problems with manual therapy techniques resulting in pain relief and improved function. Following the exam, we'll discuss our findings with you and outline a personalized treatment plan aimed at achieving the best results. Most patients start feeling better after their first session and see significant improvement by their third visit.