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TLC/Women's Health

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Incontinence is the involuntary loss of urine, feces, or gas. Incontinence can be difficult to discuss, but even more difficult to endure. Fortunately,help is available. If you suffer from incontinence, you are not alone. It is estimated that 25 million Americans suffer with urinary incontinence. Most cases of incontinence can be cured or improved with proper diagnosis and treatment.

Types of incontinence
Urinary Stress incontinence - the involuntary loss of urine associated with normal activities such as laughing, coughing, sneezing, lifting, jumping, pushing and pulling.

Urge urinaryincontinence - the involuntary loss of urine associated with a strong urge to urinate even if you just emptied your bladder.

Anal incontinence - an impaired rectal sensation or lack of muscle control that results in loss of stool or gas, or staining of underclothes.

Causes of incontinence
Incontinence can be caused by many factors, such as the following:

  • Pelvic floor muscle weakness
  • High-impact physical activities
  • Pregnancy, vaginal delivery, episiotomy
  • Estrogen depletion
  • Medications, nerve damage, prior surgeries
  • Infection, diabetes, stroke

Evaluation and Treatment
During your initial visit, our physical therapist will assess the strength,coordination,and integrity of your pelvic floor and abdominal muscles. Based on these findings, a personalized program will be established.

Typical treatment interventions may include:

  • Muscle re-education (abdominal and pelvic floor)
  • Instruction in how to protect your pelvic floor muscles
  • Education about normal bladder function
  • Education to avoid bladder irritants
  • Biofeedback/surface electromyography (EMG)
  • Electrical stimulation
  • Bladder retraining
Pelvic Floor Dysfunction

The muscles of the pelvic floor form a sling from the pubic bone to the tailbone. They assist in supporting the abdominal and pelvic contents, encircle the bowel, bladder and vagina for closure and to enhance sexual activity. Pelvic floor dysfunctions are divided into four categories, each producing unique signs and symptoms.

Types of Dysfunction

Supportive dysfunction - characterized by a loss of strength and integrity of the pelvic floor tissue and muscle fibers.

Hypertonous dysfunction - characterized by increased tension in the pelvic floor and muscle fibers.

Incoordination dysfunction- described as inappropriate use of pelvic floor muscles.

Visceral dysfunction- caused byorgans within the pelvis such as interstitial cystitis, endometriosis, and pelvic inflammatory disease.

Common causes

  • Trauma
  • Poor posture
  • Pelvic fracture
  • Misuse or disease of the pelvic floor
  • Episiotomy-laceration/tear
  • Musculoskeletal imbalances
  • Childbirth
  • Hysterectomy
  • Prior surgeries

Typical complaints

  • Pelvic pressure and heaviness
  • Bladder and/or bowel problems
  • Pain in the lower back, vagina, rectum, tailbone, thigh and/or lower abdomen, organ prolapse
  • Painful intercourse
  • Lack of sexual orgasm
  • Vulvar or clitoral burning or numbness

Evaluation and Treatment
During your initial visit, our physical therapist will assess the strength, coordination, and integrity of your pelvic floor muscles. An individualized program will be developed based on these findings.

Typical treatment interventions may include:

  • Muscle re-education
  • Postural education
  • Muscle strengthening and/or relaxation exercises
  • Soft tissue mobilization and myofascial release
  • Spinal and pelvic malalignment corrections
  • Biofeedback/surface electromyography (EMG)
Pregnancy and Postpartum

Pregnancy is a wonderful and joyous time in a woman's life, and imposes anatomical and physiological changes. Adapting to these changes is difficult for some bodies. Typical changes in pregnancy that increase vulnerability for the musculoskeletal system include:

  • Postural changes
  • Ligament laxity
  • Weight gain
  • Fluid retention
  • Structured body changes
  • Abdominal weakness
  • Pelvic floor weakness

The three most common problems associated with pregnancy and the postpartum changes that are treatable in physical therapy are musculoskeletal, nerve compression syndrome and muscle weakness.

Musculoskeletal problems are caused by a disruption in the way your joints and muscles work together. Such conditions include:

  • Lowback pain
  • Sacroiliac pain
  • Sciatica
  • Coccyodynia (tail bone pain)
  • Rib pain
  • Neck pain, headaches
  • Pubic symphysis pain

These conditions are common during pregnancy due to weight gain and elevated levels of hormones, such as relaxin and estrogen. These hormones tend to make joints more mobile causing ligament laxity. Postural changes also play a major role in musculoskeletal problems. Typical pregnancy posture includes forward head, rounded shoulders, protruded belly, increased low back curve, locked knees, and flattened feet. For pregnant women, these changes can occur quickly with little or no warning.

Nerve compression syndromes
Fluid retention is common in pregnancy and often can cause compression on nerves that must travel in small spaces. Nerve compression has a unique pattern of symptoms in localized areas. Typical symptoms include pain, weakness, burning, numbness, and tingling. Nerve compression syndromes include:

  • Femoral nerve (front of thigh)
  • Genitofemoral (front of thigh/genitalia)
  • Carpal tunnel (thumb, index, middle finger)
  • Thoracic outlet (arm)

Muscle Weakness
Hormonal influence, weight gain, and postural changes can contribute to weakness of the abdominal muscles and muscles of the pelvic floor. In some cases, the abdominal muscles become so strained that they can separate under the increased pressure. The rectus abdominus is one muscle in particular where this occurs. The muscleruns from the breast bone down to the pubic bone and has a small separation between the muscle bellies. With weak- ened abdominals, increased weight, poor posture, poor body mechanics, and hormonal influence, this separation can increase.

Another common area of weakness occurs in the pelvic floor. The pelvic floor muscles provide support, sphinectric control, and enhance sexual function. This muscle group is often weakened during pregnancy and as a result, urinary incontinence can occur.

Evaluation and Treatment
For all these conditions, the physical therapist will conduct a thorough evaluation of your present condition byassessing your musculoskeletal system and developing a treatment plan. Working together, the healing process can often be started immediately. Your personalized program mayinclude techniques such as:K

  • Muscle energy technique (MET)-Symptoms from joint dysfunction can cause pain. Our physical therapist will performMET that will restore normal joint alignment. The techniques are extremely gentle and therapeutic.
  • Soft tissue mobilization/Myofascial release- Our physical therapist will performtechniques that will maximizerelaxation of tense tissue.
  • Therapeutic exercises-Our physical therapist will develop a home exercise program that will be designed specifically for your unique needs.
  • Postural alignment training- Our physical therapist will educate you in new postural positions to decrease the chance of future flare-ups.

TLC and Rascal Creek PT can help restore healthy movement, function and comfort so you can focus on what's really important - your new baby

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