For both urge and stress incontinence, the best treatment is actually physical therapy.  You’ll probably have to do some digging, but there are physical therapists(many of them are DPT’s(doctors of physical therapy) as opposed to having a master’s in physical therapy) out there who focus in on pelvic floor health and rehabilitation.  Do some searching with keywords like ‘urinary incontinence’ or ‘pelvic floor dysfunction’ with ‘physical therapy’ and toss in your county, town, or zip code, and you’re likely to find some options. You can also search for them using your insurance company’s website.  If you are at all uncertain, call the location first and confirm that they treat urinary incontinence and pelvic floor dysfunction.

What to expect

Sessions with the PT are likely to be around 45 minutes.  There likely won’t be many more patients in there than therapists to treat them.  If a patient comes in with family members, they are usually a partner, a parent or an adult child.  This type of therapy is more intimate than standard PT and their offices often reflect that. The treatments I have had include biofeedback, exercises to do at home, massage(both internal and external), dilators, kinesio tape, and occasionally application of heat(or cold) to tight areas.  

Yes, you do get half-naked(off with those pants!), and at least in the office I go to, I’m given privacy to do that(I recommend wearing uncomplicated outfits that are easy to take on and off .  This is not a day to wear garters or pantyhose!), and a sheet to cover me while I’m being worked on.

The biofeedback process involves 3 sensors, one attached to muscles between the butt cheeks, and in two spots in the buttock to the inner thigh area.  The PT connects them, and the sensors are sticky and disposable, so it’s a pretty easy process. These are used to measure muscle tension. You then clench and unclench the muscles associated with peeing(if you’ve heard kegel exercises mentioned, it’s that muscle set).  These muscles also are used in sex, so there is a fair bit of information available about kegels. There is a male equivalent, which I have heard referred to as ‘penile pushups’ to give you a visual(ok, you might not have WANTED that visual, but you now have it. You’re welcome!)

This exercise process can help bring these muscles out of spasm, and strengthening them helps control leakage(as a side effect it also firms and tightens up the vagina, which can improve sex, once you can handle insertion).  However, it’s only really helpful when the muscles know how to relax again, which is why massage is necessary.

Massage

The PT massages buttocks, upper legs, and inner thighs to work on reducing the muscle tension and checking muscle tone.  Like all other forms of massage, the goal is for you to be as relaxed as possible while you are getting the massage to help relax the muscles.  The patient-PT relationship is a very physically intimate one, so you do want to make sure you find somebody you trust and feel safe with. If you don’t, it’s going to be much harder to make any real progress.

There is also an internal massage.  It’s a weird feeling. It is utterly non-sexual(or at least it should be), and a very matter-of-fact process.  The internal massage doesn’t have pain like an external massage can(muscle tension and the release of muscle tension can hurt at the moment, but feels better after the area is done being massaged), but instead, it’s a feeling of pressure – the intensity is an indicator of how tight the muscles are.  Yes, the physical therapist’s hand is right up in there. But she’s wearing gloves and using lube, and again it’s a surprisingly non-sexual experience.

Additional tools they might use

The kinesio tape helps tight muscles relax a little by taking the pressure off of them.  If they’re used, you clean up thoroughly post-massage(cleaning off the lotion is unnecessary otherwise – it’s all massaged in) and then the PT comes back in an applies the kinesio tape on that overly tight area(or areas…sometimes after my appointment I’ve got a few areas taped up).  

Heat and ice can also be used to relax tight muscles – so sometimes if you have extra time, they might recommend applying heat or ice for 20 minutes or so at the end of the session.

The dilator is pretty much the medical version of a vibrating dildo.  It usually comes as a set of varying size attachments, and it’s another way to stimulate and relax the vaginal muscles, and slowly help them get used to penetration.  Regular usage is recommended, and they will talk you through the appropriate sizes to use(you start small with the goal of going up). This is another way to help the muscles relax out to a healthier size, and also help you on the path to non-painful sex.  

What you need to do between appointments

At the end of the appointment, you’ll get assigned exercises to do regularly at home.  These are usually daily or every other day, while you see the pelvic floor PT more like weekly to every few weeks, depending on their availability, what your insurance covers, and how frequently they want to see you.  Sticking to the exercises is vital for an effective recovery.

Usually, you also end up discussing bladder retraining, which is predominantly about extending the time between trips to the bathroom, which helps the bladder get used to filling up again, and can help it regain its normal capacity(bladders are stretchy, and can shrink over time).  

Getting the right treatment

If you are having problems with urgency or incontinence I can’t emphasize enough how useful the pelvic floor PT’s can be.  If you see a urologist and they suggest an invasive treatment, please double-check them by being evaluated by a pelvic floor PT.  If they can help you solve your problem with exercises, that is generally much much better for your long-term health than an unnecessary surgery!  If there truly is a need for surgery, the pelvic floor PT can likely confirm that and can help you manage your recovery post-surgery.

Conclusion: Yes, internal physical therapy is a thing!

It might partially be because I’m right in the thick of treatment again, but I think that getting pelvic floor PT has been one of the more helpful treatments for one of my most embarrassing and disruptive symptoms.  While my movements are disruptive to others, I am well past the point of being embarrassed by them. However, that urge incontinence, that needing to go feeling, when that happens, it feels impossible to think and plan.  

I hope this has helped you to better understand what a pelvic floor PT is and does, and why they might be useful to see.  If you have any questions related to being treated by a pelvic floor PT, please feel free to contact me and ask away!

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