Urinary Incontinence and Pelvic Organ Prolapse

Rebekah Wolinetz, PT, DPTReact Physical TherapyLakeshore East clinic

What is pelvic health (women’s health) therapy?● Provided by a physical therapist or a physical therapist assistant● Advanced training and education on women’s specific conditions● Advanced training and education on conditions related to pelvic

floor dysfunction● Specialized assessment and treatment of the pelvic floor muscles

Anatomy

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https://portmelbournephysio.com.au/wp-content/uploads/2017/10/DRAM-1.jpg

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Urinary Incontinence● What is it?

○ Involuntary loss of urine● Most common types

○ Stress Urinary Incontinence (SUI)

○ Urge Incontinence○ Mixed Incontinence

(combination of SUI and urge)

Stress Urinary Incontinence● What is it?

○ Involuntary loss of urine with exertion or effort such as coughing, sneezing, exercising, etc.

● What causes it?○ Pelvic floor dysfunction○ Weakness in abdominal

muscles○ Changes in hormones https://vibrance.com.my/wp-content/uploads/2018/08/Fig-2-Strong-Weak

-PFM.jpg

Urge Urinary Incontinence● What is it?

○ Involuntary loss of urine associated with a strong urge to urinate

○ Usually a stimulus or outside event such as running water, walking by the bathroom, putting the key in the lock

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Risk factors for urinary incontinenceStress urinary incontinence● Pregnancy and childbirth● Pelvic organ prolapse● Obesity● Asthma● History of abdominal or pelvic

surgery● Post-menopausal

Urge urinary incontinence● Habitual causes● Bladder irritants● Overactive bladder

What can you do?● Keep a schedule● Avoid “Just in case” urination● Avoid bladder irritants● Do not limit fluid intake● “The Knack”● Physical therapy

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Pelvic Organ Prolapse● What is it?

○ Descent of pelvic organs (bladder, uterus, or rectum) in the pelvic bowl

● Symptoms: ○ Heaviness, pressure, bulge○ Urinary symptoms○ Bowel symptoms○ Sexual symptoms

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Risk factors for pelvic organ prolapse● Number of vaginal deliveries and instrument delivery● Trauma to pelvic floor muscles during childbirth● Chronic constipation● IBS● Maternal history of POP● Heavy physical work● High impact exercise● Overweight● Chronic illness that results in excessive coughing

What can you do?● Avoidance of Valsalva

(bearing down)● Constipation

prevention/management● Avoid heavy lifting and

prolonged standing/walking● Weight loss● Physical therapy

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The overflow principle

“So if I don’t know if I should be doing kegels or not, how do I improve my symptoms of urinary incontinence or pelvic organ prolapse?!”

● Use surrounding muscles to activate the pelvic floor muscles

How can pelvic floor therapy help?

● Evaluation and assessment done in a private treatment room● Hands-on therapy or manual therapy to address muscle

imbalances● Exercises recommended are based off of an examination and are

specific to YOU! ● Lifestyle modifications and recommendations are specific to you

Questions?

Rwolinetz@bereact.com312.929.3646

React Physical Therapy @Lakeshore East

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