Physical Therapy to Rebuild and Maintain Urinary Control

Physical Therapy to Rebuild and Maintain Urinary Control

A common condition that crops up in the field of women’s health is urinary incontinence. This condition is often thought to be related to aging, though injury and childbirth stress can lead to urinary incontinence in women of any age. Physical therapy can help women feel the location of muscles that have been damaged or grown weak, and then begin a path to strengthen those muscles.

Each Woman Is Unique

Building and maintaining strength and flexibility in the muscles of the pelvic floor is the best way to prevent urinary incontinence. There is no one cause of urinary incontinence, so we must be prepared to consider several options to reduce the condition.

The four different types of urinary incontinence are

1) Stress Incontinence. This is the leakage that occurs when pressure from above the bladder such as sneezing can result in leakage. Under active pelvic floor muscles, often weakened and stretched by episiotomy or childbirth tearing and stress can lead to stress incontinence.

2) Urge Incontinence is caused by bladder spasms that can cause leakage. This can be exacerbated by dietary choices and sensitivities.

3) Mixed Incontinence is a frustrating combination of Stress and Urge Incontinence, and

4) Functional Incontinence is caused by simple lack of access. If your ability to move is impaired or the bathroom is hard to get to, urine can leak before you arrive. Functional incontinence can also occur if the woman is confused or disoriented and unable to locate the bathroom.

Kegel Is Not A Panacea

While women are often encouraged to do Kegel exercises on a regular basis, until the cause of your incontinence is determined, Kegel exercises may or may not be helpful. If your childbirth experience led to a tear from vagina to anal sphincter, your muscular retraining needs may be more specific than Kegel practice. You may find that lack of muscular development is not a concern; rather, you may have a shortened pelvic floor and need stretching exercises.

Working with a physical therapist allows the patient to review her specific history, current symptoms, and needed muscular work in moving forward.

Focus On Your Musculature and Needs

Your physical therapist can use a wide variety of tools to aid you in becoming aware of which muscle group needs the most work. This can be done through a variety of methods, including keeping a journal of bathroom use.

Other methods include setting a schedule and extending the times between bathroom breaks as control is regained and maintained. Dietary changes to omit bladder irritants such as caffeine can be helpful.

If you and your therapist are not able to locate the muscles of the pelvic floor by attempting to stop the urine flow and feeling the clench of the muscles strengthened by Kegel exercises, biofeedback can be of great help.

During biofeedback training, electrodes are placed outside the vagina and the patient is notified when she begins to achieve the proper Kegel contraction. As awareness of this muscular action is built, the exercise will become easier to do. Building the sensation of the clench will enable the patient to do the work on her own.

Take Your Life Back

If an overactive bladder or urinary incontinence is impacting your quality of life, you need to act. Contact your physician to discuss therapy options to help you regain control. This is not just a function of aging, nor is it something you should just put up with. With the help of the right diagnosis and a physical therapist, you can get back to your daily activities with no worries.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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