Stress Incontinence

Stress incontinence is the involuntary leaking of urine with activities such as coughing, laughing, changing positions, or exercising. Stress incontinence is usually the result of muscular weakness and incoordination.

Most people are led to believe that the pelvic floor (known as the "kegel" muscle) is the only muscle that needs strength training, this is not true. Incontinence is often a coordination dysfunction. It is the correct isolation of the transverse abdominus (deep abdominal muscles) and the pelvic floor muscles during an increase in intra-abdominal pressure.

Literature has shown a strong correlation with low back pain, incontinence and paradoxical breathing patterns. People with breathing dysfunction are frequently unable to perform a correct isolation of the muscles without holding their breath or mass contracting the wrong muscles.

Pelvic floor muscle weakness can be the result of childbirth, a tear or episiotomy, hormonal changes, high impact activities, organ prolapse, surgeries, chronic low back pain, hip pain/sacroiliac joint pain or general muscle deconditioning. Physical therapy treatment may include:

     •   Core stability program (Inner corset includes: the pelvic floor and transverse abdominals)
     •   Bladder Diary
     •   Patient education and behavior modification
     •   Manual therapy treatment for co-existing pain conditions
     •   Progressive home exercise program
     •   Range of motion exercises
     •   Gentle electrical stimulation if needed (performed with internal rectal electrode)
     •   Biofeedback if needed (computerized device that teaches you to contract & relax your pelvic floor muscles)

Urge Incontinence

Urge incontinence is the involuntary loss of bladder control due to an overwhelming and sudden urge to urinate. It is often difficult to get to the bathroom before having an accident. Physical therapy treatment may include:

     •   Bladder diary
     •   Bladder retraining (learning to hold larger volumes of urine and increase time between
         bathroom trips)
     •   Dietary modifications
     •   Biofeedback
     •   Therapeutic exercises
     •   Gentle electrical stimulation if needed
     •   Relaxation techniques
     •   Manual therapy treatment for co-existing pain conditions

Fecal Incontinence

Fecal incontinence is the inability to control your bowel movements, causing stool (feces) to leak unexpectedly from your rectum. Also called bowel incontinence, fecal incontinence ranges from an occasional leakage of stool while passing gas to a complete loss of bowel control.

Muscle damage is involved in most cases of fecal incontinence. In women, this damage commonly occurs during childbirth. It's especially likely to happen in a difficult delivery that uses forceps or an episiotomy. An episiotomy is when a cut is made to enlarge the opening to the vagina before delivery. Muscle damage can also occur during rectal surgery such as surgery for hemorrhoids. It may also occur in people with inflammatory bowel disease, constipation or diarrhea.

People can often compensate for muscle weakness. Typically, incontinence develops later in life when muscles are growing weaker and the supporting structures in the pelvis are becoming loose.

Damage to the nerves that control the anal muscle or regulate rectal sensation is also a common cause of fecal incontinence. Nerve injury can occur in the following situations:

     •   During childbirth.
     •   With severe and prolonged straining for stool.
     •   With diseases such as diabetes, spinal cord tumors and multiple sclerosis.

Fecal incontinence may also be caused by a reduction in the elasticity of the rectum, which shortens the time between the sensation of the stool and the urgent need to have a bowel movement. Surgery or radiation injury can scar and stiffen the rectum. Inflammatory bowel disease can also make the rectum less elastic.

Because diarrhea is more difficult to control than formed stool, it is an added stress that can lead to fecal incontinence. Physical therapy treatment may include:

     •   Manual therapy treatment for co-existing pain conditions
     •   Bowel diary
     •   Biofeedback (computerized device that teaches you to contract & relax your pelvic floor
         muscles)
     •   Core stability program
     •   Relaxation techniques
     •   Patient education
     •   Progressive exercise home program
     •   Gentle electrical stimulation as needed (performed with internal vaginal electrode)
     •   Dietary modifications

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Pregnancy and new motherhood should be times of joy and promise - not pain. Fortunately, times have changed since your mother was pregnant: you don't have to live with pain or other problems related to pregnancy, delivery or recovery after the birth of your child.

That's because physical therapy has changed. Treatment is no longer just for joint problems; it's also a safe, proven, and widely prescribed treatment for pregnant women and new mothers. It promotes a far healthier, less stressful, more comfortable pregnancy that pays lasting dividends: an easier labor, a speedier recovery, and less likelihood of postpartum pain or incontinence (urine leakage).

There are a variety of pains that can arise during your pregnancy. Low back pain (LBP) is a common complaint that can easily and safely be treated by physical therapists that specialize in the care of pregnant women. It is well documented that the pelvic ligaments and joints have more laxity because of increased hormone secretion with pregnancy. We have seen at least a 50-70% decrease in pain within 3-5 physical therapy visits for sacroiliac joint dysfunction (SIJ). SIJ is a condition that is commonly mistaken for Low back pain (LBP).

Our postpartum rehabilitation program can be effective for those that have developed:
     •   Pain with intercourse because of a difficult delivery, episiotomy or tear
     •   Urinary or fecal incontinence
     •   Lingering low back/hip/groin pain, especially with carrying, lifting, holding your baby or with
         simple household chores
     •   Weak stomach muscles (abdominals) or when traditional situps or strength training don’t feel
         as effective as they used to
     •   Painful c-section scar
     •   Feeling of pelvic heaviness or your insides are going to fall out
     •   Abnormal feelings or sensations of the vulvar area
     •   On and off pains they do not seem to go away after 6-8 weeks.

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Lymphedema is the chronic swelling of a limb. Lymphedema that occurs in the arm is usually secondary to the treatment of breast cancer. Please see the services that we provide for breast cancer patients, with or without lymphedema ,under Post Breast Therapy Pain Syndrome (PBTPS). Lymphedema can also occur in the trunk, legs, genitals and head. The cause is usually from a surgery, cancer of other medical conditions. There is also another rare form of lymphedema that you are born with (primary lymphedema).

Treatment for lymphedema of an extremity includes complete decongestive therapy (CDT). CDT is a combination of manual lymphatic drainage (MLD), compression therapy and decongestive exercises. When there is excessive fluid accumulation in an extremity the body is no longer able to return it to the body through normal mechanisms. MLD is a specially designed massage technique that promotes the fluid to start draining back into the body. Compression therapy is provided after the MLD by using concentric layers of padding and short stretch bandages that are applied in a gradient pressure to push the fluid towards the trunk. CDT is provided on a daily basis until the swelling in the extremity is reduced. Lymphedema is chronic and can only be managed. Therefore, after the swelling in the extremity is reduced the swelling will stay down by a compression stocking that is worn during the day and the application of a modified compression therapy at night.

Patient education is also a big part of our therapy. We educate you in what we call "at risk activities". These activities can put you at risk for increased swelling in your extremities. We need to review all of your leisure and recreational activities to give you specific recommendations

Treatment, complete decongestive therapy, may take anywhere from 2 weeks to months depending on the chronicity of your condition.

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Post Breast Therapy Pain Syndrome (PBTPS) remains an underreported-yet often debilitating-consequence of breast cancer therapy. This condition is estimated to affect 10 to 30% of women who have had breast cancer surgery. Because PBTPS is not well understood by many physicians, it is frequently not recognized as an issue that needs to be addressed.

PBTPS can be a side effect from anyone of the following, or a combination of: surgery, chemotherapy, radiation therapy, hormonal therapy, and/or lymphedema.

In post-surgery follow-up visits, patients may describe some early postoperative pain, but often PBTPS does not manifest as an ongoing chronic problem until at least 30-90 days after surgery.

Post Breast Therapy Pain Syndrome is a complex constellation of symptoms, which may include:

     •   Increased pain/stiffness with movement, leading to clinically significant arm and shoulder restrictions of motion
     •   Painful/ tight scar tissue
     •   Altered sensations (i.e. numbness, tingling, itching) that increase with activity
     •   Discomfort that interferes with active daily living, sleep and impairs overall quality of life
     •   Lymphedema, a potential complication of axillary dissection, may also further contribute to postoperative pain syndromes.

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Lymphedema is a chronic, debilitating condition in which excess fluid, called lymph, collects in tissues and causes swelling. Lymphedema (edema due to lymphatic fluid) frequently occurs in the arm after treatment for breast cancer. This often happens after lymph vessels or lymph nodes in the axilla (armpit) are removed by surgery or damaged by radiation, impairing the normal drainage of lymphatic fluid. We have also seen an accumulation of fluid in the chest wall and the breast.

The effects of cancer and its treatment endure long after medical treatment ends. Some changes may actually be positive (i.e., you have a better appreciation of life, or you may have become closer to your family and friends). Other negative changes, such as: pain, scars, or lymphedema; are constant reminders that you have been diagnosed with cancer.

When pain symptoms persist, you may not always find sufficient compassion and empathy. Friends and family, and even health care personnel, may appear skeptical regarding your complaints, because post-treatment pain is not always visible and can't be easily measured.

Recognition of Post Breast Therapy Pain Syndrome (PBTPS) by the medical profession is in its early stages. Many professionals are unaware of this problem because they have little experience in making the diagnosis, and in treating this syndrome. You may, need to take a proactive approach to educate your health care team about this problem, and to seek effective solutions from them. PBTBS is best treated as soon as possible, because it becomes chronic and more resistant to effective treatment when diagnosis and initiation of therapy is delayed.

The physical therapists at our office are specially trained in recognizing and treating the symptoms associated with post breast therapy syndrome and lymphedema.

Discuss your concerns and treatment options with any member of your health care team. Under most circumstances, a referral from your physician is needed for insurance coverage.

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