Everyone who treats bladder leaking agrees that conservative measures (not surgery or medication) should be the first line of treatment.  Improving your pelvic floor strength is often the place to start.  Pelvic floor muscle training  improves all types of bladder leaking: stress urinary incontinence, urgency urinary incontinence and mixed urinary incontinence.  Strengthening these muscles with a professional (like a physical therapist) cures 60% of women.  But does pelvic floor physical therapy treat bladder leaking and is it for you?

Exercising the pelvic floor is hard for many different reasons.  First of all, you can’t watch yourself in the mirror to see if you are doing it correctly.  It isn’t possible to see the muscle contract.  Second, it can be hard to tell if the muscles are getting stronger.  Third, you can’t watch your friends do them (well, you can but it isn’t really helpful).  And finally, lots of women have some altered sensation and can’t communicate well with these muscles.

When I see you in my clinic, I always test your kegel or pelvic floor strength.  I check to see:

• • the strength of the muscles
  • how confident you are with contracting these muscless
  • if the muscles work because there can be nerve or muscle damage resulting in poor muscle function
  • if other muscle groups are being recruited in the contraction (usually a big butt clench)
  • the tenderness of the muscles

Who can exercise on their own?

If you can contract the muscles, are motivated and are confident in this ability, you can rebuild your strength on your own.  “Kegel coaches” or trainers can be helpful (see my post on vaginal gear ).  These devices can help you do progressively harder exercises and can give you feedback on how you are doing.  There are pluses and minuses with this approach.  Kegel weights to improve strength are also an option.  The International Urogynecological Association (IUGA) also has great information on pelvic floor exercises.

Who benefits from PT?

Pelvic floor physical therapy definitely treats bladder leaking.  If you have trouble contracting the muscles, aren’t terribly motivated, want a better support system, or aren’t confident in your ability to engage the muscle, you are a great PT (physical therapy) candidate.  A good pelvic floor PT is worth her weight in gold (this isn’t sexist, I’ve never met a male pelvic floor PT-they are rare).  She will help you with many different things including with your pelvic floor strength, your core strength, your habits and motivation.

In addition,  working with a physical therapist will normalize your symptoms and show you how common leaking is.  There may be other muscle strains and injuries that impact your pelvic floor that can be identified and treated.  Workplace ergonomics also impact your pelvic floor (yep, all of that repetitive motion can impact your pelvic floor muscles too).  And pelvic floor physical therapists are (in general) kind, compassionate, and passionate about what they do.  I am lucky enough to work very closely with PT’s and I love it-they are some of my favorite people.

Who doesn’t like physical therapy?

But PT is not for everyone.  It can be expensive depending on your health insurance benefits and is time intensive.  Many women just don’t have the time to commit to PT.  And for PT to work, you have to commit to continue to do the exercise and that may not be your style.  Most importantly, you will have a pretty intimate relationship with your PT- when you are comfortable and it is therapeutically appropriate, they will touch the pelvic floor muscles through the vagina.  Some women aren’t comfortable with this.  It can be particularly difficult or even triggering for women with a history of abuse or a pelvic trauma.  If this is you,  just know it is ok to say no to PT.

Physical therapy also has to be as convenient as possible.  The office should be close to home or work and have good hours.  I also strongly believe in the therapeutic relationship.  You have to like your PT.  Because if you do not, for whatever reason, you need to find someone else.  This does not mean your PT is incompetent, she just may be a bad fit for you. And the right relationship is key to get better and makes the journey a little easier.

Dumoulin C et al Neurourol Urodyn (2016);35:15-20.

Lucacz ES et al. JAMA (2017);318(16):1592-1604