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Pelvic Health Table

1. What are some of the common symptoms?
2. What are some of the common causes?
3. What can I expect my first day of therapy?
4. What can I expect my ongoing therapy to be like?
5. How long can I expect my therapy to last before I begin to see improvement?
6. How long can I expect my therapy to last before I am healed/cured/fixed?
7. What are the credentials of my uro-gynecological physical therapist?

There are four types of incontinence, all of which are treated at Kirk Center for Healthy Living. These four types are Urge Incontinence, Stress Incontinence, Mixed Incontinence and Functional Incontinence.

1. What are some of the common symptoms?

Urge Incontinence is urinary leakage accompanied by a strong urge or sensation that you need to urinate. The urine loss amount can range from a few drops to wetting your outerwear. It is common for the loss of urine to occur trying to get to the bathroom in time.

Stress Incontinence is urinary leakage with an increase in intra-abdominal pressure like coughing, sneezing, laughing, lifting, exercising or jumping. The urine loss amount can range from a few drops to wetting your outerwear. Usually there is not any urge or signal that you need to use the bathroom.

Mixed Incontinence is a mixture of urge incontinence and stress incontinence.

Functional Incontinence consists of the inability to get to the bathroom in time due to a physical impairment. Usually this impairment decreases the speed in which you can get to the bathroom in time or it may impair your ability to unbutton or unzip your pants. It may also affect your ability to sit down on the toilet safely.

2. What are some of the common causes?

Urge Incontinence: The bladder is a hollow muscle that stores urine. As it fills up it sends a message to the nervous system in the spine that it needs to be emptied. Typically that message travels to the brain, so that we can make a decision whether we want to go to the bathroom or delay it. With this condition, the nervous system is up-regulated, meaning itís very sensitive and it overreacts. When it overreacts, the nervous system causes your bladder to contract (squeeze) and empty without any input from you. This is the most common cause, but other causes could include scar tissue that does not allow the bladder to function properly, or the bladder may not be supported by the muscles and surrounding tissues.

Stress Incontinence: There are multiple causes for this condition, but one of the most common is a weakness of the muscles in your pelvis. These muscles wrap around your urethra (the tube that runs from your bladder to the outside of your body) and when theyíre strong they compress the tube and hold back urine with or without your knowledge of this action. Itís like squeezing a garden hose when the water is only turned on a little bit. The stronger your hand and the harder you squeeze, the less water that escapes. Another cause could be tight pelvic muscles. If the muscles are too tight, they cannot work properly. A less common cause can be hypermobility of your urethra, which just means your urethra moves too much.

Functional Incontinence: Some of the causes may be, but are not limited to, stroke, multiple sclerosis, Parkinsonís Disease, cancer amputation, total hip replacement, total knee replacement, back surgery, back pain, arthritis, rheumatoid arthritis, or any condition that may affect the mobility of your body or the dexterity of your hands.

3. What can I expect my first day of therapy?

It helps to write down all of the questions that you have about your condition and therapy. If we do not answer your questions during our evaluation process, you will be prompted by your list to ask your questions at the end of your first session.
Once in the treatment room, your therapists will ask you numerous questions pertaining to your condition. Then they will analyze your posture, balance, back and hip motion, pelvic alignment and scar integrity. They will explain the anatomy of the pelvis using an anatomical model. Then your therapist will give your privacy and ask you to get undressed from the waist down. A sheet will be provided for you to cover yourself, as you lie back on the treatment table. Your therapist will exam the perineum (the area covered by your underwear), and possibly perform a vaginal and/or rectal exam. This is only done with your consent, but can provide very important information used by your therapist to create your Plan of Care. Your therapist will use non-latex gloves and lubrication during this part of the exam, which will make the exam more comfortable. Once this part of the exam is finished, your therapist will give you privacy to dress. Your therapist will then explain their findings and what your Plan of Care should be, as well as answer any questions that you still have.
Please arrive 30 minutes early for your first day of therapy. There will be paperwork for you to fill out and we do not want to eat into your hour of evaluation time with your therapist. Also please bring a list of medications, a list of your past surgeries and list of your conditions. If you downloaded the forms and filled them out in advance of your appointment, you can arrive 15 minutes early, as there are still a few forms to handle in the office. Please bring a photo ID and your insurance card.

4. What can I expect my ongoing therapy to be like?

Treatment is tailored to each patient and you may or may not need all the techniques listed.

Urge Incontinence: Physical therapy for this condition can include bladder retraining, down-training your nervous system, teach urge control techniques, connective tissue manipulation, scar mobilization, visceral manipulation, myofacial release, diaphragmatic breathing, strengthening/stretching of pelvic muscles, hip muscles and/or back muscles, bladder education, and dietary education.

Stress Incontinence: Physical therapy for this condition can include pelvic muscle strengthening, hip strengthening, back strengthening, avoid valsalva education, ergonomic training, stretching of pelvic, abdominal, back or hip muscles, internal vaginal or rectal releases.

Functional Incontinence: Therapy will focus on improving the mobility of your body, and the dexterity of your hands, as appropriate. If we cannot improve this through strengthening, stretching and various manual therapies, then we will focus on ergonomic training and adaptive equipment. Ergonomic training consists of teaching the proper way to move (sit to stand, rolling in bed, getting out of a car, etc) in order to decrease the amount of pressure on the bladder. If this does not help, then we will set the patient up with adaptive equipment like a bed rail to assist in rolling in bed, toilet riser, Velcro for pants, walker, cane, etc.

5. How long can I expect my therapy to last before I begin to see improvement?

Since every patient is unique, itís hard to answer this question. We have seen some patients acknowledge improvement in just two visits, while others, although rare, may need months of therapy before seeing improvements. Usually some improvement is seen within 4-6 visits. Your participation in your own healthcare can also have a big impact. This means that you have to take some responsibility for your own health and do what your therapist asks you to do outside your treatment sessions. You are your therapist are a team. Improvement rates also depend on the severity of your condition and how long you have been suffering from it. The longer youíve had your problem, and the more severe it is, will increase the time needed for treatment before you see improvements.

6. How long can I expect my therapy to last before I am healed/cured/fixed?

Again, each patient is unique, so this time frame can vary greatly. Research shows that it takes at least three months of treatment to create a permanent change in the body. We most often request a frequency of once a week for 12 total visits. That is why our office staff will ask you to schedule all 12 of your sessions before starting therapy. If you need more than 12 sessions, your therapist will discuss this with you after you have completed 12 visits and you will decide together whether continuing with therapy would benefit you or not. If so, your therapist will reevaluate you and send a progress note to your physician requesting an extension.

7. What are the credentials of my uro-gynecological physical therapist?

At Kirk Center for Healthy Living we are very selective in our hiring process. We take great care in selecting the most skilled therapists we can find. We also require that they attend multiple post-graduate continuing education courses every year, predominantly with the Herman & Wallace Pelvic Rehabilitation Institute and the Barral Institute, in addition to receiving one hour of one-on-one training with the owner of Kirk Center, Brandi Kirk, PT, BCB-PMB.
All licensed physical therapists have had to apply and be selected to attend Physical Therapy school. It is a very competitive process and only those will the highest grades and best potential are selected. Physical therapists have invested a minimum of 5 years into their undergraduate and graduate training at universities. Once they graduate, they have to sit for a State Board Exam and pass to receive their license to practice. In order to keep their license active, they must dedicate a certain number of hours to continuing education each year.
Uro-gynecological physical therapists have done everything listed above, but have also become a specialist in the field of pelvic health. As a specialist, all continuing education is focused on the conditions that we treat at Kirk Center. Some physical therapists have multiple letters after their names, indicating a license and/or certification in an area of study. Uro-gynecological physical therapists have been trained in internal vaginal and rectal evaluation and treatment techniques and by our state license we are legally allowed and qualified to perform these procedures.
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