By Kelsey Max, DTP

Many women experience urinary incontinence at some point in their life. Some women cope with urinary incontinence by using pads and others try the “bladder sling” surgery. But, there is another option.

November is National Bladder Health Awareness Month, so it is a great opportunity to bring to light another conservative option that can make urinary incontinence go away. Pelvic floor physical therapy is becoming more prevalent as doctors are utilizing physical therapy more to treat pelvic floor dysfunction including urinary incontinence and pelvic pain. 

As I have found in my practice with pelvic floor, many women do not know what to expect when they come to physical therapy for pelvic floor. So today, I want to discuss what to expect when you have your pelvic floor evaluated by a physical therapist. 

To begin physical therapy, you must have a referral from your primary care provider to be able to bill insurance. A pelvic floor physical therapist will begin by asking several questions about the patient’s bathroom habits, bathroom frequency, pain, pregnancy and surgical history, and even what you drink in a day. A manual pelvic exam is then completed to palpate the pelvic floor and determine whether the patient can complete a kegel. 

Most women are surprised that pelvic exam is necessary but that is the only way to palpate the pelvic floor and evaluate its function.  Whether a patient can isolate a kegel or not will drive the physical therapy treatment. Most women do know how to kegel, but they are not doing enough repetitions during the day to see improvements in urinary incontinence. Also, if you are having pain during the pelvic exam, pain will be addressed.  Once the pelvic exam and subjective exam are completed, the physical therapist can then determine a treatment plan that is best suited for the patient.

Physical therapy treatment often includes kegels, pelvic floor stretches, core strengthening, and possibly electrical stimulation. The Physical Therapist will also educate you on strategies with fluid modification, urge suppression, and bladder/bowel emptying that will also aide in your progress. I tend to encourage women to come to physical therapy 1-2x a week. Most women are seeing progress by 3 weeks and reporting decreased symptoms. The home exercise program prescribed by the PT is an essential component to the patient’s progress. By the time you finish pelvic floor physical therapy, you will have all the tools you need to continue to improve and maintain independently. 

Disclaimer: This is based off of what I do in the clinic but other pelvic floor physical therapist may practice differently.