Pelvic floor physical therapist

cantwait

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I was curious how many of you have seen a pelvic floor physical therapist and what your results were?
I’ve been seeing a pelvic floor physical therapist, and she told me that my pelvic floor is too tight. She thinks this is the cause of my urgency incontinence and frequency issue. Have any of you been diagnosed with a tight pelvic floor? A weak pelvic floor seems to be much more common.
 

mickdl

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Hello,

a tense pelvic floor is not as uncommon as many think. Men suffer from it more often than women - and it is often the result of sitting incorrectly and for too long.

The training in this case is different from the commonly known pelvic floor training and it contains exercises that train the perception of the pelvic floor and help to relax it specifically. In fact, "normal" training can make the situation worse - especially if the muscles are specifically tightened and the whole thing is not built into a movement sequence. For "normal" pelvic floor training, it is probably better to walk for an hour every day than to train the muscle directly for 10 minutes.

Unfortunately, this knowledge has not yet reached some therapists and the training is often geared more to women or rehabilitation after prostate surgery. If you are not sure, you should ask the therapist specifically. A trained therapist and also the urologist can recognize a pelvic floor tension very quickly - but they also have to look at it - which they unfortunately do not always do...
 
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CheshireCat

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I am currently seeing an Oncological Physical Therapist for radiation induced chronic colitis and IBS. After several appointments of discussion only, and a thorough pelvic exam, my PT has determined that I have several issues:
pelvic floor damage from radiation, which exercise may help
neurogenic bowel, which I am being asked to see a neurologist about though there is nothing they can do about it
pelvic floor that is profoundly affected by my neuromuscular genetic disorder, which gets weaker with exercise
I am an interesting case for her, because of my neuromuscular genetic disorder. What she has found most interesting is that I am willing to openly discuss my issues. Only about 5% of men referred post prostate cancer will talk whatsoever, making physical therapy impossible for the overwhelming majority.

As an aside, I was urinary incontinent before I had prostate cancer. Fecal incontinence has now been added as a result of prostate cancer treatment.
 
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Pino

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cantwait said:
I was curious how many of you have seen a pelvic floor physical therapist and what your results were?
I’ve been seeing a pelvic floor physical therapist, and she told me that my pelvic floor is too tight. She thinks this is the cause of my urgency incontinence and frequency issue. Have any of you been diagnosed with a tight pelvic floor? A weak pelvic floor seems to be much more common.
I am diagnosed with to tight pelvic floor, resulting in a Detrusor Sphincter Dys-Coordination (DSD). I went to a special physical therapist for "relaxing" the pelvic floor (hard to find, most do only strengthening) and learned some techniques, a part of them i do regularly, some only when it is really bad.

I think i developed the tight pelvic floor a long time ago, when i worked long hours without the possibility to take pee brakes, i had a huge bladder back than. 5 years i ago the problems with bladder pain and OAB started, in combination with the DSD it was a real pain in the as.
Three years ago i lost control first time (NDO). My problems with my lower spine have something to do with it additionally, when having pain in the lower back the pelvic floor gets like concrete. The flow gets down to 7ml/s and i get retention about 50% of the bladder volume.
So i think there is more than one cause for it.
 
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jdinvirginia

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CeshireCat mentioned how few men will discuss pelvic problems (post-prostate cancer). I am bowel incontinent. Some years back I was seen at a university pelvic specialist clinic by a Ph.D. physical therapist specializing in those problems. She was delighted to get me as a patient as so few men will go for such therapy.

We did the expected Kegels, anal manometry, ability to expel an inflated balloon, and video defecography. However, she surprised me by digitally mapping the internal nerve structure of my rectum to determine where I had suffered nerve damage causing loss of sensation and the ability to sense an approaching BM. It turned out that I have lost almost all my sensing nerves except right up against my sphincter, so I have very little "early warning." That was helpful to know as it confirmed what I had suspected.

The outcome of all this is that I better understood my body, and learned where my limits were and how far I could reasonably push things before I encountered a high risk of a fecal accident. I now am more emotionally accepting of my situation and manage it better.

Guys, the experience can be embarrassing, but is well worth it.
 
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mickdl

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Hi CashireCat,
I was not so lucky with my therapist... I had the pelvic floor training at that time only in the context of the rehab - and that was not particularly individual and took place in a group...

Anyway - as far as the neurologist is concerned - I would take a closer look again. I don't know how it is in the States - but here in Germany there are clinics with special continence centers where urologists, neurologists, gynecologists and proctologists work together.

I also went to a neurologist first as it figured out that also a neurological problems my the reason for my continence problems. The neurologist did all kinds of tests but found nothing really significant. I only really got further in the continence center. Maybe it's different for you - but the problem with neurologists is that they normaly can only measure the large nerve tracts. If peripheral body parts (legs / arms) are affected, they usually find something. But if the autonomic nervous system and internal organs are affected, it is more difficult and special knowledge not only about the nerves but also about the affected organs is needed.

I think you have to make a very differentiated diagnosis to be able to distinguish between the things. In my case, it is also a multifactorial problem - and I lost a lot of time while several specialists try to work on it separately. In fact there are several thinks that may work even with neurological issues - depending on the problem you might be e.g. a candidate for an interstim.
 
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CheshireCat

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mickdl said:
Hi CashireCat,
I was not so lucky with my therapist... I had the pelvic floor training at that time only in the context of the rehab - and that was not particularly individual and took place in a group...

Anyway - as far as the neurologist is concerned - I would take a closer look again. I don't know how it is in the States - but here in Germany there are clinics with special continence centers where urologists, neurologists, gynecologists and proctologists work together.

I also went to a neurologist first as it figured out that also a neurological problems my the reason for my continence problems. The neurologist did all kinds of tests but found nothing really significant. I only really got further in the continence center. Maybe it's different for you - but the problem with neurologists is that they normaly can only measure the large nerve tracts. If peripheral body parts (legs / arms) are affected, they usually find something. But if the autonomic nervous system and internal organs are affected, it is more difficult and special knowledge not only about the nerves but also about the affected organs is needed.

I think you have to make a very differentiated diagnosis to be able to distinguish between the things. In my case, it is also a multifactorial problem - and I lost a lot of time while several specialists try to work on it separately. In fact there are several thinks that may work even with neurological issues - depending on the problem you might be e.g. a candidate for an interstim.

I will need to do research on Interstim.

My neuromuscular genetic disorder is caused by a channelopathy, a mutation to the muscle sodium channels. Repetitive muscle cell contractions, macro or micro, cause the sodium channels to lock open, allowing sodium and potassium to leak from the cell, thereby depolarizing it. The nerve continues to work, but the cell does not.

There is also evidence of neurological deficit. I have seen neurologists and hospitalized since I was 13 for encephalitis (twice), vision and hearing issues (recovered), severe dystonia, tremor, and severe sleep disorder (narcolepsy with cataplexy). So when I found out that my bladder does not send any signals to the brain or respond to any signals from the brain it was enlightening and not surprising.

Combining these two issues is what is making PT difficult, and I'm concerned that unless a neurologist is an expert in channelopathies (very few are) their guidance would be suspect. There is only one neurologist in the state of North Carolina that specializes in channelopathy disorders, and I've been fighting to get in to see her for over a year now. As the IBS and lack of fecal control is increasing, I think I need to start fighting harder.
 

mickdl

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Hi CashireCat,

I think your case this is really very special and both (neuromuscular genetic disorder as well as the possible consequences of the encephalitis) can cause autonomic neuropathy that may affect the nerves that are responcible for bladder and/or bowel continence… How ever - despite what it caused at the end - the question for the therapy is less the „what“ but more the „where“ and the „how“. If you look to the picture below you can see what nerves are responsible for which function. The Interstim can help in all cases where the sacral nerve is involved. This is for example the Pudenal nerve as well as some of the bowel nerves.

In fact you have to read this picture from bottom to the top because if a upper region of the spine or one of the switching points are effected this will cause the same problems. If the interstim works depends hardly on the function that is left. If there is still some nerve activity left and the switching points are not completely distorted it may work. It can be tested by a temporary installation of the electrodes and a external generator. If it works, the the generator can be implanted later. I think if you had at last some control the chances are not that bad that it works… It will most likely not solve all problems but may make thinks a bit easier and more predictable.



bladder-control.jpg
 

Raven801

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Been In pt for pelvic floor for 5 months... Very little difference control wise if I'm honest.
 
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cantwait

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Raven801 said:
Been In pt for pelvic floor for 5 months... Very little difference control wise if I'm honest.
I didn’t see any big differences either, but they were able to answer a lot of questions that I had.
 

Raven801

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cantwait said:
I didn’t see any big differences either, but they were able to answer a lot of questions that I had.
Same here
 

Diapercutie

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Yes.
 

mickdl

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I think the pelvic floor training works best with stress incontinence. In addition, you have to bring some patience and be aware that you really have to train yourself every day. The therapist can show you the right exercises but the success depends massively on your own commitment.

With a pure urge incontinence it is usually only little effective. Here, an adjustment of drinking habits and targeted toilet visits often bring more.
 

newt

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I also just started seeing a pelvic floor therapist as well, really hoping we can see some results @cantwait ! I also found out my entire left side of my pelvic floor is SUPER tight, which is what we are working on first before we do any strengthening. Keep updating this thread as you go (and I will try to as well) to share our progress!
 
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jdinvirginia

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My pelvic floor therapy was one-on-one. Although my therapy was oriented toward my major problem - bowel incontinence, it also benefited my bladder incontinence. I am OAB and the Kegel exercises improved my bladder control and reduced my post-void-residuals or urine. Mind you, I was doing a LOT of Kegel exercises.

Re Kegel exercises, I found it more effective to do Kegels against resistance, just like exercising in the gym. By resistance I mean with a soft anal plug inserted in the rectum. Squeezing the anal sphincter against the shaft of the anal plug provided the resistance. I found that I got more benefit from fewer Kegels this way. I realize there is the "yuk" factor of using an anal plug, but when you have been fecal incontinent for a long time and are highly motivated to avoid bowel accidents, the "yuk" factor becomes less important. All of my doctors approved of this.
 
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