Pelvic Floor Physical Therapy for Overactive Bladder

Introduction

A sudden and strong urge to pass urine that can not be delayed is termed an overactive bladder. Some may even break out halfway to the bathroom. Others may not lose urine but may have the urgency and increased frequency of passing urine or face the urge frequently at night (nocturia). The involuntary contraction of the bladder in an overactive bladder is responsible for this. Learning how to strengthen the pelvic muscles responsible for this helps prevent urine leakage. This article delves into physical therapies possible to prevent similar embarrassing situations.

What Is an Overactive Bladder?

A condition where it is difficult to control the urgency when the bladder is full is called an overactive bladder. This is caused by a communication gap between the brain and the bladder. The brain sends signals to the bladder, causing it to contract at inappropriate times, resulting in urine leakage. It can be uncomfortable, embarrassing, or even painful at times. It can negatively impact the quality of life and lead to emotional distress. However, treatment at the appropriate time can be beneficial. Physical therapy is generally the first line of treatment for an overactive bladder.

What Is Pelvic Floor Physical Therapy for Overactive Bladder?

Pelvic floor physical therapy for overactive bladder is a specialized form of physical therapy aimed at managing urinary incontinence (loss of control over the bladder muscles). A trained healthcare professional will assist the patient in doing various exercises with the pelvic floor muscles and bladder muscles and improve their coordination. These exercises will help to engage the pelvic floor muscles, regulating the release of urine. This helps to improve the urgency and urinary incontinence.

How Is Pelvic Floor Physical Therapy for Overactive Bladder Done?

A trained healthcare professional will first assess the pelvic muscles. The patient is then taught to identify these muscles in their body through various activities. After identifying the muscles, the patients are taught to utilize the proper muscles and strengthen them through a series of exercises. These exercises require a motivated person who is patient in learning and invests time and effort in bringing about changes in their bladder and pelvic muscles. These exercises can be easily done using improper methods if done without the assistance of an expert.

These exercises can give results only if done regularly and follow the proper technique. The expert first teaches the patient how to identify the correct muscles of the pelvic floor and then to properly contract and relax them. Verbal feedback, depending on the digital assessment, visual or auditory biofeedback, or electrical stimulation can be used to achieve this. Four main instructions are given to the patient. The patient is first asked to contract the muscles around the trainer’s finger and try to pull up and in. Secondly, the patient is asked to prevent the passing of bowel gas by tightening only the ring of muscles around the anus, relaxing the muscles of the legs and buttocks. The sensation of closing and lifting should be understood by the patient. Third is a method employed by men. They are asked to lift their penis up and down, without moving any other part of the body. The fourth one is used in women. They are asked to feel their vagina and rectum pull up and in.

Another main challenge faced in the physical therapy of pelvic muscles is muscle isolation. Studies show that more than one-third of women are not confident to do a pelvic muscle contraction correctly. They tend to use other similar muscles or substitute a straining-in method, which can actually worsen the condition. This is corrected by the trained healthcare professionals. They help to identify the correct muscles and use them correctly.

How Can Pelvic Floor Physical Therapy Help to Manage Overactive Bladder?

The pelvic floor consists of a group of muscles that support the bladder, rectum, uterus, and prostate. The muscles attach to the pelvic bone and go around the rectum. They help to hold the urine and feces until ready to be removed from the body. Childbirth, being overweight, hormonal changes, constipation, treatments for prostate cancer, etc can make these muscles loose. This results in urine leakage and urgency. Keeping these muscles strong helps them provide better support to the bladder and other organs. Physical therapy for the pelvic floor muscles helps to identify these muscles and strengthen them. Another theory states that contraction of the pelvic muscles helps to improve conscious control of the bladder by triggering the brain region responsible for the voluntary urine inhibition reflex (reflex inhibition that prevents the leakage of urine).

What Are the Other Ways to Manage an Overactive Bladder?

Physical therapy is the first-line treatment option for the condition. It is a behavioral therapy that requires it to be done correctly and diligently to give results. Hence, it can be coupled with other treatment options to yield results faster. Other treatments for an overactive bladder can include:

• Medication: Drugs like anti-cholinergic drugs and beta-3 adrenergic drugs help to control urinary incontinence. Anti-cholinergic drugs block a chemical in the body from sending a signal to the bladder for muscle contraction. Beta-3 adrenergic drugs help to relax the bladder muscles so that it can hold more urine. Either way, the leakage of urine is stopped.

• Onabotulinumtoxin A (Botox): When used in small quantities, Onabotulinumtoxin A helps to weaken or paralyze the bladder muscles, and prevents them from contracting very frequently.

• Stimulation of Sacral Nerve: The sacral nerve stimulates the bladder to contract and relax. Stimulating the nerve helps to control the leakage. It is a minimally invasive procedure is done at the doctor’s clinic. A small device similar to a pacemaker is inserted in the lower back near the sacral nerve. Electrical stimulation on the sacral nerve helps to control an overactive bladder.

• Surgery: This is the last resort when all other treatments fail. Augmentation cystoplasty (a procedure to increase the capacity of the bladder), urinary diversion, ladder lift surgery, etc, are some surgical interventions to manage an overactive bladder.

Conclusion

Physical therapy can be an effective way to manage an overactive bladder. However, it requires to be done correctly and regularly to yield the desired results. Following it for about six to eighteen weeks helps one to see the improvement in bladder control. There can be fewer leakage episodes and reduced urgency. In mild cases, improvement can be seen even within three to four weeks.