TAKE CONTROL OF YOUR BLADDER ISSUES

The Female Athlete

THE FEMALE ATHLETE

The more elite the athlete, the higher risk for bladder issues.

Due to the unique demands of sport participation on the body, female athletes are at increased risk for pelvic floor issues, most typically bladder issues.

Activities such as jumping, running, lifting, or landing that occur with athletic participation create high levels of abdominal pressure placing increased stress onto the pelvic floor. When the muscles, fascia, and ligaments are negatively impacted, the female athlete can experience pain, weakness, and dysfunction.

Click image for a larger version.

Increased neurological activity from sport also increases the nerve impulse to the bladder creating forceful and frequent urge sensations.

Female athletes, with and without children, experience accidental bladder leakage. Studies have found that 30% of young female athletes leak urine and that number over doubles after athletes deliver children [source]. Regulating these neuro impulses, stabilizing, and conditioning the pelvic floor are important components for the female athlete to take control and stay dry (and out of the bathroom).

In therapy, we determine which structures are unable to manage the increased force of intra-abdominal pressure and provide an individualized treatment plan which can include:

• Pelvic Floor Muscle Training
• Biofeedback
• Electrical Stimulation
• Recommendation for a Pessary

The goal in therapy is to ensure the athlete is 100% dry whether jumping, lifting, landing, skiing, laughing, dancing, running, or managing impact in any other sport.

Citation:

Opara, J., Socha, T., Bidzan, M., Mehlich, K., & Poswiata, A. (2011). Stress urine incontinence especially in elite women athletes extremely practicing sports. Archives of Budo, 7.

Violent Urge Leakage

VIOLENT URGE LEAKAGE

Urinary urge leakage is an overresponse of the nervous system to the bladder.

Violent urge leakage is a sudden and violent urge that causes urine leakage.

This forceful urinary urge often hits with a common trigger such as arriving home (key in the door syndrome).

There are other triggers such as walking past the kitchen sink, cold weather, making a decision when shopping, seeing your mom, the possibilities are endless.

In therapy, we use bladder retraining and work to regulate neuromuscular input the bladder.

Treatment options used may include:

• Bladder Training
• Neuromuscular Reeducation
• Biofeedback
• Pelvic Floor Muscle Training

The goal in therapy is to identify triggers and normalize bladder impulses so a violent urge doesn’t saturate you.

Click to view a larger image.

Painful Bladder

PAINFUL BLADDER

Painful Bladder Syndrome is often diagnosed as Interstitial Cystitis.

Painful bladder can present with other bladder and pelvic dysfunctions including increased urinary frequency, retention, constipation, lower back and gynecological pain.

The pain is often described as pain wrapping around the pelvis like a belt.

Advanced practices in urology recommend pelvic floor therapy for the treatment of painful bladder syndromes because it has been found that 87% of interstitial cystitis patients have pelvic floor muscle dysfunction [source].

Pelvic muscles support the pelvic organs, including the bladder, uterus or prostate, and rectum. These muscles wrap around the urethra, vagina (in women), and rectum and can reflexively cause bladder pain.

In therapy, we coordinate contraction and relaxation of the pelvic floor muscles to control bladder and bowel function and reduce pain.

Treatment options used may include:

• Manual Therapy
• Myofascial Release
• Visceral Manipulation
• Neural Gliding Techniques
• Neuromuscular Reeducation
• Biofeedback
• Warm Laser Therapy

Your therapeutic work with us will accomplish several important goals, including eliminating connective tissue restrictions and reducing neural tension and viscerosomatic reflex to eliminate our patients’ pain.

Citation:

Han E, Nguyen L, Sirls L, Peters K. “Current best practice management of interstitial cystitis/bladder pain syndrome.” Therapeutic Advances in Urology. July 2018:197-211.  https://doi.org/10.1177/1756287218761574

Stressed Bladder Leakage (Stress Incontinence)

STRESS INCONTINENCE

Stressed Bladder Leakage is when involuntary urination is caused by coughing, sneezing, laughing, or exertion.

Leakage is most common in younger women, but regularly effects women of all ages. It is especially prevalent among elite athletes.

Increased amounts of intra-abdominal pressure become too stressful for the pelvic floor muscles and the result is accidental urine leakage.

Stressed bladder leakage is usually a result of increased urethral mobility, and/or intrinsic sphincter dysfunction.

In therapy, we determine which structures are debilitated and provide an individualized treatment plan, which can include:

• Pelvic Floor Muscle Training
• Biofeedback
• Electrical Stimulation
• Recommendation for a Pessary

The goal in therapy is always to be 100% dry whether laughing, sitting, jumping (yes on a trampoline), or managing impact in any other sport.

Overactive Bladder

OVERACTIVE BLADDER

Overactive bladder is most common in older women but regularly effects women of all ages.

Overactive bladder is a sudden and strong urge to urinate that often becomes uncontrollable.

The neurological overactivity to the detrusor (bladder muscle) causes a strong urge sensation when triggered. Triggers can result from diverse stimuli like pulling in the driveway, putting a key in the door, shopping, running water, walking past the sink, and more.

In therapy, we determine what neurological triggers are overstimulating the detrusor and work to regulate the nervous system, coordinating it with bladder function.

Treatment options used may include:

• Bladder Training
• Neuromuscular Reeducation
• Biofeedback
• Pelvic Floor Muscle Training
• Electrical Stimulation of the Post Tibial Nerve

The goal in therapy is to regulate the urge sensation to release the bladder five to seven times a day and be 100% dry.

Bladder Retention

BLADDER RETENTION

Bladder retention is the inability to fully urinate.

Bladder retention can be caused a variety of medical issues including pelvic floor muscle spasms or tightness.

The muscles of the pelvic floor may be unable to hold a contraction long or strong enough to fully empty the bladder.

In therapy, we use bladder retraining and work to restore neuromuscular function of the pelvic floor muscles, so you can fully empty the bladder.

Treatment options used may include:

• Bladder Training
• Neuromuscular Reeducation
• Biofeedback
• Pelvic Floor Muscle Training

The goal in therapy is to fully empty the bladder so you only need one trip.

Recurrent Urinary Tract Infections

RECURRENT URINARY TRACT INFECTIONS

Most Urinary Tract Infections infections involve the lower urinary tract — the bladder and the urethra.

About 80–90% of UTIs are caused by a type of bacteria, called E. coli (pronounced ee-co- lie) [source]. These bacteria normally live in your intestines, but they sometimes get into the urinary tract because of a pelvic floor dysfunction [source].

Recurrent UTIs are a significant cause of morbidity in the United States [source].

Pelvic floor risk factors for recurrent UTIs can include: involuntary bladder leakage [source], overactive bladder [source], involuntary loss of feces or gas [source] indwelling catheters [source] sexual hygiene, urinary retention [source], immobility [source], and more.

Women are at greater risk of developing UTIs than men are.

A pelvic floor therapy evaluation can determine what pelvic floor dysfunctions are contributing to recurrent UTIs.

Treatment options may include:

• Bladder Training
• Neuro Reeducation
• Home Exercise Program
• Biofeedback EMG
• Manual Therapy
• Peri-Hygiene Training
• Adaptive Strategies

A pelvic floor therapy evaluation and individualized treatment plan will enable you to Take CONTROL! of recurrent UTIs.

Citations:

1. Flores-Mireles, A. L., Walker, J. N., Caparon, M., & Hultgren, S. J. (2015). “Urinary tract infections: epidemiology, mechanisms of infection and treatment options.” Nature Reviews. Microbiology, 13(5), 269–284. 

2. Ejrnæs K. (2011). “Bacterial characteristics of importance for recurrent urinary tract infections caused by Escherichia coli.” Danish Medical Bulletin, 58(4), B4187. 

3. Luber KM. “The definition, prevalence, and risk factors for stress urinary incontinence.” Reviews in Urology. 2004;6 Suppl 3(Suppl 3):S3-S9.

4. Moore, E. E., Jackson, S. L., Boyko, E. J., Scholes, D., & Fihn, S. D. (2008). “Urinary incontinence and urinary tract infection: temporal relationships in postmenopausal women.” Obstetrics and Gynecology, 111(2 Pt 1), 317–323. DOI: 10.1097/AOG.0b013e318160d64a

5. Ke, Q. S., Lee, C. L., & Kuo, H. C. (2020). “Recurrent urinary tract infection in women and overactive bladder – Is there a relationship?“. Tzu Chi Medical Journal, 33(1), 13–21. DOI: 10.4103/tcmj.tcmj_38_20

6. Saldana Ruiz, N., & Kaiser, A. M. (2017). “Fecal incontinence – Challenges and solutions.” World Journal of Gastroenterology, 23(1), 11–24. DOI: 10.3748/wjg.v23.i1.11

7. Moore, E. E., Jackson, S. L., Boyko, E. J., Scholes, D., & Fihn, S. D. (2008). “Urinary incontinence and urinary tract infection: temporal relationships in postmenopausal women.” Obstetrics and Gynecology, 111(2 Pt 1), 317–323. DOI: 10.1097/AOG.0b013e318160d64a

8. Rogers, M. A., Fries, B. E., Kaufman, S. R., Mody, L., McMahon, L. F., Jr, & Saint, S. (2008). “Mobility and other predictors of hospitalization for urinary tract infection: a retrospective cohort study.” BMC Geriatrics, 8, 31. DOI: 10.1186/1471-2318-8-31