Tag Archives: Pelvic Floor

Urinary Incontinence: Common but not Normal

There are some body issues that no one really likes to discuss, even with their doctor. Incontinence (leakage), urinary or fecal, is one of those issues. Incontinence affects both men and women, but did you know that it is two times more likely in females than males? The National Association for Continence (NAFC) says 1 in every 4 women over the age of 35 experiences incontinence. Incontinence is common, but that does not mean it is an inevitable part of aging and it does not mean you can’t find relief.

First, let’s review how the bladder functions: your kidneys filter your blood and remove waste/toxins which creates urine. Little tubes, called ureters, take the urine from the kidneys to your bladder where it is stored. As the bladder fills, it stretches. When it reaches a certain level, a message is sent to the brain telling you it’s time to find a bathroom. When you reach the restroom the brain tells the muscles of the bladder to contract (you can’t control this part, it just happens) and your pelvic floor muscles to relax (you can control this part).. If something interrupts the communication process between the brain and bladder or if the muscles of the pelvic floor are weak (or sometimes even tense), leakage can occur. While you cannot control the contraction of your bladder, you can control your pelvic floor muscles. Strengthening these muscles with a specific type of physical therapy can help.

Incontinence is not only a physical problem, but it can affect your personal life. Every patient is unique, but incontinence is usually a bigger issue than needing to wear a pad or change your clothing. Many sufferers experience impacts on their emotional and psychological well-being. A decrease in social activity is also common. Incontinence has also been associated with a 26% increased risk of falls in the elderly population, as reported by the NAFC. Some can lose their balance when experiencing a sudden need to reach the bathroom quickly.

There are many different types of incontinence and they all mean something slightly different. Knowing the various types can help when trying to communicate the problem to your doctor or physical therapist.

  • Stress Incontinence: loss of urine with physical activity/exertion. Often individuals note this leakage is associated with cough, sneeze, laugh, jump, or exercise.
  • Urge Incontinence: loss of urine that is preceded by a strong and sudden need to empty the bladder. With this type of incontinence, you may notice every time you hear running water or pull into your garage after work you feel the need to urinate and can’t make it to the toilet.
  • Overactive Bladder: with overactive bladder symptoms of urgency, urinating frequently, and not feeling like you empty your bladder all the way tend to coincide and one may or may not have leakage along with these symptoms.
  • Mixed Incontinence: this simple means a combination of any of the above listed types of incontinence; most often a combination of stress and urge incontinence.

No matter the factors contributing to your incontinence, you can find relief. It may be embarrassing to discuss with your doctor, but it is important to speak up. Your physician can rule out larger medical conditions, assess if any of your medications are contributing to the problem, and recommend a form of treatment. Ask your doctor about a referral for pelvic floor physical therapy. Return to your beloved social activities and experience less anxiety over incontinence. Have confidence and take back control!

Gosse_B_2017_ultiproBrittany Gosse, DPT
Department of Physical Therapy
Medical Associates Clinic



Men Need Pelvic Health, Too.

Sorry to break it to you, gentlemen, but pelvic health isn’t just important for women. You have a group of muscles at the bottom of your pelvis that helps support the organs of your urinary, GI, and reproductive systems, too. There are 14 muscles, several joints, ligaments, and nerves making up the pelvic floor. No matter your gender, the pelvic floor works to control the bladder, bowel, and sexual functions. And just like women, men experience issues when the pelvic floor muscles are tight, weak, or spastic.

The pelvic floor is a part of your inner core, which is used during daily tasks, workouts, and hobbies. Your pelvic floor can become affected after surgery, due to other injury/trauma, or due to lifestyle factors or disease processes. When this happens, men can experience symptoms such as urinary or fecal leakage, constipation, abdominal/pelvic/rectal/penile pain, erectile dysfunction, and prostatitis-like symptoms. (Please note, this is not an all-inclusive list.) Additionally, men may benefit from pelvic floor physical therapy before or after prostatectomy and following hernia repairs or other abdominal/pelvic surgeries. Up to 2 million men in the United States alone meet the diagnostic definition of persistent pelvic pain.1 And that’s just one of the symptoms that may stem from pelvic floor muscles that are too tight, weak, or those that have restrictions present in or around the tissue.

Many of the interventions that pelvic floor physical therapists use to strengthen these muscles can be applied to treatment of both men and women. Your provider should begin with an evaluation process to get a clearer picture of what is happening with the muscles, their strength, coordination, endurance, and tension. This may involve an internal (rectal) and external examination to better determine how your pelvic floor is contributing to your experienced symptoms. Please don’t let the thought of internal examination deter you. There may be other options to begin addressing your symptoms until you learn more and are more comfortable. Just be open and honest with your therapist.

So, men, speak up! If you are experiencing leakage, pain, constipation, urinary urgency, changes in sexual function, or are post-surgery for the pelvic or abdominal region, ask your doctor or call with questions. If you and your physician have ruled out other diagnoses or infections, pelvic health physical therapy may be a great option for you. Know that you are not alone in the symptoms you experience. Improve your quality of life with pelvic health physical therapy at Medical Associates.


Gosse_B_2017_ultiproBrittany Gosse, DPT
Department of Physical Therapy
Medical Associates Clinic





  1. Prendergast SA, Rummer EH. Pelvic pain explained: what everyone needs to know. Lanham: Rowman & Littlefield; 2016.


What is a Kegel? Are they right for you?

Your pelvic floor muscles act as a hammock at the bottom of your pelvis that supports all your abdominal and pelvic organs. Strengthening these muscles can help with problems such as urinary leakage, fecal leakage, prolapse, general weakness, pressure, pain, post-partum pain, or instability. Many physicians or therapists, friends or family members may recommend Kegels as an intervention to address your symptoms, but what are Kegels and are they right for you?

First, let’s define a Kegel. A Kegel is an isolated contraction of the pelvic floor muscles. This means that those pelvic floor muscles are the only muscles contracting in your body (lifting up towards your head and squeezing around). No other muscles come to aid in this isolated contraction. It should be a “secret” squeeze; in other words, no one else would know you are flexing them.

But when you reach for your grocery bag, move that heavy couch, lift the baby, have a bowel movement, or even sneeze – the pelvic floor doesn’t work alone. Yes, you do need to be able to isolate these muscles to help build their strength, but it needs to work together with the inner core. This allows you to anticipate movement, respond, and create a support system for stability to decrease the strain or workload to one individual group of muscles. All the muscles of the inner core need to be balanced in strength to appropriately perform actions such as these.

Kegels do have their place in Pelvic Floor therapies, however every patient is different and not everyone should do Kegels. For example, sometimes the pelvic floor is tense or in spasm, meaning the muscles are already engaged or in a contracted position. Another type of intervention or home program may be more appropriate in this case. If tension is the source of the symptoms being experienced, those muscles likely need to be lengthened and taught to relax instead. This is why it is critical to be evaluated by someone who is specifically trained in pelvic floor therapies. Knowledge of how your pelvic floor presentation relates to your symptoms and the ability to assess what the rest of the system is doing are crucial.

If you’ve tried Kegels and they haven’t helped, please contact us. There might be modifications we can make, different muscles to address, or an altogether new therapy tactic to try. Call 563.584.4465 to schedule an appointment or ask your doctor for a referral to pelvic floor physical therapy. You can also fill out our intake form here and someone from our office will reach out to you.

Gosse_B_2017_ultiproBrittany Gosse, DPT
Department of Physical Therapy
Medical Associates Clinic

Myth Busters: Pelvic Floor Therapy

Physical therapists can treat symptoms involving my bladder, bowels, or sexual function? True! Many have been doing this for several years. As this area of practice continues to advance, more providers are recognizing physical therapy as an effective and conservative treatment intervention for these diagnoses. However, every patient is different and everyone has a different experience. So with so much information available on healthcare, especially online, how do you know what is correct? Medical Associates Clinic physical therapist Britt Gosse, DPT, shares her experience and training below to help you sort the facts from the myths.

“Physical therapists can’t do anything to address this.”
Physical therapists are experts in treating the musculoskeletal system. There are 14 muscles, several joints, ligaments, and nerves making up the pelvic floor.  Not all physical therapists are trained in treatment of the pelvic floor, but there are some who have completed further training to become experts in this specific type of therapy.

“I’ve already done kegels, physical therapy can’t help me.”
Physical therapy can help. Many kegel programs can be beneficial but not for all symptoms. Additionally, a balance of muscles that engage for activities is required. Finding someone who can assess all your symptoms and the balance of your body will give you the optimal outcome.

“Only women who have had a baby go to pelvic floor physical therapy.”
Yes, post-partum women are a group that commonly benefit from pelvic floor PT, but everyone has a pelvic floor. Therefore anyone could have symptoms of pelvic floor dysfunction and benefit from pelvic floor physical therapy.

“I had surgery on my (ex. bladder, uterus, etc.) for these symptoms and it didn’t help, so physical therapy won’t either.”
Sometimes surgery isn’t the answer or it’s not the whole solution to the underlying issue that is creating your symptoms. Physical therapy may be a great non-invasive option for you as well. Discuss this with your doctor and physical therapist. Even after surgery you can benefit!

“I don’t have any pelvic floor symptoms but I just had surgery on my (abdomen, bladder, uterus, bowel, etc.).”
Even if you are not experiencing symptoms, a result of surgical procedures is scar tissue. Scar tissue can restrict normal tissue function and impair daily activities. Maybe not now, but possibly in the future you might exhibit symptoms. Being proactive with therapies to strengthen your pelvic floor muscles is a great idea for preventive health.

“My diagnosis is related to genetics. Physical therapy won’t address that.”
If this is the case, physical therapy likely won’t change the driver of your symptoms but it CAN help you manage the secondary issues occurring because of your symptoms, such as urinary urgency, constipation, abdominal pain, pelvic pain, pain with intercourse, etc. You can learn new strategies and ways to help you manage symptoms you experience.

“Other people I know said they leak when they workout. It must be normal.”
It is not normal to leak when you lift, run, jump, sneeze, sit…the list goes on. Leaking may be common but it is not normal. You can learn new recruitment strategies, balance your muscular system, and optimize overall function by working with a skilled physical therapist.

“I just had a baby; isn’t leaking or prolapse normal?”
Again, I want to stress that while these are common symptoms for many women, it is not normal. Just because something is common does not mean you have to live with it. Pelvic floor physical therapy can help you.

“I have the separation of the abdominal muscles. They said I’d have to avoid core work forever.”
This separation occurs as a natural part of pregnancy but it can create symptoms following delivery, such as feelings of instability, abdominal pain, low back pain, pelvic pain, urinary leakage/urgency. You may not have to avoid the exercises or activities you love. Many women benefit from learning recruitment strategies to protect the core, optimize function, and not create further symptoms.

“I already went to pelvic floor physical therapy and it didn’t work.”
Therapists treating the pelvic floor are all trained differently. They may have a different focus, see a different number of patients per week, or have a different type of experience or approach. Seeing another therapist just gives your symptoms another set of eyes. Research and consider a new therapist that specializes in pelvic floor therapies. Be open to your therapist and be honest about your previous experience. They will use their expertise and knowledge to address your needs with a new approach.

If you are experiencing symptoms of pelvic floor dysfunction, you may be a candidate for pelvic floor physical therapy. Contact your primary care provider and receive an appointment referral or contact the Physical Therapy Department at Medical Associates directly at 563-584-4465. For more information or to submit an electronic inquiry, follow this link.


Gosse_B_2017_ultiproBrittany Gosse, DPT
Department of Physical Therapy
Medical Associates Clinic