Urinary Incontinence in People with Parkinson’s: Part Two
I had no idea that physical therapy for incontinence existed! I was also sure that I would be so embarrassed that I would never be able to handle the whole course of physical therapy, but I wanted to go in with an open mind. Fortunately, I had an awesome physical therapist. She put me at ease and we connected immediately.
Physical therapy for incontinence ("pee-pee" PT)
I had the unique and actually most rewarding experience going to physical therapy for my incontinence.
As you can imagine I was a bit hesitant at first but my lovely therapist was wonderful! I think this is very important that you feel very comfortable with your therapist, as this can already be an embarrassing issue. A proper therapist can make you feel more comfortable and less embarrassed, allowing for a greater exchange of ideas. Pelvic floor physical therapy is an effective treatment for symptoms of urinary urgency and urinary incontinence in people with Parkinson’s disease.
Preparing for your appointment with the phsyical therapist
This appointment is for an initial evaluation that will last approximately 45 minutes. Usually, they ask you to arrive 20 minutes before your appointment to complete all necessary paperwork.
The initial evaluation includes a thorough review of the following (as time permits):1
- Past medical history
- Symptoms as related to your current diagnosis
- Daily bowel and bladder habits and current functional limitations
- Musculoskeletal examination of your pelvic region, including your posture, biomechanics of your spine and pelvis, range of motion and strength testing, and mobility of your abdominal-pelvic muscles, connective tissue, and organs
- If appropriate, a gentle, internal pelvic exam is performed to evaluate tone and strength of your pelvic floor musculature, as well as determining painful structures within the pelvic cavity
Depending on initial findings during the exam, the physical therapist will often prescribe pelvic floor muscle exercises, bladder retraining, dietary irritants, as well as extensive education on pelvic floor anatomy, function, and bowel/ bladder function.
Follow up physical therapy appointments
Based on your initial evaluation one or more of the following will be performed therapies could be recommended.
- Extensive education on pelvic floor anatomy and bowel/bladder function
- Biofeedback training to record the muscle activity of your pelvic floor muscles and re-educate the coordination of these muscles at rest, in various positions, and during functional activities
- Individualized exercise program to improve strength and endurance of the weak pelvic floor
- Biofeedback and education on techniques to relax the tight, overactive pelvic floor muscles
- Electrical stimulation to assist in the strengthening or relaxation of either weak or tight pelvic floor musculature
- Kegel exercises, which are the constricting and relaxing of muscles surrounding the pelvic floor
- Mobilization of your spine and pelvis to restore symmetry and normal biomechanics
- Exercise program to improve posture, flexibility, and strength of the low back, abdomen, pelvic region, and lower extremities
- Instruction in lifestyle changes such as diet, skincare, and self-treatment techniques
Pelvic health therapy is a whole-body approach, so the physical therapist might find it appropriate to treat other areas of the body, which could be affecting the pelvic area.
Return visits usually occur weekly for 8-12 weeks depending on exam findings. Biofeedback training is often to record the muscle activity of your pelvic floor muscles and re-educate the coordination of these muscles at rest, in various positions, and during functional activities.
Other treatment options to strengthen the pelvic floor
There may be some alternative treatments available as well, including:
- Tai chi
All of these have the potential to assist with bladder/urgency issues.
The goal of this article was to open up a dialogue about incontinence and urgency and Parkinson’s disease. It is one of those embarrassing non-motor issues that many of us, regardless of our age, have as a result of being diagnosed with Parkinson's.
The good news is that there are things that can be done to help that do not necessarily include medication! Exercise, diet, therapy, and a willingness to open up about this common issue with those of us with Parkinson’s disease is very important. We need to keep talking about it!
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