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Pelvic Floor Physical Therapy for Overactive Bladder

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People with overactive bladder (OAB) experience a strong and sudden urge to urinate. They may find themselves waking up two or more times each night to use the bathroom. OAB may also cause involuntary loss of urine, known as urge incontinence.

The symptoms of OAB are thought to be caused by miscommunication between the brain and the bladder.

OAB can be uncomfortable and even painful at times. The condition can greatly affect your quality of life and can lead to emotional distress. Fortunately, treatment can help you manage symptoms.

One treatment option for urge incontinence due to OAB is a specialized form of physical therapy known as pelvic floor physical therapy. A trained physical therapist will work with you to help you coordinate the muscles of the pelvic floor and bladder through muscle-training exercises such as Kegels.

Pelvic Floor Physical Therapy

Pelvic floor physical therapy is a form of physical therapy that helps you to properly engage the pelvic floor muscles that regulate the release of urine and feces. If you have OAB, pelvic floor physical therapy may help you to control sudden or frequent urges to urinate.

A specially trained physical therapist will first assess your pelvic floor. They’ll help you to identify and utilize the proper muscles, then guide you through a set of pelvic floor exercises based on your individual needs.

Some of these exercises may include:

  • Kegel exercises, which focus on tightening and holding the muscles that control urine flow
  • abdominal exercises
  • exercises that target the glutes, such as glute bridges and squats
  • exercises to help strengthen your posture

If you have trouble identifying your pelvic floor muscles, biofeedback can help. A pelvic floor physical therapist will apply special sensors to the pelvic floor that capture electronic activity. A monitor displays a chart that changes or lights up when the right muscle is tightened.

A pelvic floor physical therapist may also teach you other behavioral strategies that can help control a sudden, frequent, or uncontrollable urge to urinate. These may include:

  • bladder training and urge suppression strategies
  • lifestyle measures, such as diet
  • programmed urination

The pelvic floor is a group of muscles and ligaments that support your bladder, rectum, uterus, and prostate. The muscles attach to your pelvic bone and go around the rectum. They help you to control bladder and bowel function and allow you to hold on until you are ready to relieve urine or feces.

Muscles around the bladder can become weak due to a number of factors, such as:

  • childbirth
  • weight
  • age
  • changes in hormones
  • constipation
  • prostate cancer treatments

If the pelvic floor muscles weaken, you may have problems with urine leakage, urgency, and frequency.

To help with these OAB symptoms, it’s important to keep the pelvic floor muscles strong so they can properly support the bladder and other organs. Pelvic floor physical therapy helps you to identify and strengthen these muscles.

Another theory suggests that contracting the pelvic floor muscles can improve conscious control of the bladder by activating the part of the brain responsible for the voluntary urinary inhibition reflex.

Research suggests that pelvic floor physical therapy can reduce OAB symptoms of frequency, urgency, and leakage. It may also help ease pelvic pain and improve quality of life.

One small study found that pelvic floor muscle training significantly improved a variety of symptoms in women with OAB, including urinary leakage, nocturia (frequent urination at night), and the extent of discomfort caused by urinary symptoms.

A 2016 studyTrusted Source found that pelvic floor muscle training paired with biofeedback significantly reduced symptoms and complaints of OAB and increased quality of life for the study participants after 9 weeks of treatment.

meta-analysis of several studies also found that pelvic floor muscle training significantly reduced OAB symptoms, including urinary frequency and urgency urinary incontinence, across at least five studies. However, the authors believe that more studies are needed with higher quality methods to draw better conclusions.

Pelvic floor physical therapy is a good option for anyone with OAB. You may want to consider seeing a physical therapist if you can’t find your pelvic floor or want to be sure you’re properly doing pelvic floor exercises recommended by the doctor who’s treating your OAB.

This type of therapy may have the most noticeable results in people with mild-to-moderate urine leakage. If you have severe symptoms, you may need medications and other treatments on top of exercises to improve your symptoms.

Keep in mind that it can take several months for pelvic floor physical therapy to show benefits. Success may vary from person to person.

The American Urological Association’s 2019 OAB treatment guidelines recommend behavioral therapies including pelvic floor muscle training as a first-line treatment. Your doctor may also recommend medications in combination with behavioral therapies.

If this isn’t enough to control symptoms, medications and other procedures can help control the bladder muscles.

Beyond behavioral therapies, OAB treatments may include:

  • Anticholinergic drugs. These medications block a chemical in the body from sending a message to your bladder to contract. Examples include:
    • tolterodine (Detrol, Detrol LA)
    • fesoterodine (Toviaz)
    • trospium (Sanctura)
  • Mirabegron (Myrbetriq). This beta-3 adrenergic drug works by relaxing the smooth muscle in the walls of your bladder so it can hold more urine.
  • OnabotulinumtoxinA (Botox). In small doses, onabotulinumtoxinA temporarily paralyzes or weakens the bladder muscles to prevent them from contracting too often.
  • Sacral nerve stimulation. This procedure is done in your doctor’s office to regulate the signal of the nerves that carry impulses to the bladder. Your doctor will implant a device similar to a pacemaker in your lower back that delivers electric signals to the sacral nerves.
  • Surgery. If you have severe OAB that doesn’t respond to other treatments, your doctor may suggest surgery for overactive bladder. Surgical options include:
    • augmentation cystoplasty, which increases the size of the bladder
    • urinary diversion, where the tubes leading from your kidneys to your bladder are rerouted directly to the abdominal wall and urine is collected in an external pouch (in extreme cases, may also include removing your bladder)
    • bladder lift surgery, which can help better support the bladder if you experience incontinence (leakage)
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