Angela Fishman, MS, PT

Pelvic floor muscle training is the number one treatment for women with incontinence. Other treatments include behavioral modification and medications such as estrogen cream or medications for overactive bladder.
 
Transcript: "What treatments are available for women with incontinence? There's two major types of incontinence that women tend to have. One is called stress incontinence. That's when you leak with coughing, sneezing, exercising, anytime there's pressure. And then the other type is called overactive bladder slash urgent continence because not everybody with overactive bladder actually loses urine, and some people do. So you've got stress incontinence, urgent continence, overactive bladder syndrome, and some people have both. So the first-line treatment for both of those is going to be pelvic floor muscle training. And what does that mean? That means where are your pelvic floor muscles right now? Are they too weak? Then we need to strengthen them. Are they too tense? Then we need to get them to relax and lengthen. And what's all the other muscles around the pelvic floor, what are they doing? How are they impacting the pelvic floor? So it's really rebalancing everything around the pelvis so that your pelvic floor muscles work to their best of their ability to control your bladder. Then there's some different things we call behavioral modifications, like teaching you how do you respond to your bladder. If you really have to go to the bathroom, do you rush in right away the second you have to go, or do you wait, regain control, and then calmly walk into the bathroom? Strategies like those can be super effective in helping to control your bladder. So those are the first-line main treatments for either type of incontinence. Then there's some medications that might work. If you are estrogen deficient in the vaginal tissue, so what does that mean? Well, if you're on birth control pills, you're breastfeeding, you've gone through menopause, there's not enough estrogen there, and so using estrogen cream can help. Then also for overactive bladder, there are some medications that can help with that as well. So there's a lot of different treatments that are available to you, but pelvic floor muscle training is number one."

My typical clients range in age from their twenties to eighties, and they come to me with issues such as bladder issues, pain with intercourse, prolapse, and vaginal pressure. They also want to learn more about incorporating healthy behaviors for their pelvic floor.
 
Transcript: "Who is your typical client? I don't really have a typical one. The ages range from people in their 20s all the way up into their 80s. But the categories of clients that I see are certainly people with bladder issues. I see a lot of people with pain with intercourse. I see a lot of people who just want strengthening for their pelvic floor and core and they're just not sure how to go about it. I see some people that have pelvic organ prolapse and are having vaginal pressure when they're on their feet during the day. I see some people who just want to incorporate healthy behaviors for their pelvic floor and they want to learn more. So yeah, it's really a large variety of who I see and a huge variety in age group."

Waking up multiple times a night to use the bathroom could be a sign of weak pelvic floor or it could also be caused by drinking too much before bedtime or taking certain medications. If you're getting up more than one time per night, it's best to reach out and find out what might be causing it so that you can get better quality sleep.
 
Transcript: "Is having to wake up multiple times to use the bathroom at night a sign of weak pelvic floor? It can be. It's actually, we would call that overactive bladder. So there's different things that can cause an overactive bladder. It could be, let's say it's as simple as you drink a lot before you go to bed or you take a medicine that makes you urinate a lot right before you go to bed, right? It could be a simple reason that your black bladder is overactive at night or it could be that you do have a weak pelvic floor and there's some pelvic floor muscle dysfunction going on that and that contributes to why you're waking up at night to pee. So there's a lot of different reasons of why you can have overactive bladder at night. If you're getting up more than one time per night, that is considered not normal because it interrupts your sleep too much. So the norm is really zero to one time per night and if you're getting up more than that, then we really encourage you to reach out and find out more so that we can address it so that you can start getting better quality sleep."

When the pandemic hit, I had just started my business and had to quickly learn how to treat patients via computer and video. During the first few months, I focused on building my website, presence, and connecting with patients to understand what made them feel more comfortable starting pelvic health treatment.
 
Transcript: "How did you manage your caseload during the pandemic? Well, actually for me, I had just started my business about two weeks prior to the pandemic happening, so I had kind of a steady increase in patients over time, which actually really worked well for me so that I could get used to treating via a computer and via video versus being in person. Because prior to that, for over 20 years, I was treating my pelvic health patients in person. The technology piece, that was something to kind of learn, and then learning what my patients needed to feel comfortable before they came to see me to start a session. So I really used those first few months just to not only build a presence, build my website, etc., but really to kind of connect and see what makes somebody else on the other side of my screen much more comfortable starting with pelvic health."

Pelvic floor muscle training is the first line of treatment for bladder control issues, and Physical Therapy can help with both stress incontinence and urge incontinence. The type of therapy used will depend on the kind of incontinence a person has.
 
Transcript: "Can pelvic therapy help with bladder control and urinary incontinence? Absolutely. In fact, pelvic floor muscle training is actually, that's the first-line treatment for bladder control issues. There's two main types that we treat. One's called stress incontinence and one's called urge incontinence. These can happen at any age. This is not just in older people and a lot of people have problems with both. In order for therapy to be effective, we need to know what kind of incontinence that you have. There's not like one exercise or one change in behavior that we can give you. We have to figure out what kind of incontinence do you have, and then we target the therapy towards that. But yes, absolutely, physical therapy can help with bladder control and incontinence and it's well supported by research."

Pelvic floor disorder can affect a person's sex life by causing pain with intercourse, difficulty orgasming, and issues with arousal, erection, and ejaculation.
 
Transcript: "How can pelvic floor disorder affect a person's sex life? This is a great question. The pelvic floor muscles are very involved in sexual function in both men and women. And yes, men have pelvic floors. So if something's going wrong with those muscles, something certainly can be going wrong with sexual function. So a really common one, probably the most common thing I see in women is pain with intercourse. So if those muscles in the pelvic floor are tense, can't relax, have trigger points in them, just like you can get tight trigger points in shoulder muscles, then you can have pain with intercourse. So that's probably one of the most common. Pelvic floor muscles are involved in orgasm as well. So if a woman's having trouble having orgasms, that pelvic floor muscles can be involved in that. Same thing in men. In men, pelvic floor muscles are involved in arousal, erection, ejaculation. So any of those things, if there's something going wrong, it's possible that the pelvic floor muscles are involved. So it's a really important area to get some guidance in if you are having those types of difficulties."