Urinary Incontinence and Pelvic Floor Dysfunction

Urinary incontinence is a little-talked-about problem that at any given point in time affects 20% of all women. Women are much more susceptible than men to this problem, but both are affected.

There are several problems related to urination:

• Urgency
• Frequency
• Excessive night-time urination (nocturia)
• Inability to empty the bladder (urinary retention)
• Loss of urine without awareness
• Leaking urine with cough, sneeze, sudden strong laugh (stress incontinence)
• Leaking urine with sudden, uncontrollable urge (urge incontinence)

There are some urinary problems that can only be addressed with surgery. In women, this would be when the supporting tissues of the bladder and urethra (the tube that exits from the bladder to the outside) have failed and the bladder structure is no longer positioned correctly, making it so the forces of the muscles that would ordinarily hold the urine are unable to engage. This is often the cause of stress incontinence. This will also occur when there is pelvic prolapse, meaning when the uterus or vaginal walls have fallen from their correct position due to loss of supporting structure effectiveness.

When surgeries are performed for pelvic prolapsed, the surgery will often improve the stress incontinence, yet at the same time, an “accepted” outcome of the surgery is that urge incontinence can be a consequence of the surgery.

Surgical outcomes can be optimized by adding stem cells to the treatment, in order to get the best rebuilding of the vaginal support following the procedure. Stem cells are recruited to the area in need of healing by a “homing mechanism” (similar to how a homing pigeon “homes” to its headquarters), which takes it to the area of need, and at that point, the stem cells engage as if they were a conductor of an orchestra, recruiting the different players (like the individual musicians) of the body for healing.

All other aspects of urinary incontinence are not linked to surgical procedures for treatment. The non-surgical treatments are together called “pelvic floor rehabilitation,” or, as known at Advocate Health Care, “PFR.”

What is PFR?

PFR is a group of procedures that are developed and designed to “rehabilitate” the various physiologic functions of the pelvis to bring them back to their normal function. This includes re-training the pelvic muscles to relax and to contract with strength and endurance, and speed of response. It includes retraining so the bladder will stop accepting incorrect signals as being the time to expel urine (such as a “key in the lock of the front door” or “seeing the toilet” or “opening the bathroom door” (you know what I mean!). Re-training involves both training the muscles and training the nerves that control the pelvis.

What to expect with PFR

Once we have visited and decided that PFR is a good choice for you, we will schedule an initial PFR evaluation visit, in which testing is done to establish diagnoses and to confirm that the procedures will be appropriate. These include measuring any retained urine following emptying of the bladder, checking whether the spinal reflex of the nerves of the pelvis is normal, evaluating the background muscle tone and electrical signaling of the muscles of the pelvis, checking for muscle coordination, strength and endurance. It will also include a measurement of how much urine the bladder is able to hold at capacity, whether the bladder is contracting inappropriately, and whether a bladder spasm or some other pelvic muscle spasm is occurring.

Treatments involve exercises while under measurement and observation to increase muscle response, strength, and endurance. An additional treatment is done to essentially “re-set” the nerves of the pelvis to train them to again fire and signal the bladder and the muscles of bladder control normally.

This treatment typically involves a series of 8 treatments, each scheduled one week apart.

These treatments are highly successful in reaching the patient’s and the doctor’s goals for a return to normal bladder function.

Is there any other effect of PFR?

While the PFR is training the muscles and nerves of the pelvis for normal bladder function, it also has a number of other positive effects. These include a normalizing effect of the nerves and muscles that control fecal continence. Additionally, the muscles and nerves involved in sexual perception, response and interaction are benefitted from these procedures, in addition to the role these structures play in pain perception and other functions.

Is PFR covered by insurance?

Typically, PFR is covered by insurances, assuming it is being performed for covered diagnoses.

Are there any other conditions PFR would not address?

While PFR will improve muscle signaling, strength, and endurance, other factors are also at play with the control of the bladder and other pelvic structures. For example, along with the muscles that close off the urethra so urine is only voided with conscious control, there is also a role that is played by simple collagen in the same location that adds to the bulk of the muscle as it squeezes down, essentially forming the seal as the muscle contracts. If the collagen in the area has been lost, which might occur in relation to injury or from the chronic hormone deprivation of menopause or aging, this will also need to be addressed in addition to the PFR. Historically, this used to be dealt with by injections of collagen into the area, which sometimes was successful but could also cause some problems. Currently, it is felt that the best treatment is the use of stem cells to repair the tissues in the area and to stimulate new collagen deposition. When done in conjunction with PFR, this can be highly effective in restoring the tissues and their function to normal.

How do I find out if PFR is a good choice for me?

The first step is a visit with Dr. Woods to go over your complete history and to talk with you about your concerns. From there, if it is indicated, we would schedule the initial evaluation, and following that, set up the series of treatments. We would invite the opportunity to hear your concerns and to work with you to find the best treatment plan. Even if your situation is one that is best dealt with by surgery, our evaluation and objective recommendation, which may be followed by a referral, would assure that you had a thorough and unbiased evaluation and that you receive the best treatment for your situation.