Let's talk about pelvic physical therapy

Urinary incontinence is a problem faced by a large number of women but many of them do not openly talk about it as they think of it as an embarrassing subject. The impact of this problem on their lives physically and psychologically is debilitating. For this reason, pelvic physical therapy is being popularised in the West to help women deal with the problem. This therapy helps to strengthen the muscles and must be followed from the birth of the first child.

Dr Anuradha Koduri, senior urogynaecologist at KIMS Hospital, explains the need for physicians to accept the best practices and young women to opt for therapies that will help them manage these problems.

What is the damage caused during the birthing process? Leaky bladder issues are profoundly felt after 40. Why? 
Muscles around the birth canal are different from the rest of the body. They have special fibres and can stretch to 10 times their length and also contract to the original size. In some cases, due to the large head of the baby or the weight of the baby in the womb, the muscle fibres are torn. Instruments like forceps or vacuum make the problem greater because of the unnatural stretching of the tissues. In ageing women, if they are not exercising and lifting weights, muscles are not toned up. They tend to have less muscle and more of fat. In the pre-menopause stage and during menopause, the lack of toned muscles lead to incontinence. For this reason, women must continue to lift weights as it keeps the muscles toned.

In women who are 60 years and above, the leakage is terrible. What is the reason for this? 
The leakage can be due to the laxity of the muscles around the genital organs. The tube that carries the urine from the bladder sags and is out of place. Due to this reason, women start leaking urine uncontrollably. The second reason is that there is a change in the nerves that cater to the bladder and they start sending incorrect signals, which will make the patient want to go more frequently or lose control before she reaches the toilet. There are also neurological diseases that affect the whole body including the bladder.

What is pelvic physical therapy? How can it be done? 
Pelvic physical therapy is an important tool to prevent and treat these problems in the early stages. Having your first child is enough to start the weakness in the muscles. So it is important to start exercises in the pelvic muscles while you are pregnant. These can be easily done at home, when you are asked to pull your vagina and anus into your body without holding your breath. This will isolate the muscle that needs to be toned, which will help in the birthing process and also help the muscle come back to its original strength quickly. After the birth of the baby, while you are doing your Kegels exercises, after six weeks you can start pelvic physical therapy in consultation with the doctor.

What are the exercises that women must follow on a regular basis? 
Women should understand that the parts of the body are connected and cardio and aerobic exercises help to burn calories. Lifting of weights help to tone every muscle in the body. Some women are scared of weights but lifting weights is recommended for women. However, it has to be started early on.

How can those who are overweight and suffering from co-morbid conditions such as heart diseases and diabetes, deal with this problem? Will medicines help? 
An exercise regimen helps to control the problem much better. While medication gives relief, it is not able to help get rid of the problem completely. Hence, exercises like walking, stretches, etc., can be opted for. Swimming is another great option. Due to lack of awareness and also because they are scared to deal with the problem, many young women do not seek help. For this reason, this issue is now being addressed during the process of birthing to make women aware and opt for exercises, which will help them deal with it.