Women of all ages may experience the uncontrolled loss of urine known as urinary incontinence. Weak pelvic-floor muscles can be a contributing factor to this problem. Aging, pregnancy, childbirth, chronic coughing and constipation can weaken the pelvic floor. Whether the problem involves stress incontinence, urge incontinence, or a combination of both, patients can be treated by a medical team approach that includes physical therapy.

Physical Therapy Intervention:

• Instruction in strengthening exercises for the weakened pelvic floor (kegels exercises)
• Instruction in strengthening of the abdominal and hip musculature.
• Biofeedback training to help learn how to correctly tighten and relax the pelvic floor muscles.
• Electrical stimulation to help tighten the muscles and reduce bladder over activity.
• Instruction in appropriate bladder habits and bladder irritants.
• Instruction in bowel regulation techniques.

Chronic pelvic pain may be associated with prolonged sitting, intercourse or urination. Other symptoms may include lower abdominal pain, numbness, or tingling in the vaginal region. Pelvic pain can be caused or worsened by low back pain. Pelvic pain may be closely connected to problems in the muscles, joints, or nerves imbedded in the pelvis. Scars from surgery or childbirth may contribute to this painful condition. Chronic pain can cause holding patterns in rigid positions and altered breathing patterns, leading to muscular weakness and muscle spasms. A physical therapist with special training can help manage these painful and debilitating conditions.

Physical Therapy Intervention:

• Exercises designed specifically to stretch or relax the tight muscles, and strengthen the weak ones.
• Manual therapy techniques to release tight and tense muscles.
• Improvement and restoration of joint movement.
• Electrical stimulation, TENS, heat cold, and ultrasound for pain relief.
• Biofeedback for down-training of tight muscles.

Abdominal surgeries, including C-section, hysterectomy, removal of ovarian cysts, and hernia repair, may disrupt the abdominal muscles. Weakened muscles make moving difficult and may lead to poor posture. A SR therapist will guide women in appropriate exercise performance and self-care activities.

Physical Therapy Intervention:

• Deep breathing and coughing techniques to decrease the chance of infection in the lungs.
• Leg exercises to maintain adequate blood circulation, and prevent stiffness while on bed rest.
• Movement techniques to lessen pulling on the stitches.
• Exercises and self-help techniques to encourage normal bowel activity, and reduce post-surgical pain caused by gas.
• Relaxation training.

Breast surgeries (such as mastectomy, lumpectomy, and reconstructive surgery) can irritate or disturb the soft tissues in the shoulder, chest wall, and under the arm. Scars and radiation can make the skin stiff and cause a pulling sensation in the chest and shoulder with movement. After surgery, it is common to avoid movement due to pain and pulling sensations. The lack of movement may cause stiffness in the shoulder, and pain and swelling in the arm. Difficulty with daily activities (such as reaching above head level, washing hair and getting dressed) may ensue.

Physical Therapy Intervention:

• Physical therapy manual techniques to improve mobility of the shoulder joint and girdle, ribs, and to improve circulation
• Scar massage and desensitization techniques to reduce tightness and limitations
• Exercises to improve posture and to strengthen upper back muscles, which may include the use of elastic bands, light weights, wands, and pulleys.
• Exercises to overcome tightness, weakness, and pain in the shoulder, neck, chest, and abdomen.

This condition develops when the normal drainage of lymphatic fluid is disrupted. Persistent gathering of fluid causes swelling of the arm or leg. Most commonly, this occurs in women who have had breast surgery with removal of lymph nodes followed by radiation therapy. This problem can develop weeks, months or even years after the initial surgery. It can also occur following injury or infection.

Physical Therapy Intervention:

• Manual lymphatic drainage techniques to help improve the flow of lymph from the affected arm or leg.
• Compression bandaging following lymphatic drainage.
• Instruction in appropriate exercises to assist in the drainage, and to improve cardiovascular health.
• Instruction in proper diet to help decrease the retention of fluids.

Osteoporosis (brittle bones) ensues when not enough bone is being built, or too much is broken down. The bones become brittle and break more easily. More than 25 million Americans have osteoporosis. Approximately 250,000 hip fractures (three times more common in women than in men) occur every year. Spinal fractures occur in one-third of women over age 50, due to osteoporosis.

The risk factors for osteoporosis.

• Family history (blood relative with the disease)
• Age (older adults have increased risk)
• Gender (women are at greater risk)
• Race (Asians and Caucasians have an increased risk)
• Diet and exercise are factors within the individual’s control.

Physical Therapy Intervention:

• Instruction in Posture correction and body mechanics to protect the spine.
• Instruction in bed mobility and transfer techniques.
• Exercises to strengthen the postural muscles, legs, hips, and back.
• Exercises to improve balance and walking ability.
• Instruction in fall-prevention at home.
• Fitting of back brace if indicated.

All services are provided by a licensed physical or occupational therapist with specialized training in the treatment and rehabilitation of women’s health issues.