This month’s column is a discussion with Katherine Oxford, a physical therapist with a doctorate in physical therapy and board certified in orthopedics. While not a medical doctor, she is included in this column because she is highly regarded by local physicians for her unique work with women’s pelvic issues. In addition to her practice, she also presents seminars and teaches continuing medical education courses for physicians on this topic.

Oxford began her work as a physical therapist working in sports medicine. She found many female athletes experiencing back pain and pelvic-related problems, including pelvic organ prolapse, pelvic pain, incontinence and nerve issues related to pelvic problems.

The pelvic floor is a network of muscles, ligaments, and tissues that act like a hammock to support the organs of the pelvis: the uterus, vagina, bladder, urethra and rectum. If these muscles become weak and do not fire, then atrophy results.

Oxford says that pelvic floor disorders can result from any type of trauma to that part of the body (including childbirth, Caesarean sections, hysterectomies or other surgeries). She says, "This can bring about a weakening in the abdominal muscles which then sag or fail to support the organs. Pelvic pain can also be caused by chronic bladder infections, muscle spasms or bacterial infections. The abdomen is the armor for the organs and needs to be kept strong."

Incontinence can be a big issue for women. There are two kinds: urge incontinence and stress incontinence. Stress incontinence occurs when the patient loses bladder control when laughing, sneezing or coughing. Physical therapy can be used to treat mild cases of stress incontinence.

Urge incontinence is typified by the tendency to lose bladder control the nearer you get to the bathroom. Oxford says that a typical patient gets up three or more times a night. "This is something I frequently can resolve," she says. "Strengthening the muscles and sometimes changing urinary habits can make all the difference. I empower my patients teaching them how to use and strengthen their muscles."

What makes Oxford’s treatment so unique is the use of biofeedback to teach women how to strengthen their own pelvic muscles. In the early ‘90s a group of therapists designed a sensor that allowed measurement of vaginal muscle strength.

The biofeedback device (electro-myographic biofeedback) tracks electrical firing patterns of the pelvic muscles and actually measures the strength of certain muscles. "Patients say to me, ‘I have tried kegels and they do not work.’ But, after this training, the patient is able to move these muscles herself, exercise them and when retested, see on a monitor the gains she has made in strengthening them. It gives the patient control, and then they see improvement in their condition," says Oxford.

One patient says, "I was sporadically incontinent at age 53, very embarrassing. Once I could see my progress on the monitor, I kept it up and everything was resolved. I can control this now with a simple, fast set of exercises. No more incontinence and no surgery."

More advice from Oxford: "My take home message for persons with these problems is: Are you urinating appropriately? Zero to one bathroom trips at night are normal instead of three or more. If not, you should cut caffeine and soda intake. Water is necessary, yes, six to eight glasses a day to keep the urine pH balanced. And, you can retrain your pelvic muscles (including vaginal, bladder, bowel) to become stronger and function better at any age. Getting older does not have to mean losing control of this part of the body." FP