Urinary incontinence is the loss of bladder control. Urinary incontinence ranges from occasional urine leakage to the complete inability to control urination. Symptoms include frequent urination, urine leakage, or an overactive bladder.

Urinary Incontinence Self-Assessment Questionnaire:

If you answer "yes" to any of the following questions, you may benefit from our Pelvic Health & Incontinence Training Program.

• Do you leak or wet yourself when you stand up, cough, laugh or sneeze?
• Do you feel an uncomfortable urge to urinate?
• Do you sometimes wear pads to absorb urine or "just in case?"
• Do you wake up more than twice during the night to use the toilet?
• Do you sometimes feel your bladder is not quite empty?
• Do you often feel anxious because you think you might not make it to the bathroom in time?

Pelvic pain can be caused by muscle spasms, as well as tightness or weakness of the pelvic floor muscles. You may experience pain from the lower stomach into your pelvis, hips, low back, and sacrum, pain in your tailbone with sitting, or pain when urinating, having a bowel movement, or during sexual intimacy.

Pelvic Pain Self-Assessment Questionnaire:

If you answer "yes" to any of the following questions, you may benefit from our Pelvic Health & Incontinence Training Program.

• Do you have pelvic, rectal, vaginal, or genital pain, numbness, or tingling?
• Do you still have pain from abdominal or pelvic-related surgery, including gender confirmation surgeries?

Many people of all ages experience some form of constipation during their lifetime. It is a common but treatable bowel problem. People who suffer from chronic constipation know how it can affect their lifestyle.

Common symptoms of constipation include:

• Infrequent bowel movements.
• Straining to have a bowel movement.
• A feeling of incomplete emptying.
• Abdominal bloating and a general feeling of being uncomfortable

There are two different types of constipation, general constipation, and outlet constipation. Both can negatively impact your pelvic floor.

General Constipation: This occurs when the muscles of the large intestine (the colon) have problems with peristalsis, which are waves of muscle contractions that move waste out of the body in the form of stool. This causes the waste to move very slowly or not much at all.

Outlet constipation: This occurs when the stool is stuck in the rectum, which is usually due to dysfunction of the pelvic floor muscles. If the pelvic floor muscles in the rectum are too tight and unable to relax, it becomes difficult for stool to be passed. This can lead to straining during a bowel movement which causes the muscles to tighten even further.

Our team is ready to help you tackle this problem, personalizing a treatment plan for your unique condition.

Bowel incontinence is an inability to control bowel movements, resulting in involuntary soiling. Symptoms include accidental bowel movements, constipation or painful or infrequent bowel movements. 

Bowel Self-Assessment Questionnaire:

If you answer "yes" to any of the following questions, you may benefit from our Pelvic Health & Incontinence Training Program.

• Do you leak when you stand up, cough, laugh or sneeze?
• Do you have to push or strain during bowel movements?
• Do you have pain during bowel movements?
• Do you have accidental bowel movements after a meal or beverage?

Sexual dysfunction can be any problem that prevents a person from experiencing satisfaction during sexual activity. Many pelvic and sexual dysfunction conditions can be addressed successfully with our PHIT program. Once your doctor rules out a medical condition, pain with intimacy, difficulty or pain with orgasm or ejaculation, and erectile dysfunction are all things our team treats. We also offer an erection recovery program for those undergoing a prostatectomy or a TURP (transurethral resection of the prostate), combining that with addressing the urinary incontinence that can occur after these surgeries. In addition, our team includes specially trained therapists to help you before and after gender-confirming surgeries.

Pelvic-perineal dysfunctions are the most common problems in women after pregnancy. By one estimate, 35 percent of new mothers experience urinary incontinence following childbirth, and 20 percent of first-time moms experience severe pelvic floor muscle injury after a normal pregnancy and delivery.

Weakened, overworked, or damaged pelvic floor muscles may need to be re-trained to function properly. The physical therapists on Middlesex Health's Pelvic Health & Incontinence Training (PHIT) Rehabilitation team are specially trained to restore muscle function in the pelvic floor. 

Often athletes have trouble returning to sport-specific activities after childbirth due to pain, weakness, and pelvic floor dysfunction. Our team can help you do that safely. 

In some cases, a pelvic floor disorder and its symptoms may be severe enough that surgery to repair the weakened muscles may be recommended. Our PHIT program can help you recover from that as well.

The pelvic floor comprises tendons, ligaments, and muscles attached to the bottom of the pelvis and extends along the front of the pubic bone, around the sides of the hip bones, and to the lower back where the tailbone (coccyx) is located. 

Additional muscles that are attached to the tailbone and pelvis include vaginal, anal, abdominal, gluteal, and hip muscles. This means that issues affecting the pelvic muscles can cause problems for other areas of the body, such as the lower back and hips. More specifically, when muscles or ligaments in the pelvis become weak, too tight, or damaged, this can lead to a condition known as pelvic floor dysfunction. 

You may have weak and short, or long and tight muscles, or any combination therein, and the best way to determine their actual status is an exam by one of our pelvic health Physical Therapists. 

In addition, 11 of the 12 pelvic floor muscles attach to the tailbone (coccyx); any trauma to the tailbone (during delivery of a baby or from a fall - even years prior) or high tone in the pelvic floor can alter the position of the coccyx, creating pelvic floor dysfunction. Therefore, the old adage “there is nothing we can do for your tailbone” is no longer true. A pelvic floor therapist can evaluate your pelvic floor and treat your tailbone injury.

Physical Therapists are trained to evaluate and treat many orthopedic issues of the spine, hip, pelvis, and sacrum. We will treat your pelvic health issues and any orthopedic problems that we find and have access to specially trained orthopedic therapists.

Our Pediatric Pelvic Health and Incontinence Program focuses on education and exercise to treat pelvic dysfunctions that can affect children ages 5 to 18. For example, many children suffer from urinary incontinence and constipation. In addition, we use biofeedback to help reeducate the pelvic floor muscles, help to incorporate daily dietary and behavioral modifications and provide guidance for parents for success at home and in school.

After a prostatectomy, many men experience pelvic floor weakness, urinary frequency, urgency and incontinence, and sexual dysfunction. At MH, we offer a highly successful pre-op and post-op prostatectomy program to prepare you and educate you before your surgery, and address issues after your surgery, including erection recovery. 

Our team will discuss the problems you are having, address any pelvic floor dysfunction that may be causing your erection issues and discuss options that may be beneficial to you, including vacuum pump systems.

Hormone therapies, medications, pre-existing conditions (listed above), or gender-confirming surgeries can sometimes result in problems with movement, ongoing pain, incontinence,  bladder issues, difficulty with dilation of a neovagina, and sexual dysfunction. Our PHIT Rehabilitation team can provide various services and treatment options to help with issues specific to the LGBT and Nonbinary community.

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• Learn more about Middlesex Health's Center for Gender Medicine and Wellness.
• Learn more about MIddlesex Health's Center for Continence & Pelvic Health.
• Learn more about Middlesex Health's Physical Rehabilitation.

Pelvic Health therapists perform evaluations and treatments in the home for patients who can not get to outpatient therapy or have recently been discharged from the hospital and need to bridge the gap between home and outpatient therapy. Treatment options include education, behavioral and dietary modifications, strengthening, and biofeedback.

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