Surgery for Bladder Leakage: Why You Still Need Pelvic Physical Therapy

Today, we’re talking about a question that has come up for a few patients recently. Both of these patients are scheduled to have surgery for bladder leakage and have also been referred to physical therapy beforehand. So preoperatively, both came in, wondering why they were referred to Pelvic Physical Therapy if they were going to have surgery that was going to fix their leakage.

MARY'S STORY
Mary is a 55-year old woman who has been experiencing bladder leakage that’s gotten worse over the past probably 2 to 3 years and that bladder leakage happens on the way to the restroom. She gets this urgent feeling that she’s got to go and then she can’t get there in time. Mary is dealing with leakage with urgency, and she is also dealing with leakage when she coughs or sneezes or laughs. She has been scheduled for a bladder sling procedure to help with her bladder leakage. But, her doctor also referred her to pelvic physical therapy before the surgery.
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Mary was a bit confused as to why she was referred to pelvic physical therapy before her surgery. This is actually one of the common reasons that we see people preoperatively, is that Mary has something that’s called, “mixed incontinence”. She actually has 2 different types of bladder leakage. She has urgent incontinence, which is leaking with a sense of urgency and not getting to the bathroom in time. She also has stress incontinence. That’s leaking with the coughing, laughing and sneezing. 

The bladder sling procedure can work really well for people to help with stress incontinence leakage. That procedure is most likely going to help Mary stop leaking with coughing, laughing and sneezing. But, it’s not going to do much of anything for her urge incontinence. We actually have had patients whose urge incontinence issue actually gets worse after having some type of a surgical procedure for bladder leakage.

Coming to Pelvic Physical Therapy, first, to help keep that urge incontinence under control, can be really helpful. There are lots of different techniques that we can do to help with that urgency and we can teach Mary techniques so that she can get to the bathroom in time, so she’s not having the urge incontinence. Not all types of bladder leakage are the same and some- like urge incontinence or urge leakage- do not respond well to surgical interventions and may need some other type of intervention like pelvic physical therapy. 

SHARON'S STORY
The other scenario we commonly see relates to a patient we saw earlier this week named Sharon. Sharon is a 63- year old woman who has been experiencing bladder leakage for probably the past 4 or 5 years. It’s gotten worse, and now she has leakage when she’s getting up and down from a chair, bending over, gardening, squatting, or has to lift anything. She has noticed that she’s had to wear progressively more and more pads throughout the day because of the leakage. She wanted to do something about it. The doctor recommended surgery to help with the leakage but also, referred her to pelvic physical therapy ahead of time. Like Mary, Sharon was concerned and confused as to why she had to do both therapy and the surgery. 

We like to equate the scenario to orthopedic situations. A lot of times, patients who are going to have a total knee replacement go to physical therapy preoperatively, to make sure that the muscles are as strong as they can be and working as well as they can be, with as much flexibility as possible. Then, they go to therapy again after the surgery to make sure that their muscles heal and work the way they should be. It is extremely uncommon that a person would go for a total knee replacement without having pre-operative and especially post-operative physical therapy. However, many people have surgery for abdominal issues and for bladder leakage issues all the time without any type of physical therapy. In Sharon’s case, and in Mary’s case, they thankfully got referred for physical therapy. But, if you find yourself in a similar scenario, you may have to be the one advocating to go see a physical therapist first. 

Thankfully, Sharon’s doctor referred her to physical therapy before her surgery to help with the bladder leakage. When we did the evaluation, we discovered that Sharon thought she was contracting and using her pelvic floor muscles the right way. But, she was actually pushing down and pushing out on the pelvic floor, instead of contracting the muscles up and in. So, anytime she thought she was using the muscles well, she was actually putting a ton of stress, pressure and force down through the pelvic floor. This was probably one of the reasons why she needed to have a surgery. 

If she ended up having the surgery and then after the fact, continued to use the muscles this way, that surgical repair wasn’t going to last very long and most likely,  she was going to need another surgery down the road, as the leakage would most likely to come back. She needed to change how she recruited and used these muscles, so that she got the best possible surgical outcome.

So, we worked with her before her surgery to make sure that she could correctly engage the pelvic floor. She needed to use the muscle the right way while she was lifting, while she was getting up and down from the chair, and while she was bending over. Actually, her leakage got a little bit better before she even had the surgery because she started using her muscles better.

She hasn’t had her surgery yet, but once she does, we would see Sharon again just to make sure that everything has healed up well, and make sure that she continues to use those muscles well. We would help her continue to strengthen them and work them together with all of her core muscles- her abdominal, her back, her hip, her buttocks muscles- so that she has the best possible outcome and then that surgery lasts as long as possible.

One thing that we hear commonly at Legacy is that women had previous bladder leakage surgeries, maybe 5 or 10 years ago, and it worked well for a little while, but then their leakage started up again. Now they are back, trying to do something about it again but they want to avoid another surgery. Usually, we asked those patients, “Did you have any pelvic physical therapy the first time when you had the surgery?” The answer is almost always NO and that breaks our hearts because if they had done physical therapy after the surgery to make sure that their muscles were doing what they need to be doing and working in the right way, they probably could have avoided the leakage coming back and then having to see us down the road.

We are big advocates or partnering up with a pelvic physical therapy preoperatively to make sure that everything is moving and working optimally. As we saw in the case scenarios, there are certain situations that don’t respond well to surgery, so partnering up can help with that aspect of it. On the postoperative side, working with a physical therapist can help to make sure that your muscles come back and do what they are supposed to be doing.
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If there’s anything that you have questions about or would like us to chat about, reach out to request to talk with one of our pelvic physical therapist by clicking here.