Women’s Health and Pregnancy

Cystocele: A cystocele is the fall of the bladder into the vagina due to pelvic floor muscle weakness and may result in incomplete emptying of the bladder and consequently urinary leakage. It is graded from mild (grade 1; possbily no symptoms) to severe (grade 3, wherein the bladder protrudes out of the vagina). It may occur due to repeated muscle straining (during childbirth) and/or estrogen deficiency (seen with menopause and/or oral contraceptive pill usage). Hysterectomies also weaken the pelvic floor muscles and may lead to a cystocele.
A cystocele can be managed with pelvic floor physical therapy which includes strengthening of the pelvic floor muscles. A pessary (ex. Colpexin) may also be prescribed by the referring physician. Surgery is prescribed when physical therapy and/or a pessary are not effective.
A cystocele may be prevented through correct body mechanics with lifting, avoidance of straining, controlling and treating constipation (increases pressure on the bladder during straining), weight control, and kegels (performed under supervision of the physical therapist initially to prevent pelvic floor muscle tightness).
Enterocele: Herniation of the small intestine between rectum and vagina.
Rectocele: A rectocele is the herniation of rectal tissue in the vaginal wall and may sometimes lead to drooping of vaginal tissue out of the vaginal canal. It may occur with childbirth, chronic constipation, chronic coughing, heavy lifting, estrogen deficiency and/or obesity. Symptoms may include constipation and/or pelvic pain. A rectocele may be prevented through correct body mechanics with lifting, avoidance of straining, controlling and treating constipation, weight control, and kegels. A rectocele can be managed with pelvic floor physical therapy, pessary, or surgery.
Uterine Prolapse: Herniation of the uterus into the vagina.
Bladder Disorders/Bladder Dysfunction
Common Symptoms:
Urinary frequency-greater than one bathroom trip for every two awake hours
Urgency, hesitancy, retention and/or incomplete emptying
Nocturia- nighttime urinary frequency: more than one trip to the bathroom in the night
Pain in the urethra, bladder, and/or pelvis; pressure, spasming, or difficulty with initiating urination
Weak urine stream and/or a stream that stops and starts
Definitions of Bladder Conditions: The following definitions explain bladder conditions as they relate to pelvic floor dysfunction. While there can be many causes for bladder dysfunction, the physical therapists at Beyond Basics Physical Therapy focus on treating the musculoskeletal components of these conditions. In all of these bladder conditions, irritation in the lining of the bladder or urethra can also irritate surrounding tissues, including skeletal muscle tissue. If this irritation persists and continues to irritate the surrounding muscles, trigger points can result. Trigger points result in increased tightening and shortening of the muscle, which can create more pain, irritation, and musculoskeletal imbalance. Physical therapy can help by increasing the tissue mobility and decreasing trigger points in the muscles of the pelvis.
Interstitial Cystitis (IC): Also known as painful bladder syndrome (PBS). Recurring pain or discomfort in the bladder and the surrounding pelvic region. Signs and symptoms may include urinary urgency, frequency, or retention; dyspareunia; pain in the back, suprapubic area, and/or abdomen; nocturia (nighttime urinary frequency); and pain before, during, or after urination.
Urethral Syndrome: This involves urethral pain, burning, and sensitivity.
Urgency-Frequency Syndrome: This disorder causes urinary frequency, urgency, hesitancy, or retention with or without pain in the bladder, urethra, abdomen, or pelvis.
Urinary Incontinence: An accidental loss of urine from the bladder. This can be due to muscle weakness or muscle spasm/tightness.
Urge incontinence: Urine loss due to a strong desire to urinate (urgency), with only a quick warning.
Stress incontinence: Urine loss due to an increase in abdominal pressure, such as coughing, sneezing, lifting, laughing and running.
Mixed incontinence: Combination of both urge and stress incontinence.
Urinary retention: Difficulty or inability to urinate. This could be caused by various medical conditions of the prostate, kidneys or urethra. Also, some medications can cause urinary retention. Retention can also be a symptom of pelvic floor dysfunction, when pelvic floor muscles are in spasm or become tightened.