On your first session which is the evaluation a number of questions regarding your will be asked to establish a baseline.
For example you will be asked about your urinary symptoms including frequency during the day and night, urgency, number and types of pads you use if any. Color of the urine, as well as strength and length of of urination.
For the Bowel movement/constipation or diarrhea some of the questions you will be asked will include frequency per day/week/month, urgency, type of stool, how much you have to strain etc.
With regards to pain you will be asked about location, how much on a scale of 1~10, type (eg burning, stabbing), length, duration, what aggravates it, diminishes it etc.
Dietary questions with regards to how much is your fluids intake, types of fluids you consume, when and if you avoid drinking before going out, or going to bed etc.
Then your lumbar & hip, lower extremity muscles will be assessed and if you are comfortable them internal exam floor of the pelvic will be done as well. This is to establish the strength, spasm, ligament and muscle shortening, and trigger points.
The therapist will explain the anatomy and physiology of the bladder as well as the bowels. The effect of nutrition and behavior on the bladder and bowel will also be explained to you in detail and you will have the opportunity to ask questions.
An individual plan of care will be established for you because though so many people suffer from bowel and bladder dysfunctions, each person is unique with regards to why they have these symptoms, So that is why a plan will be tailored specifically for you.
In addition the following modalities may be used
Electrical Stimulation: Internal or external sensors may be used in or around the pelvic floor muscles. Electrical stimulation increases the blood flow, relaxes and strengthens the pelvic floor muscles. It also relaxes the pelvic floor muscle and thereby decreases muscle spasm and pain.
Biofeedback: By using surface or internal sensor patients are able to visualize the PFM contraction. They are able to isolate the muscles and perform correct pelvic floor muscle exercises without tightening the hip and abdominal muscles.
Ultrasound: An US machine generates high frequency sound waves which can travel deep into the tissue creating heat. This increases blood supply due to vasodilation. Fresh oxygen and nutrients reach the muscle and waste products are removed. The muscle relaxes and pain is eliminated as well as inflammation is decreased.
Myofascial release: A myofascial trigger point occurs because of injury to the motor endplate.It can occur due to multiple reasons including trauma whether repetitive like straining due to constipation, sudden strain during sports, exercise or dancing. History of sexual abuse, difficult toilet training. Traumatized pelvic floor muscles become shortened and weak. Accupressure and Soft tissue mobilization release and decrease these trigger points.
Relaxation and breathing exercises: Pranayam or breathing exercises performed correctly will decrease stress, thereby decreasing muscle tension and inducing both mental and physical relaxation, inflow of endorphins.
Postural and other exercises: The pelvic floor is the center of our tension and energy. If the pelvic floor muscles and area work optimally most issues relating to bowel and bladder dysfunction can be resolved .Since the Pelvic floor is surrounded by other structures, muscles and ligaments it is important that these core muscle are strong and have normal strength, length and tension.
Nutritional: The role of nutrition in well being of the body as well the bladder and bowel cannot be emphasized enough. Nutritional guidelines are established and reinforced during therapy session including drinking water. Bladder aggravants such as soda, coffee etc cause urgency and frequency. This does not mean you should not have any, just that be aware of how much of these aggravants you consume.
Behavioral strategies: We develop the habit of going frequently to the bathroom from childhood. Strategies are taught to not go “Just in case” and also to hold the urine inspite of running water, opening the garage door.