Fluid Dynamics – Incontinence Doesn’t Have to Continue

By Gretchen Gross

Some things are meant to be leaked. Like the secret start date of a great sale at the best shoe store in town, the web address for amazing Tiffany and Vuitton knock-offs, and the real salary range of that job you’re applying for. Urine, however… now that’s another story. If we are to believe the TV and magazine ads, all aging and post-partum women have Detrol and a good absorbent incontinence pad in the future. Jane Kaufman, physical therapist and owner of Phoenix Physical Therapy of South Burlington, knows otherwise. She and her colleagues make a difference in women’s lives every day.

In a calming and private office space, Kaufman’s practice offers a non-surgical, non-medication reliant alternative for treating stress incontinence, pelvic prolapse, overactive bladder, and pain with intercourse – in other words, many of the responses of a pelvic floor to childbirth, aging, and injury. Their treatments are not limited to women. Men often have similar issues following surgeries or treatments, but Kaufman’s passion is women’s health.

What causes stress and urge incontinence? Aerobic exercise, lifestyle patterns such as daily caffeine intake (coffee, while soothing nerves, irritates bladders), birthing multiple or large babies, decreasing estrogen levels brought on by aging, illness or surgeries, or genetic predisposition – any, or all, of these can add up to a dreaded “ooops!” moment.

As a general physical therapist, Kaufman recognized a treatment breakthrough ten years ago when she saw the next wave in pelvic floor treatments known as Surface EMG Biofeedback. According to Kaufman, this is “a non-surgical approach which enables women to learn to strengthen pelvic muscles and regain control of their bladder and their lives.” Pointing out that women often take leakage for granted, begin wearing pads and sharing knowing looks while laughing too hard during a movie, Kaufman and her partners know that leakage can be reversed, not endured. With a referral from a physician, Kaufman teaches women to relax and strengthen their muscles while watching their contractions on a computerized screen. There is, it seems, a right way and a wrong way to do Kegel exercises. With education and awareness of how pelvic muscles work, women practice individualized exercise programs between treatment visits.

The treatment is simple, painless and fascinating. A small tampon-like insert detects muscle strength and reactivity, transmitting the pattern data to a computer in the treatment room. The woman watches her muscle behavior on the screen, which lights up with the peaks and valleys. Next Kaufman teaches her how to keep flexing those muscles to strengthen and relax. “Many of these issues are caused by tensed muscles. Like a knot in your shoulder or back muscles, a tensed set of pelvic floor muscles will not be able to do what it should,” she explains. The patient repeats the exercise, gets immediate feedback, learns to do them correctly, and goes home with a treatment plan.

“It’s really important that a woman not wait long to ask for help,” Kaufman emphasizes. “Sadly, the average woman leaks for six years before telling her doctor about it. By then, the muscle really needs conditioning and patterns need to be changed. A woman experiencing some leakage will probably begins to go to the restroom more frequently, thinking this will prevent leakage. Then she starts wearing mini-pads daily, which actually gives her brain the signal that it can be less aware of sensations. Women have no idea that while they are trying to prevent a leak, they’re reinforcing leaking!”

In any given week, over 100 women between the ages five and 95 come through the doors of Phoenix Physical Therapy. The five-year-old may be having trouble with bed-wetting. The 95-yearold thinks she’s leaking as an unavoidable part of life.  Though the procedures are different with the five-year-old – using external rather than internal sensors – the muscle training is the same.

When a woman is referred by a doctor’s office, Kaufman knows that other possible causes, such as fibroids or tumors have been ruled out. Kaufman smiles as she adds, “I can’t tell you how often a woman is referred by a physician who tells the patient ‘I know just where to send you!” The good news keeps getting better. This treatment is covered by insurance. The average woman with a relatively uncomplicated situation needs between 6-15 treatment sessions. Everyone leaves the office with a daily exercise program to be done at home long after treatment is over, ensuring that good muscle habits continue.

“A study we did in conjunction with Dr. Julie LaCombe of Fletcher Allen [Health Care] identified an interesting side effect,” Kaufman notes. “Women who undergo these treatments not only lessen or stop urine leakage, but they noted an increase in sexual functioning and satisfaction. That really just makes sense. Any muscle that is in better shape functions more effectively.”

Gretchen Gross is a freelance writer in So. Burlington.