Written by Diane Borello-France, PT, PhD; and Susan Clinton PT, DSc, MHS, OCS, WCS, COMT
After your surgery for bladder cancer, including urinary diversion (neobladder), you will need to learn new skills to urinate in the toilet. At first, you will likely experience urinary incontinence (urine leakage that you cannot control) during the day and night. Over time, you will get better at knowing when your bladder is full, urinating will become easier, and urine leakage will improve. In addition, you will feel stronger and start resuming your usual activities of daily living. As with any surgery, people differ in the time it takes to make improvements. Likewise, the extent of improvement differs across individuals. Your doctor will assess your progress, and may recommend that you make an appointment with a physical therapist (PT).
Like physicians, PTs specialize in the treatment of certain disorders. Therefore, if you seek help from a PT, it is important to find one that is specially trained in pelvic health. Physical therapists with this specialty training have the expertise to evaluate and treat bladder and bowel problems for both women and men. If you seek care from a PT, you may need a referral or prescription from your doctor. Although some PTs can treat patients without physician referral, many insurance companies will not pay fees unless a physician referral is obtained.
In some areas of the US, it may be difficult to locate a pelvic health PT. The American Physical Therapy Association, Section on Women’s Health has a website with a PT locator that can help you find one. To find the PT locator you will need to go to: http://www.womenshealthapta.org/pt-locator/.
If you need the services of Physical Therapy, you can expect the following to occur on your initial visit. The PT will conduct a thorough examination of your condition beginning with an extensive review of your medical and surgical history, current symptoms (pain, urinary symptoms, and bowel symptoms), activity restrictions, and role limitations (work, spouse, parent, etc.). The PT will then examine your posture, mobility, strength, and sensation. A vaginal and/or rectal exam of your pelvic floor muscles (depending on your symptoms), is often necessary to determine whether the muscles need to relax (during urination and bowel movements) and/or tighten (to prevent leakage of urine and feces). The examination will also include an assessment of your movements such as lying to sitting, sitting to standing, bending, lifting and walking. This assessment is important to determine if faulty movements with potential to strain muscles may be a contributing to pain, urinary, and/or bowel symptoms. Once the examination is completed, the PT will determine a comprehensive plan of care based on examination findings and specific to your needs.
Common physical therapy interventions for persons with bladder issues include:
- Education on proper sitting, standing, and toilet posture
- Exercises to strengthen weak muscles around or within the pelvis
- Exercises to increase flexibility of stiffened, tense or painful muscles around or within the pelvis
- Exercises to strengthen “core” muscles (deep abdominal and back muscles) that work with pelvic muscles to support the bladder
- Modalities such as biofeedback and/or neuromuscular electrical stimulation can also be added to help with activation, coordination, and relaxation of the pelvic floor muscles
- Education of fluid intake and diet to promote bladder and bowel health
- Education on proper lifting techniques and body mechanics during daily activities to prevent strain on muscles essential to bladder and bowel health
- Recommendations for resuming aerobic and other exercise to promote overall health
In general, if you seek physical therapy, you should expect to see the PT usually once a week. The PT should also provide you with an individualized home exercise program. It is extremely important to follow the home exercise program. The ultimate goal of physical therapy is to help each individual achieve independent self-management prior to discharge.
Diane Borello-France, PT, PhD, is Associate Professor in the Rangos School of Health Sciences, Department of Physical Therapy, at Duquesne University.
Susan Clinton PT, DSc, MHS, OCS, WCS, COMT is Adjunct Instructor at the University of Pittsburgh; and Co-owner- Embody Physiotherapy &Wellness, LLC