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Freedom From Bladder Leakage

February 6, 2020 9:29 a.m.

  • April Ritz

Pelvic rehabilitation goes from laughable to life changing for a woman suffering with incontinence.

Like thousands of women, “Nancy,” age 58, knows what it’s like to live with the embarrassment and discomfort of urinary incontinence.

“I was to the point where I had to know where the restroom was everywhere I went, including the grocery store,” she said. “My husband and I love to walk, but if we were going to walk more than two miles, I had to wear a pad because when I had to use the restroom I had just a matter of seconds to get there before I had an accident. It was constantly on my mind.”

Limiting her fluid intake had failed to help Nancy control the situation, so she made an appointment with Nurse Practitioner Nicole Wochner, APRN, who focuses her practice on women’s healthcare. Nancy learned after the exam that her pelvic organs (including her bladder, vagina and rectum) were prolapsing, or descending downward. “I had three issues going on, two that I didn’t even realize,” she said. “I knew about the bladder because I couldn’t keep things under control.”

Nancy’s medical diagnosis, pelvic floor dysfunction, refers to a wide range of disorders that occur when muscles of the pelvic floor are weak, tight or torn. While it becomes more common as women age, it isn’t part of the aging process and can be caused by childbirth, heavy lifting, chronic coughing, constipation, a history of sexual trauma or abuse, injury or obesity; it can also develop over time due to repeated physical or emotional stress on the body. Pelvic floor dysfunction affects men and children, too.

Nancy was surprised when Wochner recommended physical therapy as treatment. “I actually laughed because I couldn’t imagine what kind of physical therapy was going to fix this kind of problem,” Nancy said. 

Despite her skepticism, Nancy decided to give it a try, and to her amazement, Nancy credits pelvic floor physical therapy for changing her life. “I didn’t want to take medication or have surgery, so I thought the worst thing that could happen would be to try it and find that it didn’t work,” she said. “I had no idea there were things that I could do to help my situation and, in my case, almost entirely fix the problem. It has changed everything for me.”

Nancy was extremely nervous when she first visited Sarah Bush Lincoln Physical Therapist April Ritz, PT, DPT, because she had no idea what to expect. Ritz has her doctorate in physical therapy and is certified in pelvic floor rehabilitation. She specializes in problems that patients are often too embarrassed to talk about, including urinary or fecal incontinence, difficulty with urination or bowel movements, constipation, chronic pelvic pain and painful intercourse. “I love doing this because most of the people I see think there is no help for what they have going on,” Ritz said. “Many people think that having incontinence or other pelvic symptoms are normal, especially as they age or after childbirth. We want people to know there are things they can do to take control of their symptoms and improve their quality of life.”

During Nancy’s initial evaluation, Ritz spent a great deal of time listening to Nancy’s story and thoroughly reviewing Nancy’s health history in order to devise a multifaceted treatment plan. The smallest part of the exam focused on an internal exam. In Nancy’s case, this meant inserting vaginally a small device to monitor on a computer screen the strength of Nancy’s pelvic floor muscles. “April was so good at explaining what we were going to do, and she even gave me the option of skipping that part of the exam if I wasn’t comfortable with it,” Nancy said.

Ritz taught Nancy how to properly perform Kegel exercises, which are performed by squeezing the muscles around the vagina and rectum. Up to 40 percent of women do Kegel exercises improperly and Ritz focuses on proper coordination and activation of the pelvic floor muscles. The biofeedback device allowed Nancy to watch on the screen the force of her contractions. “The very first time, it was obvious that my muscles were very weak,” Nancy said.

Ritz also suggested exercises that would strengthen Nancy’s core. “The exercises were very simple and they didn’t take much time. In the beginning, I kind of had doubts about whether they would make a difference,” she said.

Nancy faithfully performed the exercises twice a day at home and visited Ritz for physical therapy sessions once a week for three months. “It wasn’t an overnight fix, but when I starting seeing on the screen my muscles getting stronger, it was a big boost for me. That just made me want to keep working at it, because I could see that I was making progress,” she said.

Ritz also advised Nancy to drink more water and fewer caffeinated beverages, since caffeine irritates the bladder. “It seemed backwards to me to drink more water, but April gave me several bladder retention techniques which taught me to use more of my bladder instead of just a small portion of it,” Nancy said. Ritz explained that the extra fluid kept the contents of Nancy’s colon soft to help reduce constipation and worsening of the rectal prolapse. “When April told me about new things, I always laughed because it seemed so unlikely that it would make a difference,” Nancy said, “yet everything she told me made such a huge difference.” 

Ritz offered numerous other tips and found natural products for Nancy to use to improve her condition. “April had information on absolutely everything. There just wasn’t a question or a problem that I had that she couldn’t find some information on,” Nancy said. “All the changes we made changed everything. I feel like I avoided a triple surgery here.”  

When Nancy visited SBL Women’s Healthcare for her annual appointment in November, Wochner couldn’t believe how much Nancy’s condition had improved. “She told me there was a night-and-day difference between this year’s exam and last year’s exam – and that’s a night-and-day difference in my life too.”

Nancy is grateful for her newfound freedom. Since she and her husband love to travel, she is especially thankful that scouting the restroom at each destination is no longer her top priority. “I just wish I had known to do this simple set of exercises before I had a problem,” she said.

It is all too common for women to suffer in silence from incontinence, pelvic pain, painful intercourse or another type of pelvic dysfunction. Through Sarah Bush Lincoln’s Physical Therapy department, trained specialists can help women correct these issues through a full evaluation in which they assess core strength, pelvic floor and hip muscles, along with connective tissue and ligaments and prescribe exercises to help women regain control of their lives.


Physical therapy may benefit you if you are experiencing the following symptoms:

• Urinary or fecal incontinence

• Urinary urgency or frequency

• Pelvic organ prolapse

• Pre- or postnatal pain or incontinence

• Painful intercourse

• Vulvar pain

• Vaginal muscle spasms

• Constipation

• Cesarean scar pain or immobility 

• Painful or difficult breastfeeding 

• Preparation for labor and delivery

• Separation of abdominal muscles

Physical therapy services include:

• Individualized one-on-one treatment

• Computerized biofeedback training  

• Exercises to strengthen and coordinate the pelvic floor muscles

• Manual therapy

• Myofascial release

• Behavior modifications and education

• Home exercise program

• Electrical stimulation

For more information, call Sarah Bush Lincoln Physical and Occupational Therapy at 217 258-2530. Prior to scheduling an appointment for an evaluation, please obtain a referral from your medical provider.

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