Patients may present with one or many of the issues below.

• Stress Incontinence: Urinary stress incontinence is urinary leakage with sneezing or exercise. Leakage can vary from a few drops to full bladder emptying. Basically, as the pressure in the abdomen increases from these activities, the corresponding structural support in the pelvis is not enough. Often, pelvic floor strengthening coupled with hands-on technique to the bladder itself and pelvic floor and some habit modification can take care of the problem. Many patients needlessly wear pads or pantiliners for years, when a short course of therapy (often 6-12 visits) may have corrected their problem.

• Urinary Frequency: Our bladder is meant to hold around 16 ounces of fluid and only to be emptied 5-8 times a day. Patients often think they have a small bladder or that they just need to empty often because of drinking fluids throughout the day. Patients may find themselves knowing where the bathroom is every place they visit or making “just in case” trips to the bathroom before changing locations or getting in the car. This is not normal, and it is often easily corrected with a bladder retraining program and visceral or manual therapy to the bladder, fascia, and scarring in the region.

• Urinary Urgency: Urinary urgency is an overly strong sensation of the need to urinate. Often patients will report leaking as soon as they pull into their garage or leaking once they are on the way to the bathroom. Urgency and Frequency often go hand in hand, but they can be separate. Bladder and habit retraining, manual visceral and internal pelvic floor techniques often resolve this program.

• Urinary retention: Urinary retention leaves patients feeling like they can not fully empty their bladder or they have difficulty starting a stream. Sometimes patients report they urinate, only to feel the need to try again in 15 minutes. Retention can result from overactive pelvic floor muscles that we can teach to relax.

• Interstitial cystitis: IC or interstitial cystitis is a painful or urgent bladder condition. IC is now classified as painful bladder syndrome to include patients who may or may not have lesions in the bladder when viewed under a scope. The international continence society now lists relaxation training and physical therapy in the top two tiers of the recommended treatment sequence. In addition, diet can contribute. Treating IC is often a trial and error situation, as each case is very individual. We try every possible modality and approach with our patients, addressing one at a time to see which combination of modalities will leave our patients most able to lead a full life. We will work in tandem with your urologist.

• Post prostatectomy urinary leakage: Often as men hit middle aged, they start to notice changes in their urination habits, most often due to an enlarging prostate. Non-cancerous, benign prostate hypetrophy (BPH) can be treated surgically. Sometimes these men are left with leakage of urine. This leakage is often improved with physical therapy, including internal work to decrease scarring in tissue, pelvic muscle retraining, and lifestyle modification. However, since this clinic cannot work with Medicare, we are happy to refer to Medicare providers.