Cook County North Shore Hospital Physical Therapist Margo Furcht is now offering a program that promotes pelvic, bladder, and bowel health. She can work with patients suffering from numerous problems such as chronic pain and incontinence, teaching them about dietary modifications and helping them learn specific exercises that can eliminate problems without medication or surgery. The program is very effective in preventing problems as well.
Incontinence is a topic people may not talk about a great deal, but TV ads for products and medications to deal with it have become common. Women who have gone through childbirth education classes may have been taught to do special pelvic muscle contraction exercises known as Kegels. Cook County North Shore Hospital Physical Therapist Margo Furcht offers a program that is more comprehensive, and it works for both incontinence and chronic pain in the pelvic region, which happens with some women after they give birth.
A friend of Furcht’s from physical therapy school is a specialist in women’s health and recommended to her that she get some specialized training in pelvic health. Furcht took her advice and received training in an exercise and diet regimen called Beyond Kegels, and it works for men as well as women. She’s getting several referrals a month now.
The problem
“Urinary incontinence is a common problem in older adults and very often wrongfully accepted as a normal part of the aging process,” Furcht says.
Incontinence has numerous causes but manifests itself mainly as an inability to control the bladder under stress, such as when sneezing, coughing, jumping, bending, lifting, or running; frequent, sudden, very strong urges to urinate; or a combination of both.
A report on a six-year study, entitled Behavioral vs. Drug Treatment for Urge Urinary Incontinence in Older Women, published in the December 16, 1998 edition of the Journal of the American Medical Association states that incontinence predisposes patients to other health problems and contributes to depression and social isolation. “It’s not something you should live with,” Furcht says. “It’s something that can be fixed with exercise and lifestyle changes.”
The causes
Childbirth can cause pelvic organ prolapse, when the uterus, bladder, or rectum are no longer held in place by the tissues that once held them in place, putting pressure on the pelvic floor or herniating below the pelvic floor, and this can cause incontinence. Both obesity and chronic constipation are risk factors as well, for both men and women. In addition, some men who have had prostate surgery suffer incontinence.
“Self-care is a big part of the problem,” Furcht says, but selfcare is also a preventative. “It’s like brushing your teeth,” she says. Food and drinks containing caffeine, artificial sweeteners, strong spices, and even chocolate have been found to irritate the bladder.
“Walking is huge,” Furcht says. “Continence is directly linked to walking.” Dementia and incontinence are the two biggest reasons people enter nursing homes, she says, and people who do not stay physically active and stop walking are likely to become incontinent.
The cure
Medicines can help with incontinence, especially with the problem of frequent, sudden, strong urges to go, but research has shown behavioral treatment to be highly effective. Surgery can be done as well, but its effect may not be permanent. A bladder sling can be surgically implanted, for example, but so far the effectiveness of bladder slings appears to be about five years, although according to Furcht research results not available yet may show that they could last longer.
In two to four visits plus a follow-up visit, Furcht can send patients on their way with a solution to their incontinence. Fixing the problem can involve dietary changes along with special exercises designed to strengthen the pelvic region.
While Kegels are still a good exercise to prevent and eliminate incontinence, Furcht teaches patients some other exercises as well. She instructs patients to lie on their backs on a flat surface with their knees bent, their feet flat, and their pelvic regions raised up on a foam wedge. This gets all the organs to settle into their proper places, and while they are in this position, she has them practice deep breathing and strengthening exercises involving the muscles throughout the entire hip and pelvic region.
Furcht helps her patients retrain their bodies. While our sphincter muscles relax when we eliminate, the pelvic muscles around the bladder tighten. Dealing with the problem of frequent, sudden, strong urges to go involves learning to override the signals the pelvic muscles are sending unnecessarily and training them to stop tensing up when they shouldn’t be tense.
The bladder muscles become strongest when the bladder is not empty all the time, so learning to hold urine until the bladder is partially full is part of the program. Furcht recommends that people wait until they have enough urine to eliminate for 10-20 seconds at a time. “Less and the bladder is not full enough, more and you‘ve waited too long,” she says.
People struggling with incontinence often stop drinking adequate amounts of liquid, Furcht says, and this makes the problem worse. Their urine becomes more concentrated and more irritating to the bladder, causing the muscle around the bladder to clamp down and increasing the urge to go.
“The nervous system operates in two modes: fight and flight or rest and digest,” Furcht says. “Getting our bodies into the rest and digest mode is vital to bladder and bowel health. Learning how to relax and tense the right muscles at the right time is an important part of the process. For people who have a hard time figuring out how to control their bladder muscles, biofeedback is available.
Prevention
“A healthy diet is so important to our bladder and bowel health,” Furcht says. Eating fruits and vegetables helps keep the bowel healthy and functioning, and a healthy bowel can prevent problems with incontinence. She recommends eating plenty of fruits and vegetables that grow above the ground (such as berries and spinach) because they move through the system faster than ones that grow below the ground (such as carrots and potatoes). A spinach salad with pears, berries, nuts, and olive oil will do more to keep bowels eliminating regularly than dried fruits, like prunes, alone because of the moisture in them. Warm liquids help move food through the system as well, Furcht says.
Entering the program
Furcht wants everyone who needs help improving his or her pelvic health to feel comfortable – both physically and mentally. Patients who come to her will be asked about their medical history and will remain clothed while she does an examination of their muscle fitness and breathing patterns.
People who are interested in working with Furcht on bladder, bowel, and pelvic health can talk to a physician at the Sawtooth Mountain Clinic about a referral or contact her by phone at (218) 387-3284 or by email at mfurcht@sisunet.org.
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