I had the amazing good fortune to be introduced to John Barne’s Myofascial Release treatment and pelvic floor therapy in the first years out of Physical Therapy school.  This experience not only had a profound effect on my Physical Therapy career, but also on my personal life.  I was a new mother with two young boys when I graduated from Physical Therapy school and had developed pelvic floor and bladder symptoms from pregnancy and C-sections.   John Barnes, PT was way ahead of the times, way ahead of anything that Physical Therapy school and training courses were teaching Physical Therapists regarding pelvic floor dysfunction 25 years ago.   What I learned from him as well as having my own living proof of how Myofascial Release can eliminate pelvic floor pain and bladder dysfunction made me a bit of a crusader for Women’s Health issues.  Over the years, Hands On has attracted therapists with the same passion not only for spreading the word about Myofascial Release, but it’s profound effect on treating pelvic floor issues in women and men.   All of our clients are special to us and we learn something from almost everyone.   However, every so often, one comes along that makes us want to learn more and pushes us to dig deeper and look harder at helping them solve their problem.  The following information is a case study on a client who was referred to us for urinary retention.

We can’t reveal names so we will call her Client A.  As stated, Client A was referred to us for pelvic floor treatment due to urinary retention.  Urinary retention is the inability to fully empty the bladder.  Her symptoms were identified in 2007 during her 1st pregnancy.  Her sonograms showed a distended bladder.  At that time, she had no symptoms.  Her physician asked her if she planned on having other children.  Because she did, he told her to just continue on and address the urinary retention after she was finished having children.  In 2009, she had her 2nd child and her symptoms were exacerbated.  Both were vaginal births with a small amount of vaginal tearing with her first child.  Starting in August of 2009, she began self catheterizing 4x/day due to high residual volumes (urine left in the bladder after urinating) and risk of bladder infections.  She very quickly started having a high incidence of urinary track infections (UTI’s).

In 2010, she was sent to a neurologist due to numbness and tingling in her hands and arms.  Cipro is an antibiotic that has a potential side effect of numbness and tingling.  Since she had recently taken Cipro for a bladder infection and spine tests were clear, neurological concerns were dismissed.  From 2009 to present, she was on and off of antibiotic therapy to control the bladder infections.  Starting in November 2011, she had 2 failed trials of InterStim therapy for urinary retention.  She was finally referred to physical therapy in August, 2012.

Client A has no history of trauma.  She is a very active and physically fit young woman.  She was a High School cheerleader and their squad was very acrobatic/gymnastic.  She is an avid runner and is currently a fitness trainer.  Her Physical Therapy evaluation revealed a moderate amount of muscle imbalances especially high muscle tone and lack of flexibility in the hamstrings and quadriceps  as well as poor alignment of the pelvis and lumbar spine.  Her internal pelvic floor exam revealed moderate to severe high muscle tone and imbalance of the pelvic floor muscles.  The pelvic floor muscles are the muscles that run from the pubic bone in front to the tail bone in back.  The form a sling-like structure that supports our bowel, bladder and reproductive organs.  They also provide sphincter control for the bowel and bladder.  She actually had a strong pelvic floor muscle contraction but had difficulty relaxing the pelvic floor after contractions.  She also reported a severe history of constipation.  Constipation is another issue which can have a profound effect on bladder function.  Client A had no pelvic pain issues.  She did report abdominal discomfort  or “fullness” when the bladder needed to be emptied.

Client A responded well to Physical Therapy treatment which included external and internal treatments to gain better flexibility and alignment of the lumbar spine and pelvis.  Internal treatments were focused on restoring proper pelvic floor muscle tone and better relaxation of the pelvic floor muscles.  We worked on identifying body mechanics and postural issues that were contributing to her pelvic floor and spinal alignment issues.  We also addressed constipation issues.

We were able to see improvements in all of the areas that we were addressing.  However, Client A continued to have on going bladder infections due to the continued need for self catheterization.  The bladder infections would reduce the ability to do internal treatment and would send her on yet another round of antibiotics.

Frustrated, but unwilling to give up or accept what conventional medicine was continuing to offer her, Client A went on a mission of her own to find some better answers to her situation.  We both knew that the cyclical bladder infections and the need to be on antibiotics were affecting her outcome.  However, urinary retention and bladder residuals lead to infections so self catheterizing is necessary to avoid the infections.  It was a vicious cycle.

One of the side effects on long term antibiotics and/or repeated antibiotic use is the destruction of beneficial bowel flora.  You can find many good resources in the literature that explain how and why this happens.  “Beyond Antibiotics” by Lawrence Wilson, MD is a great reference.   Our intestines have a delicate ecology in which certain bugs help digest food, produce certain vitamins and maintain a balance of organisms that prevent harmful bacteria and yeasts from multiplying.  Wide spectrum antibiotics derange the normal ecology of the intestines which can cause parasitic infections, vitamin deficiencies, loss of minerals through diarrhea, inflammation of the gut, malabsorption syndromes and development of food allergies due to defects in intestinal function.  People treated with antibiotics tend to have more repeat infections then those not treated.

It was confirmed by two independent  sources that antibiotics had wiped out Client A’s bowel flora and suppressed her immune system.  Armed with this new information, she continued her fight to get her health back.  The story is far from over.  Client A has stopped self catheterizing and has totally changed her diet.  She told me that it has changed her perception of food and now treats it as a source of medicine.  She has been infection free for at least 3 weeks now. She is having to void more then normal at this time but eventually, the pelvic floor therapy will be able to restore the bladder and pelvic floor to it’s proper level of functioning.

One of the things that she told me the last time we spoke was that she knew it took a village to help her get on the road to recovery.  That road involved learning to listen to her body, taking her heath in her own hands, and being willing to change her life style and especially her diet.  Another thing she said to me that she picked up from one of her resources, “Food can be a powerful medicine or the slowest toxic poisoning”.

I am thankful for my training which has taught me that anything is possible and not to listen to diagnoses and follow symptoms when they do not make sense.  That has been the biggest teacher through John’s Myofascial Release training.    Our bodies are incredible in their ability to heal.  Sometimes, we have to think outside of the box……..or just get rid of the box!  In looking back, we surely can not predict a different outcome with different treatment.  However, Client A first showed symptoms back in 2007 and was not actively treated for this condition until 2 years later and not referred to physical therapy for 5 years after her initial diagnosis.   Had she understood her condition, she may have opted to seek out Physical Therapy when she initially learned about her distended bladder.   Treatment of pelvic floor muscle imbalances along with timed voiding may have changed the course of her symptoms.  It surely would not have hurt.

This article is meant to be a sequel to the article that I just wrote explaining Urinary Retention.  It’s important to note that self catheterizing is widely noted in the literature as  necessary to prevent bladder infections associated with urinary retention.  Indeed it is.  However, it is important to be educated and understand all the possible side effects when taking any medication or utilizing a procedure long term.  We also need to be advocates in our own health care and search out information that answers questions to our satisfaction.

 

Jody Hendryx, PT