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Bladder Dysfunctions

• The Institute of Medicine advises women to consume approximately 91 ounces of water daily and for men, 121 ounces of water.

• Decreased water intake ―› concentrated urine ―› bladder irritation ―› increased urinary urgency and frequency.

• The bladder is able to hold 500 ml of urine.

• Urinary frequency per day: 6-8 times when awake; i.e. 1/3-4 hours.

• It is better to sit and urinate --- men too !!!!

Types of Bladder Dysfunction

• Emptying dysfunction wherein excessive urine collects in the bladder and overstretches the muscle.

• Storage dysfunction is when the bladder sends a signal that it is ready to empty with only a small amount of urine.

• Combined dysfunction: The bladder signals the urge to urinate with only a small amount of urine and the external sphincter contracts rather than relaxes resulting in incomplete emptying.

The above bladder dysfunctions could be a result of muscular hypertonicity/tightness, muscle incoordination, and/or muscle weakness. It could also be a result of neural irritation.

• Symptoms: Urinary frequency, urgency, hesitancy (difficulty with initiation), incontinence, nocturia, urinary tract infections, pelvic pain, retention and/or weak stream.
• Physical therapy can assist in improving bladder control through muscle and neural re-education.

Urinary Incontinence

• Urge incontinence: Urine loss due to a strong desire to urinate (urgency), with only a quick warning.
• Stress incontinence: Urine loss due to an increase in abdominal pressure, such as coughing, sneezing, lifting, laughing
• Mixed incontinence: Combination of both urge and stress incontinence.

Primary Nocturnal Enuresis
Persistent night-wetting in individuals older than 5 yrs, which can be possibly due to a smaller bladder capacity, longer sleep periods, anxiety, genetics, or structural abnormalities. This condition is more common in boys than girls. (Daytime wetting, urinary urgency and frequency are more common in girls.)

Underactive Bladder
"Lazy bladder syndrome," The individual voids only 1-2x daily-children don't void upon waking and are dry at night. Children may have increased bladder capacity and have a diminished sensation of fullness in the bladder. This condition is more common in girls than boys.

Interstitial Cystitis (IC)

• Recurring pain or discomfort in the bladder and the surrounding pelvic region. Irritation of the bladder can cause the surrounding pelvic floor and abdominal muscles to tighten or spasm, resulting in an increase in pain.
• Signs and symptoms may include urinary urgency, frequency, retention, dysparuenia, back, suprapubic, and/or abdominal pain, nocturia (night time urinary frequency), pain prior, during or after urination.

Prostatitis
Male chronic pelvic pain (CPP) symptoms without demonstrable etiology.

• Bacterial: Classification-NIDDK 1995
  • Acute bacterial prostatitis: acute infection of the prostate
  • Chronic bacterial prostatitis: recurrent infection of the prostate
• Non-bacterial: Classification-NIDDK 1995
  • Chronic non-bacterial prostatitis/chronic pelvic pain syndrome (CPPS): discomfort/pain in the pelvic region (at least 3 months) with possible voiding and sexual symptoms
• No infection

Prostatodynia (Chronic pelvic pain syndrome [CPPS])
Used to designate unexplained complaints of chronic pelvic pain associated with either (1) nonspecific voiding symptoms and/or pain located in or around the groin, genitalia, or perineum, or (2) the absence of pyuria and bacteriuria, with or without excess white cells or bacteria, on results from Gram stain and culture of expressed prostatic secretions (EPS) in male patients.

Our Specialties

Musculoskeletal/Sports-Related Injuries
	Back Pain, Pre and Post–op Sports related injuries, TMJ, Coccygodynia, Fibromyalgia, Osteoporosis, Osteoarthritis
Pelvic Floor Dysfunction & Pelvic Pain
	Pelvic Pain, Pudendal Neuralgia, Bladder Dysfunctions, Sexual Dysfunction, Gastro-Intestinal, Disturbances/Bowel, Disorders
Men --- Women --- Children
Women's Health
	Pre-Natal, Post-Partum, Diastasis Recti
Lymphedema
	Breast Health, Pelvic Congestion, Upper/Lower Extremity Lymphedema