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A professional obligation to bladder liberation

  • Written by Submitted by Shannon Pazier, MPT, MSW

As a pelvic floor physical therapist, your objective is to cure urinary or fecal incontinence, pelvic pain or other dysfunction related to the bowl-shaped set of muscles lying beneath the bladder, uterus and rectum, known commonly as “the Kegel muscles.”

Seven years into my practice as a pelvic floor physical therapist, I was frustrated. I had a healthy referral base of clients coming to me for urinary incontinence or for pain related to pregnancy. I did not feel, and nor did my leaking clients, that they were getting better fast enough or, for some, even improving at all. I was teaching them pelvic floor muscle strengthening exercises and using a top-of-the-line SEMG biofeedback unit.  

In 2008, I signed up for a course called “Beyond Kegels” by Janet Hulme, a physical therapist with more than 30 years of experience. As Hulme explained, the interaction between specific muscles in the hip and the pelvic floor muscles is the key to curing urinary incontinence. I tell my clients to think about a broken trampoline. Rarely is it the mat (pelvic floor muscles) that is the problem. The springs (hip muscles) are what need attention.  

And thus, sometimes with confused or slightly skeptical looks, my clients place a small yellow ball between their knees, wrap a piece of Theraband® around their legs and off they go with an exercise called “Roll for Control”®.  As soon as two to four weeks later, they are returning with somewhat shocked looks on their faces and saying “I already notice improvement!” or “I’m not leaking at all!”

I along with other health care professionals have an obligation to destroy the myth that after babies or by the time we turn 60, leakage is inevitable. On a regular basis, women (and men) are graduating leak-free from my practice in their 60s and 70s and beyond.

Another reason for teaching Hulme’s approach concerns the very private nature of all that I am writing about. Many individuals may find it very uncomfortable not only to discuss issues related to their genitalia, but also to undergo an internal vaginal or rectal muscle exam. To be given a ball and band and an exercise that emphasizes hip motion and strengthening prevents the need for this exam, thereby avoiding embarrassment for the patient, fostering compliance with the exercise and leading to a life without leakage.

Without my services, an individual may banish themselves to their own home for fear of leakage, or at best will travel in their community and beyond in a constant state of anxiety, always searching for the closest bathroom and dreading the next mortifying accident. I cannot begin to express how gratifying it is to see that look of liberation on a client’s face, a knowing that the simple pleasures of chasing after a child or grandchild, or of laughing wholeheartedly at a friend’s joke, have returned to them.

Shannon Pazier, MPT, MSW practices at Flex Physical Therapy in Bothell. You can contact Shannon at This email address is being protected from spambots. You need JavaScript enabled to view it. to learn how pelvic floor PT can be of use to you or someone you know.

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