Urinary incontinence is a common and often embarrassing problem that ranges from a person occasionally leaking urine when they cough or sneeze, to having an urge to urinate that's so sudden and strong they don't get to a toilet in time. Although common, it is not normal and people do not have to suffer with symptoms that can be mild and annoying or so severe that a person has to miss work, can't sleep and can't exercise.
Sufferers can seek to recover their quality of life at the Voiding Dysfunction, Incontinence and Pelvic Pain Diagnostic and Treatment (VIP) Institute at Providence Rehabilitation Centre in Grosvenor Close West, where Urologist Dr. Robin Roberts and physiotherapist Christina Messara practice.
Messara says voiding dysfunction, incontinence and pelvic pain can be treated, cured and managed successfully. Dr. Roberts diagnoses and medically manages pelvic conditions while Messara applies therapeutic medical technology in combination with internal and external hands-on or manual techniques to treat, cure or manage a patient's condition.
"If you are a person that is hyper-vigilant about knowing where the washroom is, or someone that is reluctant to go to a movie, or reluctant to go on a long car trip -- who won't drive out west because you are afraid you won't be close enough to a washroom should need the arise, you need to see a physiotherapist," said Messara. "If you sneeze and leak urine, if you jump up and down and leak urine, or if you laugh or dance, or get out of a car quickly and you leak urine, you need to see a physiotherapist. If you have pelvic pain ... an ache, if you will, or a sharp pain in the area of the pelvis that is affecting your ability to engage in sexual relations or not, if you are simply living with a pain, then you need to see a physiotherapist."
A study published in the March edition of Medwire News reported that physical therapy results in significant improvements in quality of life among women from a clinical trial. The study included 72 women with symptoms of stress urinary incontinence or mixed urinary incontinence. Their mean age was 53.1 years, 59.7 percent were postmenopausal.
The intervention comprised eight, one-hour sessions of physical therapy delivered over four weeks. Therapy included pelvic floor muscle training using vaginal cones and electrical stimulation together with behavioral training with advice on liquid intake, urination schedules and strategies to reduce leaking.
In a study limited to urinary incontinence, conducted by Dr. Roberts along with Dr. Curry, through The College of The Bahamas, the results suggested that 15 to 18 percent of the Bahamian population deals with pelvic floor dysfunction, and needs the services offered at the VIP Institute; that number, Messara said, is likely low because the study did not look into all aspects of pelvic floor dysfunction, including fecal incontinence, pelvic pain or sexual dysfunction.
The pelvic floor muscles function as a sphincter to prevent urinary and fecal leakage; support for the internal organs; core stabilizer for the back and pelvic girdle, sexual enhancer for sexual satisfaction/orgasm and to assist the lymphatic system and veins to bring blood back to the trunk.
Messara, who is qualified in the assessment and treatment of voiding dysfunction, leaking urine and pelvic pain, not only provides intervention that may treat the underlying cause(s) of pelvic floor dysfunction, but provides education in symptom management and support in lifting some of the stigma surrounding the issue. Treatment involves internal and external assessments, exercise, manual physiotherapy techniques, biofeedback and modalities as necessary.
Tests and diagnosis
Tests and diagnosis to figure out the root of a person's pelvic dysfunction often involve a process of elimination, because many different disorders can cause pelvic dysfunction. Tests that a doctor might order include measurements of post-void residual urine, measuring bladder pressures, ultrasound, cytoscopy, anal manometry, anorectal ultrasonography and a resting electromyography.
Specific causes of pelvic floor dysfunction include neurological injury or disease, such as stroke, diabetes; menopause; prostate surgery; history of multiple pregnancies and vaginal deliver. Certain medicines like diuretics, chronic constipation; diarrhea; hemorrhoids/anal fissures; muscle damage; nerve damage; urinary tract infection and smoking also contribute. Physical conditions affecting mobility such as multiple sclerosis, arthritis and paraplegia; obesity, prolapse (rectal, vaginal, bladder, urethra); caffeine and fluid intake; high impact physical activities; occupations that involve heavy lifting and straining and psychological factors are other causes of pelvic floor dysfunction.
Pelvic dysfunction has many different characteristics. Signs and symptoms include severe and steady pain; pain that comes and goes; dull aching; sharp pains or cramping; pressure or heaviness deep within the pelvis; pain when you urinate; peeing too often; pain when the bladder is full; urine leakage when you cough, sneeze, laugh, stand up, lift, exercise or have sexual relations. In addition, you may experience pain during intercourse, pain while having a bowel movement or urinating and pain when you sit for long periods of time.
The physiotherapist said the pelvic floor muscles are like a hammock or a sling that support the bladder, uterus and bowel. She said that pregnancy, childbirth, obesity, surgery, disease and the straining of chronic constipation could weaken the pelvic floor in both men and women, causing voiding dysfunction, stress incontinence and pelvic pain; spasms or tension in a person's pelvic floor muscles could cause urge incontinence, pelvic pain and difficulty with sexual function.
Cost
Pelvic floor care is covered by insurance, including the National Insurance Board (NIB) if the injury is due to industrial injury, said Messara. If a patient does not have insurance, the cost of treatment depends on the service rendered, and starts at $100 for an office visit, to physiotherapy treatments at $85 per session and clinical psychologist sessions at $65.
While the VIP Institute is doing its part in helping people deal with their pelvic floor issues, Messara said it has been a "journey" to get Bahamians to realize that they don't have to suffer with their symptoms.
"When I practiced in the States, I was even surprised at how willing the patients were to get on the bed ... they thought nothing of it. They seemed very open to it, and I was actually surprised by that. With Bahamian patients, I'm very sensitive that this is a new area, and we do tend to be a little more private in The Bahamas around our bodies. It's funny, we will talk about sex in sexual terms but we will never talk about sex if there is a dysfunction," she said.
In respect to the privacy that people seek when they visit the VIP Institute, Messara said the physical facilities reflect discretion, with a quiet entrance and rooms that are private and soundproofed so that patients can feel comfortable knowing that it is a place where they can share their physical experiences as well as their emotional experiences.
The VIP Institute was borne out of urologist Dr. Roberts and Messara's common vision to help men and women living with the pain and embarrassment of a pelvic floor dysfunction recover their quality of life. Their focused treatment to improve pelvic floor muscle function, often in combination with medication and or surgery, can alleviate or resolve a person's incontinence.
"This is an entirely new model in The Bahamas and the first time we're offering a multi-disciplinary approach to care," said Messara.
In physiotherapy, much like medicine, graduates are able to provide all aspects of care, and can then go on to become specialized. It was a personal goal for Messara to specialize.
"I always feel that it's important if you're going to provide a service for a patient that you feel confident in your skills within that service, and if I was going to provide this service for my patients, I wanted to make sure that I had not only the academic expertise to back my claim that I could provide this service, but I also wanted to have the hands-on expertise and I was able to get that by going to the Cleveland Clinic in May 2013, where I worked under a physiotherapist there who taught me the hands-on clinical skills that you cannot get through academic knowledge alone," she said.
"I've been inspired by Dr. Roberts' passion and compassion for patients. I know this is an area he has been passionate about for a very long time and something that he has wanted to bring to the forefront of the medical and physiotherapy community for a long time. We were very fortunate to come together and work towards a common goal," said Messara.

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