True Case Study : Patient is having pain in low back with sciatic issues. Patient is sent to physical therapy where patient is evaluated for piriformis syndrome. The Physical Therapist that is performing this evaluation notices patient needs to use restroom before and during the evaluation session. Patient is asked about frequency with urine use, to which the patient replies with using the bathroom at every stop just in case; not aware of time or duration between bathroom use. Patient is then asked to complete a urine incontinence short form to address if, and how often patient experiences urine leakage issues and if so, during any activities including coughing, sneezing, laughing, jumping, sit to stand, etc. Patient discloses that they do have issues with mild leakage during sneezing and laughing. Patient discloses that they have recently considered purchasing leakage pads for use as needed, and felt that since generations prior have used these, that this was just a normal part of the aging process.

The Physical Therapist then informed the patient that there is help! The patient’s diagnosis then changed from piriformis syndrome to pelvic floor dysfunction. The patient was surprised to learn that the bathroom issues that have occurred lately, may be causing the pain in the low back and sacral area. The patient has become so trained due to fear of leakage that the pelvic floor muscles have lost the strength and endurance functionally for urine control. Patient is then educated and trained on pelvic floor relaxation and contraction techniques. Patient is provided with a home exercise program as well as a diary for water intake and urine output during day and night hours to become aware realistically what is occurring in these areas.

Patient is surprised to find out that bathroom use is more frequent then is recommended for their age as well as nocturnal bathroom use frequency is also higher then recommended. Patient performs techniques on home exercise program as often as prescribed by the therapist. Patient returns the following week with less pain noted in low back. The patient continues weeks following, performing exercises at home and reporting back to therapist at weekly sessions with progressions to exercises as tolerated. Patient is happy to announce, post therapy, that there is no fear or occurrence with leakage during sneezing and laughing, pain in the low back and sciatic issues have diminished, and bathroom use at night has decreased to once at most in the middle of the night. Patient went from thinking urine issues was just a sign of aging, to living with no leakage and no pain that mislead the diagnosis from piriformis syndrome to pelvic floor dysfunction, an easy misconception.

If you are experiencing issues similar to this or find yourself thinking that urine leakage or constipation is a normal way of living; don’t fret, there is help for you! Contact us here at Premier Physical Therapy and we can get you on the right track with less trips to the bathroom.