It's an affliction not just of the elderly, infirm and women weathering postpartum complications.
Active, fit women and men — even athletes — can experience pelvic-floor pain and malfunctions. But because incontinence or other urinary difficulties are the most telltale symptoms, the condition usually is suffered in silence and resignation, sometimes isolation from family and friends.
Urinating too often can be just as harmful as not going often enough.
"Women always go just in case," says Amanda Olson of Therapeutic Associates Medford.
But emptying a partially full bladder in anticipation of a busy day or lack of toilet facilities only trains nerves to register urinary urge when none should exist, says Olson. Over time, the situation engenders too-frequent urination and the inability to hold a full bladder for an appropriate length of time, she adds, explaining that urinating seven times daily is normal.
"A lot of it has to do with behavioral modifications."
Olson assigns a "bladder diary" to many of her incontinence patients. The written record lets her and them see the frequency of urination in relation to liquid consumed. It also helps Olson pinpoint dietary habits — caffeine, alcohol and some foods — that can irritate the urinary tract.
Therapy involves lengthening by several minutes the periods of time between urination, working up to longer intervals over the course of a few months.
Often unsure exactly how their trouble started, most patients are equally unaware that physical therapy can alleviate pelvic pain and rehabilitate the pelvic floor, say local therapists.
"It's news to a lot of people," says Amanda Olson, physical therapist at Therapeutic Associates Medford. "Most of them have been have been putting up with it."
Kayla Jenkins, 25, was such a patient. The Eagle Point resident noticed sensations similar to a urinary-tract infection that soon worsened to extreme pain in her tailbone. Multiple physicians and several exploratory surgeries provided no answers.
"I couldn't wear certain clothing," she says. "Sitting's just horrible."
After a year and a half of consultations, tests and procedures, culminating in referral to a specialist at Oregon Health & Science University in Portland, she was diagnosed with pelvic-floor dysfunction. Physical therapy was prescribed.
"It's different from other forms of physical therapy ... because the changes can take a while," says Olson.
And unlike almost every other form of physical therapy, the process starts with an internal exam, similar to annual pelvic exams for women. The procedure demands that therapists like Olson are specially trained.
Locally, the therapy has been available since 1994 at Rogue Valley Medical Center Outpatient Rehabilitation, which has three trained therapists. Providence Orthopedic Therapy in Medford and individual therapists in Ashland, Talent and Grants Pass also offer the treatment, says Ramona Horton, a therapist at RVMC who teaches nationally and internationally.
"The need is massive," says Horton. "This is not an easy area to treat."
Some of her patients have been receiving therapy for two years, says Horton. About 80 percent of patients are women. Male patients often are recovering from prostate surgery. Various surgical procedures, including bladder and Caesarean sections, should necessitate therapy, but it still requires a physician's prescription, and not all know it's available locally, says Horton.
"There's a lack of awareness that it's effective," she says.
Either weakness or too much tension in the pelvic floor are at the root of most patients' problems, with lower-back pain a ubiquitous symptom. Pregnancy and childbirth are common causes for weakness, while other people unconsciously clench their pelvic muscles under stress. Running, says Olson, puts significant stress on the pelvic-floor area and can weaken it.
"It could be a woman who's never delivered or been pregnant," says Olson.
Lower-back injuries also can impair the pelvic-floor area, a basket-weave network of muscles and fascia that — in women — surrounds the urethra, vagina and anus. Similar to herniation, pelvic-floor injuries can result from improper lifting techniques and extreme contortions, like those in gymnastics, says Olson. Regimens touted as core-strengthening, such as Pilates and yoga, can tone the pelvic floor and help safeguard it from injury, she adds.
The basic exercise for strengthening the pelvic floor is familiar, at least in name, to most women. Kegels were first promoted in the 1940s by American gynecologist Arnold H. Kegel. But the classic Kegel actually needs to be expanded to a "core contraction," says Horton. And the majority of patients don't know what a proper Kegel feels like, according to therapists.
"It should be a closing and a lifting," says Olson.
Olson recommends about 100 Kegels per day, which may take 15 minutes. The upside is they can be done anytime and anywhere.
"They can do it at the bank; they can do it at work," says Olson. "It's very discreet."
During office visits, pelvic patients also may undergo ultrasounds, which increases blood flow to injured muscles. Electrical nerve stimulation can soothe pain, while biofeedback machines indicate how fully muscles are contracting or relaxing. Manual manipulation is one of Horton's main methods, particularly of very tight muscles or scar tissue.
In-office ultrasounds, stretching and exercises have been Jenkins' course of treatment twice each week for the past few months. She takes home an electrical nerve-stimulation machine that, combined with hot baths, provides some relief. Results are slow in coming, but Jenkins says she immediately was reassured by Olson's approach and demeanor.
"She's really good at explaining things," says Jenkins. "I can call her, and I can get information back from her on what I can do at home."
At home, Jenkins follows her therapy routine three times per day every day. She stays active by walking but avoids heavy lifting and gave up frequent bike rides with family. Complications will keep Jenkins in therapy for months to come, but it's been her lifeline amid an affliction that has no apparent cause.
"I really don't have any idea how this could happen," she says.
"It's like I've never felt like I've had any hope," says Jenkins. "I totally believe that she'll be able to fix it."