Your First Visit
Your first visit with our Nurse Practitioner will take approximately one hour. At your visit the Nurse Practitioner will take a health history and perform an examination to evaluate the cause for your bladder problem. If you have not recently had a urine test performed, you should come expecting to give a specimen. You may also have a "bladder scan" of your bladder to ensure you are emptying completely. This will take place in the exam room and is not a specialized x-ray procedure. A small amount of ultrasound jelly is placed over the abdomen and a sensor is then placed on the belly. The machine gives a reading of how much urine is left in the bladder.
An abdominal and pelvic examination is then performed on female patients to ensure there is no secondary cause for the bladder problem. Male patients may have a prostate exam to ensure there are no other abnormalities.
Following the examination, muscle testing of the pelvic floor muscle will be performed. The procedure is not uncomfortable.
In females this is done one of two ways: (1) A small sensor is placed in the rectal opening and you will be asked to tighten the rectal muscle as if you were holding back gas. The reasons for these instructions is all the pelvic floor muscles attach into the rectum. Therefore, it is easier to contract the larger muscle of the rectum and it automatically tightens the rest of the muscles which control bladder leaking or urinary frequency and urgency. (2) A small sensor like a tampon is placed in the vagina and the same instructions are given as above.
In males a small sensor is placed in the rectal opening and you will be asked to tighten the rectal muscle as if you were holding back gas. The reason for these instructions is all the pelvic floor muscles attach into the rectum. Therefore, it is easier to contract the larger muscle of the rectum and it automatically tightens the rest of the muscles which control bladder leaking or urinary frequency and urgency.
The muscle testing is important because no two people are exactly alike. The level of exercises we recommend will be based on the muscle testing. If too many exercises are performed, it may actually fatigue the muscle. If not enough are performed, the muscle will not improve.
Additional treatments which may be incorporated are:
- Stimulation to the muscle. This is done with the vaginal sensor in women, which is inserted like a tampon. You will feel a gentle tapping sensation and feel the muscle contract. There is not uncomfortable for most people. This is the same type of therapy used for other muscles in the body to help them get stronger faster. It also helps those people who have difficulty with urgency and frequency by helping control the bladder.
- Dietary habits will be reviewed. We find some patients have bladders that are very sensitive to certain types of drinks or foods. Dietary changes may be recommended.
We find 75-80% of the patients we see will attain significant improvement or cure with this type of therapy alone. As with any form of treatment, there are some patients who do not benefit from non-surgical therapy. We recommend appointments every one to two weeks initially depending on your symptoms or progress. The average number of visits is six to eight. There are some people that require fewer visits and of course those who sometimes require more. Change in your symptoms should be noticed in three to four visits if non-surgical therapy is going to be successful for you. This does not mean that you will be cured in three to four visits, but you should notice gradual progress.
Remember loss of bladder control did not just occur overnight. We are working with the same muscles that have become weak so success does take some time, and most importantly it requires specific exercises and recommendations be followed. Occasionally we will also recommend medications if we feel they are warranted.
We encourage our patients to continue any vacation or travel you may have planned. Instructions may be given to keep your status of rehabilitation until you can return. Follow up visits usually take 30 minutes.
If you need to reschedule your appointment, we ask when possible to do so 24 hours in advance. We look forward to seeing you at your visit.