Addressing Stress Urinary Incontinence

stress-incontinenceStress Urinary Incontinence (leaking of urine with coughing, sneezing, laughing, jumping/jarring activities, or with exercise) is most always thought to be associated with weak pelvic floor muscles that are “under-active” — not contracting strongly enough to do their job.

However, many times the problem is caused by “over-active” pelvic floor muscles, or muscles that are in a constant state of contraction. When these over-active pelvic floor muscles are called upon to help prevent urine leaking, they fail in their job because they are extremely weak and fatigued due to constantly working…. they have nothing left to give.

When individuals are simply told to do “kegels,” or pelvic floor strengthening exercises, without proper muscle assessment first, they may be misguided and receive no benefit.

Only when a thorough pelvic floor muscle examination is performed can the appropriate treatment be determined. Don’t waste time attempting exercises that may or may not be appropriate for your situation. Seek the help of a pelvic floor physical therapist for proper evaluation and guidance in appropriate treatment for Stress Urinary Incontinence.

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Recognition and Management of Nonrelaxing Pelvic Floor Dysfunction

2000px-us-nationallibraryofmedicine-logo-svgThis very informative article provides insight into the significant role that overactive pelvic floor muscles often play as contributors to bladder, bowel, and sexual dysfunctions. Evaluation and treatment of the “nonrelaxing pelvic floor” make up the largest percentage of the work that our pelvic physical therapist does every day at Provenance Rehabilitation.

Article found here.



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Pelvic Floor Spasm: The Missing Link in Chronic Pelvic Pain


I found a gem in my research this morning…. Many of my patients have gone undiagnosed for months or years, only to find out that the origin (or at least a major contributor) of their symptoms is pelvic floor muscle spasm. We need not forget about the significance of the pelvic floor….

Article can be found here.


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From Our Facebook Page


We are very pleased to announce the opening of a second location in Decatur, GA that will be headed up by Elizabeth Kemper.

Beth has been a strong presence in the pelvic physical therapy arena in the Atlanta area for many years. She is one of only a few therapists who have completed dual board certification as Women’s Health (WCS) and as Pelvic Rehabilitation Practitioner (PRPC), and she also holds certification in pelvic muscle dysfunction biofeedback (BCB-PMD).

With over 20 years of experience in pelvic health, Beth offers much knowledge and skill to each of her patients. We are very excited to have Beth join the Provenance Rehabilitation team! Our Decatur location officially opens on Monday, February 12, 2018.

Please join us in welcoming Beth and celebrating the opening of our Decatur office!

3 weeks ago  ·  

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Thank You Patty!

TestimonialA former patient provided this recent testimony highlighting the work that Provenance Rehabilitation provides to its patients.  We wanted to share since it’s a wonderful testimony on the experience, training, and capabilities of the staff.

“After 13 months of severe sciatic nerve pain, two MRIs, one epidural, dry needling, cupping, and traditional physical therapy I was referred to Provenance Rehabilitation for a pelvic floor evaluation. I was desperate for relief.

Jenny and Lori were life savers. These two ladies are caring problem solvers. Turns out it wasn’t my pelvic floor but my fascia. Fascia?  This was life altering.

Week by week my condition improved and my pain gradually subsided. They used a combination of traditional physical therapy and myofascial release therapy (MFR) . Heavy on the MFR. They consulted each other. They worked together as a team to heal me. They have the utmost patience combined with intelligence and genuine concern for their patients. They are the gold standard for their specialty.

I learned to be patient, to listen to my body and to respond accordingly. Every week we made progress. They never gave up. They educated me, they encouraged me, and believed I could get better. I could be the poster child for MFR therapy.

Their healing has been a gift. Healing is a process. Healing is what they do.

It’s true.”


Atlanta, GA – November 2014

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The Significance of Pelvic Floor Muscle Dysfunction

pelvic-floorWhy is it important to address Pelvic Floor Muscle Dysfunction?

The “pelvic floor muscles” are a group of muscles that are arranged within the pelvis like a sling or hammock, connecting the front, back, and sides of the pelvis and sacrum.  The main function of these muscles is to provide support to the organs of the pelvis, including the bladder, uterus or prostate, and rectum.  They also make up part of the urethra, rectum, and vagina.  These muscles must be able to effectively coordinate contraction and relaxation to allow normal functioning of the bowel and bladder.  Moreover, the ability of these muscles to relax is essential to allow for normal urination, bowel movements, and sexual intercourse.

The term “Pelvic Floor Dysfunction,” or PFD, refers to these muscles when they are too relaxed or when they have too much tension.  Abnormal muscle tone can affect urinary and bowel functions, sexual function, and can cause pain.

PFD may be associated with some or all of the following symptoms:

  • urinary urgency, frequency, hesitancy, stopping and starting the stream of urine, painful urination, or inability to empty the bladder
  • constipation, straining, pain with bowel movements
  • unexplained lower back pain or pain in the pelvic region, genital area, or rectum
  • pain during or after intercourse, orgasm, or sexual stimulation
  • uncoordinated muscle contractions causing the pelvic floor muscles to spasm


PFD often accompanies medical conditions that involve pain in the pelvic region, such as Interstitial Cystitis, Endometriosis, Vulvodynia, and Pudendal Neuralgia. 

In each of these conditions, abnormal muscle tension develops as a protective response to pain.  This abnormal guarding of the pelvic floor muscles becomes a secondary source of pain and can also lead to painful intercourse.  For this reason, persons with pelvic pain often are provided significant relief of symptoms by addressing the dysfunction found in the muscles of the pelvic floor. 

Before appropriate physical therapy treatment may be rendered, an evaluation of the pelvic region must be performed by a physical therapist trained in pelvic rehabilitation to determine the condition of these muscles.  Once the evaluation is completed, the therapist will recommend an appropriate treatment plan to address the dysfunction that is found.


Possible treatments include:

  • Manual therapy:  Various methods of manipulating the muscles and connective tissues in the abdomen and pelvic region are used to promote relaxation in muscles that hold tension and restore normal mobility in other tissues that are restricted.
  • Modalities such as electrical stimulation, ultrasound, cold laser, ice, heat, and TENS unit application are sometimes helpful to address pain associated with chronic pelvic pain conditions.
  • *Education:  Instruction in self manual therapy and/or teaching a partner how to perform manual therapy to the tissues externally or internally is often very helpful for maintaining relief of symptoms.
  • Stress management/relaxation techniques/deep breathing exercises:  Symptoms of pelvic pain are often exacerbated by stress; therefore, stress-reducing techniques can be very helpful.
  • Biofeedback is a tool that can be helpful in training the muscles to relax or can assist with strengthening exercises when appropriate.


Are” Kegels” always appropriate?

In pelvic pain conditions it is often necessary to avoid exercises that can promote abnormal pelvic floor muscle tension.  Kegel exercises, or active contraction of the pelvic floor muscles, are often NOT appropriate for pelvic pain patients, as these exercises sometimes aggravate the symptoms.  The types of exercise that are appropriate can be determined by the physical therapist who assesses the muscle tone upon evaluation.


How does one know if her pelvic pain may be improved by physical therapy

The patient must be evaluated by a physical therapist who specializes in pelvic floor muscle rehabilitation.  By restoring function of the pelvic floor muscles, symptoms may be diminished, and quality of life may be dramatically improved.

For more information, please contact:

Jennifer B. Hunt, PT

Provenance Rehabilitation

11975 Morris Rd, Suite 310A       Alpharetta, GA  30005

Office:  678-819-8720   Fax:  678-819-8721

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