2026 Urogynecology for the Advanced Practice Provider-Pelvic Floor Disorders (Incontinence/Prolapse) from a PT Perspective

Video Transcription

Video Summary

The lecture focused on pelvic floor disorders from a physical therapy perspective, especially urinary incontinence and pelvic organ prolapse. Kristen Cook explained how PTs assess these conditions through detailed patient history, including bladder and bowel habits, constipation, straining, urinary urgency, leakage patterns, and prolapse symptoms. She emphasized that bowel dysfunction and constipation can worsen bladder symptoms and contribute to prolapse.<br /><br />She reviewed pelvic floor evaluation using the PERF scale and the modified Oxford scale to measure strength, endurance, repetition, and fast contractions. She also discussed prolapse grading, risk factors such as chronic coughing, heavy lifting, constipation, childbirth, surgery, and connective tissue disorders like Ehlers-Danlos syndrome.<br /><br />A major theme was conservative treatment. For prolapse, she highlighted constipation management, proper toilet posture, lifting mechanics, core and hip strengthening, and strategies to reduce intra-abdominal pressure. For urinary incontinence, she described urge suppression techniques, bladder retraining, fluid guidance, bladder irritant education, and tibial nerve stimulation. For stress incontinence, she emphasized “the knack” (pelvic floor contraction before coughing/sneezing), cough prep, pelvic floor strengthening, and, when needed, internal electrical stimulation.<br /><br />She also covered diaphragmatic breathing, transverse abdominis activation, return-to-running criteria, and maintenance exercise plans. A case study illustrated how education, breathing retraining, pelvic floor strengthening, and electrical stimulation improved symptoms in an older patient with prolapse and incontinence.<br /><br />The session ended with practical guidance for referring providers on counseling patients, setting expectations, and collaborating with pelvic floor PTs.

Asset Subtitle

Learning Objectives:

Review pelvic floor muscle abnormalities as they contribute to urinary incontinence and prolapse
Describe variety of conservative treatment options for incontinence utilized in a PT practice
Discuss prevention and conservative treatment options for prolapse in a PT practice

Speaker: Kristen Cook, PT, DPT

Keywords

pelvic floor disorders

urinary incontinence

pelvic organ prolapse

physical therapy

constipation management

pelvic floor evaluation

PERF scale

modified Oxford scale

urge suppression

pelvic floor strengthening