By Lindsay Lambert Day (Excerpt from PINNACLE magazine courtesy of

Whether it’s the result of childbirth, aging, or other factors, a weakened pelvic floor is a common condition that can mean inconvenience for women,resulting in discomforts like urinary or fecal incontinence and prolapse. While remedies do exist, misinformation leads many patients to believe that surgery is essential—but that’s often not the case.“Surgery can fix a lot of things, but it’s invasive and carries risks,” says Dr. Linda Kiley, a urogynecologist at Jupiter Medical Center. “Even if every-thing is done exactly perfectly, there’s no guarantee that the outcome is going to be the desired one. So, there needs to be a really good reason to opt for surgery.”

Instead, Kiley says, for qualified patients, a supervised course of physical therapy can put things back in working order without the added variables of an operation.There are a dozen-plus muscles within the pelvic floor, and a physical therapist can guide patients through exercises to strengthen them. Sharon Warwick, a physical therapist at Jupiter Medical Center’s Pelvic Health and Orthopedic Rehabilitation Center at the Cary Grossman Health & Wellness Center, says she first administers a pelvic exam to determine whether a patient’s muscles are weak, tight, or both, then devises a customized exercise regimen to move the right muscles in the correct manner. Most women believe kegel exercises are the best way to combat incontinence, but often kegeling can make the pelvic floor muscles too tight and trigger spasms.

Nonsurgical ways to help rehabilitate a weakened pelvic floor

“Focused breathing can also factor into pelvic floor rehabilitation, as it can help patients relax too-tight muscles,” says Gail O’Neill, who practices physical therapy alongside Warwick. “Our diaphragm and our pelvic floor muscles should work together. I tell my patients to think of it as a piston within an engine.” Patients often pull pelvic muscles in as they inhale, which is unnatural, according to O’Neill. Breathing exercises can teach them to relax those muscles as they inhale. She instructs her patients to do 10 diaphragmatic breaths an hour, which she explains “gives a nice, assisted range of motion to the pelvic floor to help it relax.”

Another tool some patients can potentially use to reverse incontinence is weight loss, as extra pounds can put unnecessary pressure on the bladder. “If someone is overweight, I recommend a five percent reduction in body weight because that can lead to a 70 percent improvement in incontinence,” says Kiley. Kiley also considers behavioral factors that might be contributing to a patient’s pelvic problems, such as consuming unhealthy foods. “It all basically filters through the bladder, and whatever doesn’t go to the bladder goes through the liver, through the colon,” she says. “If you’re filling yourself with artificial sweeteners, carbonated drinks, and other unhealthy foods, I say, ‘Let’s change some of your lifestyle choices.’”What all three women want patients with a compromised pelvic floor to know is that it isn’t a one-size-fits-all condition, and surgery isn’t always necessary to get relief. “It’s appropriate to create a hierarchy of treatment plan so you don’t start out with the most extreme option—that being surgery,” says Kiley. “There are other options.”