Skip the Drugs and Surgery

Urinary incontinence therapy targets pelvic floor muscles.

Jane*, 67, is retired but working. For 20 years, she worked as a clerk in several departments of a Miami hospital. When she retired and moved to Cape Coral, she began a job as a safety attendant for a local health system. Jane enjoys her new, part-time career because the work is diverse and she loves being with people.Stock photo from
While Jane was completely secure in her retirement role, she developed health issues that made her feel less comfortable. She started experiencing some pain in her lower abdomen and noticed urine leaking during recreational activities and at inopportune times at work.
“Every time I danced, or walked around my neighborhood, I felt leaking from my bladder,” she describes. “If I went to lift something, like a chair, I got the same feeling. I also leaked when I sneezed or coughed.
“At work, I sometimes got the feeling I needed to go to the bathroom, but because I was busy doing something, I waited for five minutes. But after five minutes, my bladder was so full that I needed to go that minute. I had to get to the bathroom very fast. It was the only thing I could think about.”
What Jane experienced was urinary incontinence. It is a condition that affects as much as 45 percent of all women and is most common among women who are or have been pregnant and women who have been through menopause, which is a time when the vaginal tissues become weaker and thinner.

“In most cases, when people take our physical therapy route, their quality of life improves dramatically.” – Dr. Miranda-Sousa

To correct the problem, Jane first began wearing pads. She later visited her primary care provider, who prescribed a few options, including medications. The effectiveness of the medications was limited, however, so her provider recommended she see a urologist and referred her to Alejandro Miranda-Sousa, MD, of Urology Experts.
“When I initially saw Jane, she was experiencing urinary incontinence, as well as frequency, urgency, nighttime urination and leakage of urine when the urge to void came on and she couldn’t make it to the bathroom,” notes Dr. Miranda-Sousa. “She was also having mild stress incontinence with lifting, coughing, sneezing and giggling.
“Jane tried medications in the past, but they did not work for her, and she was very upset by her symptoms. As I routinely do, I first listened to her to determine what concerned her most. In her case, it was very clear that the issue was her bladder behavior and, to a degree, the lack of support for her urethra.”

Pelvic Floor PT

Dr. Miranda-Sousa’s evaluation of Jane included a thorough history, including when the symptoms started, when they occurred and how long they lasted. Next was a physical exam during which the doctor checked Jane’s abdomen, back and pelvic area.
Graphic courtesy of Burrell Education.During the physical, Dr. Miranda-Sousa noted that Jane had some bloating and pain in the area under her belly button as well as in her pubic and pelvic regions. That led him to believe she had a mixture of conditions, including bladder overactivity, stress incontinence and a condition called pelvic floor dysfunction.
“The pain she experienced in her pelvic area suggested the muscles in her pelvic floor were not working correctly,” explains Dr. Miranda-Sousa. “These muscles are needed for urinary continence, fecal continence, sexual satisfaction and overall comfort in the pelvic region.
“These muscles actually need to be in mild contraction to hold the organs in the pelvic area in an adequate position. But when these muscles are tightly cramped, like Jane’s were, they don’t behave properly.”
At Urology Experts, Dr. Miranda-Sousa uses a treatment program called pelvic floor physical therapy to address pelvic floor dysfunction. The program, which Jane agreed to, is designed to restore the pelvic floor muscles to proper function without drugs or surgery.
The first stage of the program is habit awareness. Patients keep diaries of the fluids they consume and the times they consume them. The dedicated nurses who work with the program first look for urinary system irritants such as coffee, tea and soda, which tend to worsen incontinence symptoms. Patients then adjust their drinking habits to reduce symptoms.
The second stage of pelvic floor physical therapy is muscle training.
“When patients begin the physical therapy program, their pelvic floor muscles are typically in a state of chronic spasm,” informs Dr. Miranda-Sousa. “Our goal is to first relax these muscles, then exercise them and train them to work properly.“My treatment was a success, and I’m very happy. My leaking issue is much better now.” -Jane
“To achieve this, we use a combination of electrical stimulation and biofeedback. The internal electrical stimulation breaks the spasm and relaxes the muscles. The biofeedback teaches patients the location of the pelvic floor muscles and how to contract them to do the exercises that strengthen them. We teach them appropriate techniques for doing this.”
Continuing the exercises is the final stage of the program. To be most effective, patients must commit to performing the exercises on their own after treatment ends.
“The pelvic floor muscles need long-term attention if patients don’t want to end up in the state they were in before treatment,” observes Dr. Miranda-Sousa. “The exercise reinforcement is necessary so the muscles don’t return to spasm.
“Usually, patients do very well when they follow our advice, but it takes a little work on their part. Pelvic floor physical therapy is an easy way to treat urinary conditions without surgery or the cost of expensive medications that have side effects. In most cases, when people take our physical therapy route, their quality of life improves dramatically.”
After completing pelvic floor physical therapy at Urology Experts, Jane noticed significant improvement in her urinary incontinence and discomfort. Dr. Miranda-Sousa was pleased with her response to the therapy, and Jane was delighted by her outcome.

Mindful Music

“My treatment was a success, and I’m very happy,” she enthuses. “My leaking issue is much better now.”
Without the fear of leaking during activity, Jane has gone back to one of her favorites, dancing. She has diabetes and likes to boogie as exercise to help control her blood sugar levels.
“I like to dance when I’m at home because of my diabetes,” she confirms. “I listen to music – flamenco, Cuban or American music – and I dance because it’s good exercise. I love it because my mind thinks about the music, my dreams and everything that’s good for me. I let the music flow through my mind.
“I can also take my walks around my neighborhood.”
To remain active and symptom free, Jane is committed to continuing with her muscle-strengthening exercises at home. She’s grateful for the encouragement she gets from Dr. Miranda-Sousa and his staff.
“Dr. Miranda-Sousa is a good doctor,” she reports. “He’s a very kind person, and I like him. His staff are very sweet people. When I’m at Urology Experts, they make me feel like I’m at home. I recommend pelvic floor physical therapy and Dr. Miranda-Sousa. I’m very happy with him.”

*Patient’s name witheld at her request.
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    • Urology Experts

      The team at Urology Experts is dedicated to providing exceptional healthcare and personalized treatment plans. They offer a number of different urological services and specialties that will help any patient restore their quality of life.... Read More

    • Alejandro Miranda-Sousa, MD

      Alejandro Miranda-Sousa, MD, is a board-certified urologist by the American Board of Urology. Dr. Miranda-Sousa graduated from the prestigious Universidad Peruana Cayetano Heredia School of Medicine in Lima, Peru. He also completed his r... Read More