Blog: I Laughed So Hard that Tears Ran Down My Leg.


Kim Johnson, MPT

If you find the title of this rings even slightly true for yourself or someone you know, then physical therapy with a pelvic specialist would be beneficial. A therapist that specializes in the pelvic floor can work with a variety of diagnoses and conditions including: pelvic pain, post-surgical care (post-prostatectomy, post-hysterectomy to name a few), pregnancy and post-partum, and by far the most widespread condition we treat is urinary incontinence.

Incontinence can present itself in a variety of ways, for example, “I only leak when I cough, laugh, or sneeze” or “I just can’t seem to get in the house fast enough when I get home.” The most common types of incontinence are stress, urge or a mix of both.

Stress Incontinence relates to physical stressors which can cause leakage. Stressors include but are not limited to: coughing, laughing, sneezing, lifting, running, changing position, and squatting down. Often times with stress incontinence there is a small volume loss of urine. Stress incontinence is typically a product of pelvic floor muscle weakness or motor dysfunction, and can be treated very successfully with conservative physical therapy.

Urge incontinence occurs when you have a very strong and immediate urge to urinate. Essentially the bladder contracts at the wrong time. Typically with urge incontinence there is a large volume of urine lost, compared to stress incontinence. Treating urge incontinence sometimes requires a combination of strengthening, soft tissue work, habit retraining, and possibly medication intervention..

Many people actually suffer from a mix of both stress and urge incontinence. Your physical therapist will work to provide a thorough physical therapy diagnosis of each individual’s situation, and together with the patient will develop a customized treatment plan based on that patient’s case. The treatment can include strengthening, bladder retraining, manual therapy, breathing work, relaxation, dietary recommendations, and biofeedback. What a person is eating and drinking can play a huge role in continence. For example, caffeine is a bladder irritant. Sometimes just removing most caffeine from a diet can calm the bladder and allow a person to sleep through the night instead of being woken multiple times to urinate. Often time people don’t consume enough water through the day and that also can cause issues. Water will dilute urine, making it less irritating to the bladder wall. This can reduce frequency, urgency and urine leakage.

Time and time again I have had people say that their leakage is “normal.” I would disagree; incontinence is common but definitely not “normal.” Just because you have had a baby or are over the age of 65 does not mean that you should have to deal with incontinence. So many men and women live their lives around their incontinence, and it does not have to be so. Therapy is a non-surgical option, which can be very helpful and liberating. Please seek out one of our Pelvic Floor therapists if you, or someone that you know, is suffering with incontinence.

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Let's Talk About Swelling....Glycocalyx?

Let's Talk About Swelling....Glycocalyx?

By: Teresa Iattoni MSPT, CLT, CES

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March is lymphedema month, you might ask how does that impact me? Most people will experience swelling during their life, whether it is a result of an injury like an ankle sprain or a result of a chronic condition like lymphedema.  Swelling in the medical world is commonly referred to as edema.  It may be caused from a specific event or have multiple causes.  If you have swelling, you should discuss that with your medical provider.  Swelling can develop due to the following: 1) as a side effect of your medication, 2) as a symptom of a cardiac/lung/kidney condition, 3) because of diabetes mellitus, 4) secondary to a protein deficiency, 5) in the presence of venous insufficiency/varicose veins, or 6) from an infection (Stout et al., 2012). Physical and occupational therapists commonly see swelling related to inflammation from an injury or surgery, which leads to increased pain, decreased muscle activation, abnormal movement, and impaired healing.  In many cases, physical and occupational therapists can help by providing education for appropriate exercises and special treatments for swelling.


What is Glycocalyx?  First, you should understand the basics of the circulatory system.  The heart pumps the blood out into the arteries.  The arteries are linked via small blood vessels (capillaries) to the veins.  The veins take the blood back up to the heart. If our circulation was that simple it would be easy, but our bodies are extremely complex.  The third part of the circulatory system is the lymphatic system.  The lymphatic system follows the path of the veins and eventually brings fluid back to the large vein (superior vena cava).  The lymphatic system’s job is to fight infection by filtering fluid at each lymph node, to maintain the balance of fluid throughout the body, and helps process dietary fat (Lee, Rockson, & Bergan, 2018).  The glycocalyx is a protein tunnel in the capillaries that allows fluid and protein from the blood to go into the tissue spaces in our body (Hansen et al., 2015).  The glycocalyx tunnel functions as a one-way road, so what goes out cannot normally come back in.  The lymphatic system has the job of clearing the extra fluid and waste materials from the tissue space (Levick & Michel, 2010).


How does that relate to my swelling?  Your swelling is best managed by addressing the cause of the swelling and encouraging fluid return thru the lymphatic system.  In cases where the lymphatic system is not working appropriately, lymphedema can occur.  Lymphedema is a high protein swelling.  It commonly appears in arms or legs but can develop in any body part.  Lymphedema left untreated can lead to chronic large body parts, pain, limited motion, repeated infections, and to permanent thickening of tissue (Lymphedema Framework, 2006).  Advanced Physical Therapy & Sports Medicine has specialty trained physical and occupational therapists, who can provide treatment for your swelling and lymphedema, through the application of manual lymphatic drainage, compression garments, exercises, skin care, kinesiotape and pumps.   










Hansen, K.C., D’Alessandro, A., Clement, C.C., & Santambrogio, L. (2015). Lymph formation, composition and circulation: a proteomics perspective. International Immunology, 27(5), 219-227.

 Lee, B-B, Rockson, S.G., & Bergan, J. (Eds.). (2018).  Lymphedema: a concise compendium of theory and practice (2nd ed.). Switzerland: Springer

Levick, J.R., & Michel, C.C. (2010). Microvascular fluid exchange and the revised Starling principle. British Journal of Anaesthesia, 108(2), 198-210.

Lymphedema Framework. (2006). Best practice for the management of lymphoedema.  International Consensus. London: MEP Ltd.

Stout, N, Partsch, H, Szolnoky, G, …et al. (2012). Chronic edema of the lower extremities: International consensus recommendations for compression therapy clinical research trials.  International Angiology, 31(4), 316-329.