Effects of Fascial Manipulation® on urinary symptoms: A case report

Pelvic floor dysfunction (PFD) is prevalent post-childbirth, with urinary incontinence (UI) affecting approximately 30 % of women. Although pelvic floor muscle training is widely recognized as the first-line treatment for UI, emerging research underscores the significance of fascial tissue on pelvic floor muscle function. The fascia surrounding the pelvic diaphragm shares an intrinsic relationship with the abdomen, pelvis, lumbar region, and lower limb. In this sense, fascial restrictions in any of these segments may contribute to the development of UI. Fascial Manipulation® (FM®), is a method targeting fascial restrictions across the body and has shown promise in treating musculoskeletal and pelvic conditions. Given the potential influence of fascial dysfunction in PFD, this case explores the application of FM® to address UI symptoms.

A Japanese 36-year-old woman with UI symptoms that worsen six months post-partum. Two weeks after a vaginal delivery, she consulted a urologist due to increased urinary frequency and urgency, which was disrupting her sleep. At that time, she underwent a five-week program of pelvic floor muscle training, with no improvement in UI symptoms, prompting her to seek alternative treatment. A 72-h bladder diary was used to assess patient's voiding pattern, including daytime and nighttime urine frequency. Symptom severity and her distress symptoms were evaluated using the Overactive Bladder Symptom Score (OABSS) and Core Lower Urinary Tract Symptom Score (CLSS) questionnaires, respectively. Pelvic floor displacement was measured via ultrasound imaging. Additionally, movement specific tests and palpation, based on Stecco's Fascial Manipulation® (FM®) method, identified points of tissue densification. Pain intensity was measured using the 10-point Visual Analogue Scale (VAS). During the specific movement tests assessment, the patient complained about right knee pain and restricted dorsiflexion of the right ankle. Palpation revealed tissue densifications in the medial ankle and knee, posterior knee, right hip, bilateral pelvic region, and the area of the lower abdominal muscles. The patient underwent a single session of the FM® method, involving deep friction of the identified densification points. Follow-up assessments included a reassessment of the 72-h bladder diary, OABSS, and CLSS questionnaires one month after the intervention. Ultrasound images and the specific movement tests, with VAS score, were performed immediately after intervention and one month later.

One month after the treatment, the 72-h Bladder Diary indicated a reduction in urination frequency from 10 to 13 times/day to 6 times/day, and nighttime frequency from 2 to 3 times/night to 1 time/night. Questionnaire scores reflected significant improvement, with OABSS severity decreasing from 7 to 1, and CLSS distress reducing from 6 to 1. Immediately after the treatment the ultrasound imaging showed an increase in pelvic floor muscle elevation from 4 to 7 mm., which was maintained, at 7 mm., one month later. The patient reported an improvement in the specific movement tests, being able to squat without pain in the right knee, with zero on the VAS scale. One month later, the patient could sit upright without pain (VAS from 6 to 0) in the right knee.

Fascial Manipulation may reduce urinary frequency and urgency by releasing abnormal tension on the bladder via the internal fascia. Recognizing fascial influences on the whole body could be an effective strategy for treating these symptoms.