Due to COVID-19, our practice hours are limited until the "shelter in place" statute is lifted. Our satellite office on Reservoir Drive is now open on Mondays and Thursdays.
We are scheduling office visits in Sorrento Valley Monday through Friday.

We continue to take every precaution to follow all CDC guidelines along with local and federal policies. We are going above and beyond to ensure that appropriate health and safety measures are in place.
* All clients are required to wear a mask or face covering. 
* Friends and families of our clients must wait outside the clinic.
Staff in masks and gloves for your safety and ours.
Screening questions for staff and clients alike.
Hand washing with anti bacterial soap before and after every client.
Use fresh gloves when applying products to our clients and discard after each use.
Towels, linens and pillow cases changed after each client.
Tables and exercise equipment sanitized after each patient.
Increased cleaning frequency of common areas: door handles, light switches, counters.
PT schedules staggered and spread out to limit possible interaction between clients.
Virtual sessions are available for those who prefer to stay at home.
Need to see us? Call,  email or  request a virtual visit!


We encourage you to continue your home exercise programs and other specific instructions from your physical therapist. We also hope to inspire you to "exercise" your self-care and kindness to others as we all work through this situation together. We will keep you updated on any changes to our policies and eventual reopening. 

Please follow us on Facebook and Instagram for our latest news. In the meantime, keep calm, breathe deeply and keep washing those hands!

UTIs, Recurrent UTIs, and Pelvic Floor Muscles

So you feel the burning discomfort and the intense and frequent urge to urinate-all signs point to a urinary tract infection (UTI).

A UTI is an infection in any part of your urinary system - kidneys, ureters, bladder and urethra. Most infections involve the lower urinary tract - the bladder and the urethra. Research suggests that at least 40-60% of women will develop a UTI during their lifetime. Recurrent UTIs (rUTI), defined as three or more UTIs in 1 year or two UTIs within 6 months. Recurrent UTIs are also more common after menopause. Up to 15% of women over 60 will develop frequent UTIs, 20% for women aged >65 years.

The commonly believed narrative of UTIs goes like this: bacteria invading a previous sterile bladder causes infection, and then antibiotics are used to destroy the bacteria in the bladder. However, research tells us this narrative is simply not true. The bladder is actually home to lots of good bacteria that help maintain the health of the urinary tract. And it is the disruption of the balance of normal bladder bacteria that result in UTI symptoms.

In post-menopausal women, the reason why they tend to suffer from rUTIs more often may be related to the changes in the bacteria that live inside the vagina. Like the bladder, the vagina also contains many types of bacteria that typically maintain a healthy vaginal environment. The vaginal flora, as these bacteria are called, maintain a mildly acidic pH in the vagina that helps protect against infection. However, as women go through menopause, lower estrogen levels raise the vaginal pH which changes the makeup of the vaginal bacteria. And the overgrowth of "bad bacteria" (ie, Escherichia coli and Enterococcus) living inside the vagina then move to its close neighbor - the urethra and bladder. The first line of defense against these "bad bacteria" is the bladder lining. However, similar to what happens in the vagina, decreased levels of estrogen also have a negative effect on the bladder lining. Together, these factors increase the prevalence of UTI in menopausal women.

UTIs are nearly always treated with antibiotics. However, side-effects and antibiotic resistance are making healthcare providers search for alternative treatments and preventative measures elsewhere. Topical estrogen is an interventions that has been supported by research for preventing UTIs in postmenopausal women. Applying estrogen cream locally to the vaginal region has been shown to not only increase the good bacteria in the vagina but also to clinically reduce rUTI episodes.

For example, pelvic floor physical therapy can help. The muscles of the pelvic floor are responsible for controlling the flow of urine. They remain moderately engaged in order to stay continent, and then relax when it's time to urinate. If these muscles are overactive, it can be difficult for them to relax enough to urinate properly. Many people with recurrent UTIs feel like they can't fully empty the bladder and have to push to urinate. The mechanism of pushing can actually cause the last few drops of the urine to remain in the bladder, which increases the risk of infection. A pelvic floor physical therapist can help to strengthen or relax the pelvic floor muscles as needed and to regulate intra-abdominal pressure, which will help to effectively empty the bladder without pushing. The better one can empty the bladder, the lower the risk of future infections.

Besides pelvic floor physical therapy and estrogen cream, you might have also heard of other preventative measures such as cranberry juice, probiotics, Vitamin C and D-Mannose. However, the scientific jury is still out on whether these are actually effective for preventing UTIs.

Additionally, pelvic floor physical therapy might be the answer to your struggles in the not-so-rare cases where UTI symptoms are present but urine cultures keep coming back negative. Because both the bladder and the urethra are closely surrounded by pelvic floor muscles, when these muscles are too tight or when they spasm, it can result in symptoms including pelvic pain, problems emptying the bladder completely, frequent, sometimes painful, urge to urinate. A pelvic floor PT can train those muscles to release in order to relieve the symptoms.

There's a lot more that can be done for UTIs or UTI symptoms beyond antibiotics. There can often be an underlying pelvic floor dysfunction in these cases. And for women who are menopausal or post-menopausal, it can be helpful and informative to discuss hormonal influences with your doctor. Maintaining a healthy urinary tract is important for us all.

1. Franco AV. Recurrent urinary tract infections. Best Practice & Research Clinical Obstetrics and Gynaecology. 2005;19:861-873.

2. Aslam, Saima, Michael Albo, and Linda Brubaker. "Recurrent Urinary Tract Infections in Adult Women." JAMA : The Journal of the American Medical Association.: JAMA : the Journal of the American Medical Association. , 2020. Web.

3. Jung, Carrie, and Linda Brubaker. "The Etiology and Management of Recurrent Urinary Tract Infections in Postmenopausal Women." Climacteric : The Journal of the International Menopause Society. 22.3 (2019): 242-49. Web.
Shuyi Wang, SPT
The following message pertains exclusively to Dr. Wiesner's services and practice at CTS.

What is Teletherapy?

Teletherapy is the use of computers, tablets, or smartphones to conduct psychological therapy over the internet using secure audio and or video transmission. In my case I use a HIPPA secure web service that allows me to send an email invitation to a therapy session for a specific appointment time. The recipient accepts the invitation on their computer or smartphone, and we are linked together and begin the session just as if it were conducted in my CTS office.

Teletherapy has been around for over 20 years and there are numerous studies that indicate that it can be as effective as in person therapy and sometimes more effective in that for people on a tight schedule or with limited transportation it affords greater accessibility. Among its other advantages are:
1. During this Coronavirus epidemic it allows "shelter in place" accessibility for help.

2. There is no travel time involved.
3. Less total time is required for a therapy session.

4. Many people feel more secure at home.

5. For people who live far away it affords them the opportunity to see a specialist that may not be available in their community.
Many people ask if teletherapy is secure and the answer is yes very much so.  The software used is highly specialized and fully encrypted that offers the highest level of privacy and security. No sessions are recorded on my end and I am in a very private home office where no one can hear or see what is going on. 

The process is basically the same as if you were to come into my office at Comprehensive Therapy Services. You would call the office or email me directly to schedule an appointment.  We would send you forms to fill out and you would email them back. Billing is handled the same way as if you were having an in-office visit and most insurance companies cover the cost of teletherapy as they would for an office visit.

To schedule, call 858-457-8419 or email Dr. Wiesner at drmgw@comprehensivetherapy.com.