Pelvic Floor Rehabilitation Treatments

Over the past few days I was earnestly researching what treatments are available to the public concerning the pelvic floor. Thankfully I found several varieties of treatments, each with a different approach and level of effectiveness.

There are several diverse methods to prevent or rehabilitate the weakening of the PFM. The first and most common method involves the application of Kegel exercises, which are aimed at increasing the tone of the PFM via direct contraction. The American Urogynecologic Society Foundation recommends 4-8 sets x10 contractions per day. A link to a helpful PDF concerning these exercises can be found at:

https://www.mypelvichealth.org/ToolsforPatients/KegelExercisesInstructionSheet/tabid/80/Default.aspx

http://tweakfit.com/pelvic-floor-exercises

 A common instruction is to ‘squeeze the muscles that help you stop the flow of urine’, or to ‘squeeze the muscles that help hold your gas in’. These active contractions of the PFM can be difficult to isolate and may require some feedback in order to be correctly activated.

Another method involves the use of weights (vaginal cones, balls, barbells) and challenges the PFM to hold this in place for 15-20mins, 2x per day, as the patient goes about their normal ADL’s.

Interchangeable Weighted Vaginal Cone Set

   http://www.aquaflexvaginalweights.com/aquaflex_vaginal_weights.html

When the vaginal cone slips down, it provides biofeedback to the patient resulting in the contraction of their PFM to help keep it in place. Approximately 70% of women find this intervention quite useful, and no longer required surgery after a 1 month trial (Peattie et al., 1988).

Surgical intervention is often the last resort. It is more commonly completed via keyhole surgery nowadays, but the exact method is really dependent on the extent of tissue damage present. Recovery time frames range from a couple of weeks, up to several months, with the instruction of no heavy lifting or strenuous activity. As with any surgery, infection is a possible complication, and can lead to the delay in healing, or a whole new variety of problems. Therefore surgical intervention is not recommended/undertaken unless all other treatment options have proven no benefit (Olsen et al., 1997).

However there is another available treatment option before an individual requires surgery. This method is mainly for people who cannot correctly perform the Kegel exercises or use vaginal weights, as their ability to isolate and contract the appropriate muscles is considerably altered/limited. A common alternative/additional method to is via the electrical stimulation (Estim) of the PFM by the instigation of a passive contraction (Newman et al., 1995). Estim is often combined with the aforementioned conservative treatments and has been found to be very beneficial in both males and females. Many investigations into this matter have proven that >60% of Estim patients have a improvements in PFM strength and  the number of leakage episodes decrease by an order of >50% (Sand et al., 1995).  There are several different methods of Estim application to the PFM. The two main types of Estim include the application of TENS or the utilization of Interferential therapy. As far as I am aware, TENS is generally quite invasive, as can be seen in the image below:

 

http://www.geauxdawg.com/miklosandmoore/in_treat7.php

 

Just looking at this image, I could imagine many women would be apprehensive concerning the application of TENS therapy. Therefore I am going to look further into these two electrical modalities and hopefully determine which method works best.

REFERENCES:

Newman, D. K., Steidle, C., Wallace, D. (1995). Urinary Incontinence: An Overview of the Diagnosis and Managment. The American Journal of Managed Care, 1(1):68-74.

Olsen, A. L., Smith, J., Berstrom, J. O., Colling, J. C., Clark, A. L. (1997). Epidemology of Surgically Managed Pelvic Organ Prolapse and Urinary Incontinence. Journal of Obstetrics & Gynaecology, 89(4): 501-506.

Peattie, A. B., Plevnik, S., Stanton, S. L. (1988). Vaginal cones: a conservative method of treating genuine stress incontinence. BJOG: An International Journal of Obstetrics & Gynaecology, 95(10): 1049-1053.

Sand, P. K., Richardson, D. A., Staskin, D. R., Swift, S. E., Appel., R. A., Whitmore, K. E., Ostergard, D. R. (1995). Pelvic floor electrical stimulation in the treatment of genuine stress incontinence: A multicenter, placebo controlled trial. American Journal of Obstetrics and Gynaecology,. 173(1): 72-79.

The Pelvic Floor

Have you ever wondered, what the magic muscles are that stop you from voiding (peeing your pants) when you are busting, jumping or simply suffer a fright? Well think yourself lucky, some people (more commonly women) are unable to control when and where they go to the toilet, leaving them in quite the social, practical and emotional predicament.

Urinary stress incontinence (USI) involves involuntary leakeage related to activity. It is a common problem, and is believed to affect between 4-35% of people (Luber, 2004). Well since you have read this far, I believe you have earned the names of the aforementioned ‘magic muscles’. They are the coccygeous and levator ani muscles which form a hammock, holding all the precious visceroabdominal organs inside your body, as can be seen in the image below:

Pelvic Floor Muscle Hammock

 http://www.chronicprostatitis.com/myoneuropathy.html

This collection of muscles is known as the pelvic floor and is vitally important for internal support, helping to prevent the descent of the bladder neck during rises in intra-abdominal pressure. Another vital function performed by the pelvic floor muscles (PFM) involves the occlusion of the urethra, which helps prevent embarrassing situations, placing such great responsibility on such little muscles.

Well it seems most of the time my pelvic floor is functioning at full capacity, and for that I am grateful, however some people are not so fortunate. There are many factors affecting pelvic floor function, with the most prevalent disruptor being a common and rather traumatic event known as childbirth. It not only can cause mechanical damage to the PFM in the order of muscle tears, but neural damage may also occur to nerves originating from spinal segments S2 & S3. These disruptions lead to the development of urinary incontinence and is reported to be as high as 22% in women after a vaginal delivery (Baessler et al., 2008).

Obesity is a growing problem amongst the western population, and with an increase in body mass index (BMI) there is a proportional rise in intravesical pressure. This can potentially decrease the continence gradient between the bladder and the urethra, amplifying the chance of leakage with exercise (Luber, 2004).

Other conditions with the possibility of disturbing the PFM include having a:

prostatonomy, hormone imbalance or chronic constipation (Baessler et al., 2008). Well seeing as there are a wide variety of contributing factors, I am going to look into what treatments are available and how I could help someone experiencing this situation.

REFERENCES:

Baessler, K., Schussler, B., Burgio, K. L., Moore, K. H., Norton, P. A., Stanton, S. L. (2008). Pelvic Floor Re-education. Springer. London.

Luber, K. M. (2004). The Definition, Prevalence, and Risk Factors for Stress Related Incontinence. Reviews in Urology. 6(3): S3-S9.