Women’s Health Physiotherapy

What are the Pelvic Floor Muscles?

The pelvic floor muscles are located along the floor of the pelvis acting like a supportive hammock at the front, back and sides of your pelvic bone and sacrum. They form a sheet that lies between the pubic bone, the coccyx and the two sitting bones (ischial tuberosities).They support the pelvic organs (bladder, vagina, uterus, anus) and control the outlet from the organs. Like any other muscles in the body the more you use them the stronger they become. These muscles can become weak and the integrity of the openings can be compromised causing the leakage of urine. Causes of weakened or damaged pelvic floor muscles may be childbirth, coughing, ageing or inactivity. The pelvic floor muscles also have a roll in stabilising the lumbar spine and pelvic area. They work alongside the deep muscles of the back and the abdomen.

How can Physiotherapy help me?

If you are experiencing any problems such as stress urinary incontinence or urgency your pelvic floor muscles can be assessed by your Physiotherapist and a treatment plan specific to you can be put in place.

Your Chartered Physiotherapist can help you with:

  • Correct activation of the pelvic floor and the abdominal muscles
  • A pelvic floor muscle training programme for weak pelvic floor
  • Knowing if you are doing the right exercises
  • Treatment strategies for incontinence
  • Urge control techniques
  • Overactive bladder – advice on good bladder habits for life
  • Specific gym advice

The Pelvic Floor Muscles will be assessed using the following:

  • Performance: a measure of strength of a maximum voluntary contraction (MVC)
  • Endurance: the time that the contraction can be held before 50% reduction in strength
  • Repetitions: number of times the contraction can be repeated beginning with rest periods
  • Fast: the number of fast contractions
  • Elevation: lifting of the back of the wall with a contraction
  • Co contraction: contraction of the pelvic floor and the transverses abs at the same time
  • Timing: timing of the involuntary contraction of the pelvic floor muscles with coughing

Aims of Pelvic Floor Rehabilitation

  • Facilitate correct muscle activity
  • Strengthen the pelvic floor muscles to provide better support for the bladder neck
  • Co-ordinate muscle activity to close the urethra effectively with increases in IAP – intraabdominal pressure

Physiotherapy Treatment Plan

  • You will agree goals with your Physiotherapist
  • You will understand the exercise programme and how to progress it
  • You will be given advice and education and written instructions

How often should I perform the Pelvic Floor Exercises?

6-8 weeks training is recommended before changes in muscle size become apparent. Improvement in symptoms may be noted after 1 week. Supervised pelvic floor muscle training of at least 3 months is used to treat stress or urinary incontinence. Each programme is individualised but the recommendations are pelvic floor muscle training programmes should include at least 8 -12 contractions performed 3 times per day. The principles of muscle training will be addressed (explained below)

Principles of Muscle Training

  • Specificity
  • Overload
  • Maintenance
  • Reversibility

Muscle Recovery

Exercises are performed until your muscles fatigue. Therefore after working the pelvic floor they will need 48 hours to recover. Pain can appear a few hours after the exercises or the next day

How do I know if I am completing my exercises correctly?

  • Your exercises should not be easy
  • Get your Chartered Physiotherapist to check you are not overworking unnecessary muscles
  • Have a review appointment with your Physiotherapist for progression
  • If getting worse stop or if unsure contact your Physiotherapist

Louise is a member of the the clinical interest group: Chartered Physiotherapists in Womens Health and Continence (CPWHC). Contact Louise for a Women’s Health appointment: 087 937 6858, lorphysio@gmail.com