Latest Research into the Pelvic Floor and Physiotherapy

The Pelvic Floor Muscles consists of four pairs of muscles which sling across the bottom of the abdomino-pelvic cavity.

They are important for:

  • supporting abdominal & pelvic viscera
  • continence
  • patients with low back pain
  • sexual response

Problems with the pelvic floor may lead to:

  • Urinary Symptoms (frequency, nocturia)
  • Voiding dysfunction (hesitancy, straining)
  • Incontinence
    – Genuine stress incontinence
    – Urge incontinence / urge
  • Prolapse
  • Ano-rectal symptoms
  • Back pain

Pelvic Floor Muscle exercises prescribed by a physiotherapist form the mainstay of conservative treatment for women with pelvic floor dysfunction such as urinary incontinence or pelvic organ prolapse.

Research has shown that many women are unable to contract the correct muscles on verbal instruction. An effective pelvic floor muscle contraction increases the urethral pressure without significant Valsalva effort (Note: A Valsalva effort (breath holding or bearing down) may have negative long term implications for prolapse and continence as the increased intra-abdominal pressure can actually depress, and therefore further weaken, the pelvic floor muscles.)
Studies have shown that on testing pelvic floor contraction (with verbal instruction) in women with urinary incontinence and prolapse:

– 26-49% could produce an effective contraction
– 25-39% used a Valsalva effort (incorrect contraction)

A recent study in 2003 of 104 women with incontinence and prolapse, asked to draw in and lift their pelvic floor muscles, resulted in 38% elevating, 19% not changing, and 43% depressing the pelvic floor (Thompson and O’Sullivan ’03).
In order to retrain a correct Pelvic Floor Muscle Contraction we need to know whether the bladder neck is elevating, depressing or not moving. There are two methods for assessing this – Digital vaginal palpation and Real-Time Ultrasound Imaging (RTUI).

RTUI (trans abdominal) has the following advantages;

  • Immediate visual feedback to therapist and patient,
  • Assesses for an ‘elevating’ contraction of the pelvic floor muscles,
  • Totally non-invasive (trans abdominal),
  • Picture easy to understand,
  • Improved proprioception for the patient (easier to learn the contraction)

We offer real time ultrasound imaging with specifically trained and qualified staff. If you suffer from incontinence (when you laugh or run), urge (desperately needing to go) or frequency (having to go again ten minutes after you have just been), or if you have a prolapse, then pelvic floor retraining with RTUI may be able to assist you. Breathing retraining may also be part of your rehabilitation program.