Pelvic floor rehabilitation in women’s health

Pelvic floor rehabilitation in women’s health 

– by Ana Aguila

Pelvic floor disorders are common in women, from young age until after menopause. Their dysfunctions include incontinence, pelvic organ prolapse, painful sexual intercourse and lower back or pelvic pain.

The pelvic floor is a diaphragm of musculature supporting the bladder, uterus and bowel, which are embraced by muscular walls. The side walls of the cavity are formed by muscles that assist hip rotation, but in pelvic floor problems, our focus is on the pelvic diaphragm. It is as a diamond shape sling of muscle attached to the pubic symphysis at the front and the coccyx and its ligaments at the back.
The main role of pelvic floor muscles is to support organs, to maintain urinary and fecal continence and to provide resistance and strength during maneouvres such as lifting. Also, well-conditioned muscles play an important role during sexual intercourse and childbirth.
Dysfunctions in the pelvic floor can be caused by childbirth, hormonal imbalance, fatigue and demanding activities such as lifting heavy weights.
Symptoms may include:

• a sensation of a bulge or something coming down or out of the vagina, which sometimes needs to be pushed back
• discomfort during sex
• problems passing urine – such as slow stream, a feeling of not emptying the bladder fully, needing to urinate more often and leaking a small amount of urine when you cough, sneeze or exercise (stress incontinence)

During childbirth, the nerve that supplies the pelvic floor can be stretched or compressed and is especially at risk from with small pelvic size combined a large baby, assisted delivery and baby getting stuck. Nerve compression can be both extremely painful, and affect one of the muscles that prevents incontinence. Episiotomy during childbirth can also leave this muscle weakened and ineffective.
Prolapse of pelvic organs through the vaginal wall (pelvic organ prolapse) is common after pregnancy and childbirth due to increased abdominal pressure on the pelvic floor form the growing baby and pushing during delivery.
Muscles can repair and strengthen with training. However, before starting pelvic floor training we recommend achieving alignment and mobility of pelvis, lower back and hip joints. Once these structures are balanced, training can be established to strengthen the pelvic floor.
If you are able to perceive pelvic floor contractions and your weakness is mild, it is appropriate to start training with simple exercises.
The first exercise to help pelvic floor muscles strengthen would be simple contraction as in holding your urine in or interrupting urine flow. The contraction should be held for 5 seconds and repeated 10 times. Gradually, you will increase length of contraction from 5 seconds to 8 or 10 seconds as well as increasing repetitions to 12. It is important to avoid fatigue which is one of the factors causing urine incontinence.
However, when weakness of the pelvic floor is severe or you are not capable of contracting the pelvic floor, is advisable to use biofeedback which will help to engage the pelvic floor and train not only the muscles themselves but also helps you visualise which muscles to contract. With biofeedback you can learn about how to contract your muscles progressing onto further stages of rehabilitation.
In conclusion, an accurate physiotherapy assessment will provide you with the correct diagnosis to start rehabilitation and begin to create harmonious pelvic floor muscle stability.

References:
1. Fonti, Y; Giordano,R; Cacciatore, A; Romano, M; La Rosa, R. (2009).Post-partum Pelvic Floor Changes. Journal of Prenatal Medicine. Volume 3(54-59)
2. Marques, A; Stothers, L; Macnab, A. (December 2010). The Status of Pelvic floor muscles training for women. CUAJ. Volume 4 (issue 6), 419-424
3. Rose Day, M; Leahy-Warren, P; Loughran, S; O’Sullivan E. Community- Dwelling Women´s Knowledge. (November 2014) British Journal of Community Nursing. Volume 19, (issue 11), 534-538.