Pelvic Floor Reeducation For Women

• Do you experience involuntary dribbling of urine while laughing/ coughing or sneezing?
• Do you experience leaking of urine during day to day operations (when you don’t want to)?
• Are you required to wear pads or sanitary protection to manage this issue?

If you are experiencing any of the listed symptoms, you are not alone. Did you know that:

• Urinary incontinence is almost thrice as common in females than males (2,114,688 female cases each year vs. 718,430 cases in males)
• Stress urinary incontinence is the most common form of incontinence that affects almost 15 to 60% of all females at some point of their life

What is Pelvic Floor?

Pelvic floor is comprised of muscle fibers such as coccygeus and levator ani along with connective tissue to support the pelvic organs. Certain risk factors such as physiological aging, high parity, menopause, chronic metabolic disorders (diabetes), history of weight lifting or high impact exercise, morbid obesity (BMI more than 30 kg/m2), uncontrolled hypertension, surgery, trauma and long term smoking can affect the potency of muscle fibers and significantly increase the risk of urinary incontinence in females.

What are the Benefits/ Indications of Pelvic Floor Reeducation?

Traditionally, the most common indication of pelvic floor reeducation is urinary incontinence; however, it can be effectively utilized for these indications as well:

• Overactive / painful bladder
• Pelvic floor myalgia (muscle pain)
• Organ prolapse
• Chronic pain/ discomfort in other pelvic organs like vagina, buttocks and rectum
• Loss of bladder control during physical intercourse

How to Perform Pelvic Floor Reeducation?

There are 3 primary components of pelvic floor reeducation:

1. Biofeedback training
2. Muscle training
3. Neuromuscular re-education

But healthcare providers may advise other modalities of management as well such as postural exercises, behavioral therapy, massage therapies, breathing exercises, relaxation techniques and myofascial releaseBiofeedback training involves electrical stimulation to increase the subjective control over pelvic floor muscles. It is important to perform muscle training with biofeedback training in order to stimulate muscles and effectively assess the strength of contraction of pelvic muscles (it has been observed that gluteal or abdominal muscles are often mistaken for weak pelvic muscles in some cases).Muscle training exercises involve kegel exercises. You can perform muscle training by following these steps:

• Step # 1: Contract your pelvic floor muscles (around vagina and urethra). The feeling is similar to holding the stream of urine in the middle.
• Step # 2: Lift your muscles (feeling of sucking-in the muscles) and keep your pelvic muscles contracted for 5-8 seconds
• Step # 3: Let go of your muscles (or relax your pelvic floor)

Repeat this exercise at least 8-12 times a day (you can perform this exercise while lying down, sitting or standing). In order to improve the quality of results; follow these recommendations:

• Maintain normal breathing while squeezing and lifting
• Do not squeeze your buttocks
• Relax your thighs

Research data indicates that if executed properly, the positive effects of pelvic floor retraining can be seen as early as 2 – 8 weeks.

Other exercises are:

• Wall push-ups
• Extension of one leg at a time while sitting on the ball
• Rotating the shoulders while the back is supported by ball

Research conducted by Chantale Dumoulin (2) and associates suggested that 3-week pelvic floor reeducation has helped in minimizing the urinary leaking and subjective complaints. On 1-year follow-up, Dumoulin reconfirmed the strength of pelvic floor muscles and patency of urinary sphincters via sophisticated diagnostic tests.

Other Tips to Support Pelvic Floor Muscles

• Always squeeze or knack your pelvic muscles every time you cough, sneeze
• Avoid lifting heavy weights
• Avoid constipation (or excessive straining while defecation) by increasing your intake of fiber rich fruits and vegetables
• Maintain your body weight in recommended range and develop healthy habits (regular exercise and ample sleep)
• Pelvic floor exercises during pregnancy are extremely helpful in improving the performance of woman in labor. Moreover, pelvic exercises also reduce the risk of pelvic floor dysfunction after childbirth.

According to the statistics, the annual cost of urinary continence management in developed countries like United States is as high as 16 to 26 billion; but with simple lifestyle modifications and pelvic floor reeducation, you can definitely improve your health free of cost by reeducation your Pelvic Floor Muscles.References:

1. http://www.oregonurology.com/pdfs/oui-womens-health.pdf
2. Dumoulin, C., Seaborne, D. E., Quirion-DeGirardi, C., & Sullivan, S. J. (1995). Pelvic-floor rehabilitation, part 2: pelvic-floor reeducation with interferential currents and exercise in the treatment of genuine stress incontinence in postpartum women—a cohort study. Physical therapy, 75(12), 1075-1081.