Pelvic floor dysfunction and female urinary incontinence

What is the pelvic floor?

The pelvic floor is an inportant group of muscles that connect the pubic bone to the tail bone. Together they form a hammock of muscles that support the pelvic organs (the bladder, uterus and bowel), and maintain urinary and bowel continence.

They are considered an integral part of the core, and when functioning correctly co-contract with the deepest abdominal layer, the transversus abdominis.

What causes pelvic floor dysfunction?

There are many causes. Most commonly they include pregnancy, childbirth, chronic coughing or constipation, occupations that involve repetitive heavy lifting, hormonal changes of ageing, and repetitive high impact exercises.

What are the symptoms of pelvic floor dysfunction?

This may include:

1. Urinary stress incontinence, which is leakage of urine with activities such as running, jumping, laughing.

2. Frequency or urge symptoms. This involves a frequent or strong desire to empty the bladder despite low urine volumes.

3. Pelvic organ prolapse. This can involve the uterus, bladder, or rectum and is often associated with a back pain or a heavy dragging feeling in the pelvis.

The International Continence Society estimates that up to 25% of all females experience some form of incontinence. This is estimated to be as high as 40% in early postpartum women, and 36% in peri/postmenopausal women.

A Study on elite female athletes (mean age of 19) who had not been pregnant or given birth found 28% to have some degree of stress incontinence. This was highest amongst female gymnasts, basketball, and tennis players.

How does Physiotherapy help?

A physiotherapist who has special training in pelvic floor re-education and incontinence treatment is able to assess and recommend appropriate conservative treatment. At Back in Action Physiotherapy we have a specially trained therapist to provide expert help with assessment and rehabilitation of the pelvic floor .

Physiotherapy management strategies may include pelvic muscle strengthening exercises, behavioral modifications for bladder retraining, and the use of biofeedback devices.

Many studies have demonstrated Pelvic floor strengthening alone or in combination with bladder retraining, to be a highly effective treatment for stress, urge and mixed incontinence respectively.

Training of the pelvic floor muscles during pregnancy has been found to reduce the chance of prolonged second stage labour, lower the incidence of pre and post natal stress incontinence and increase the rate at which the pelvic floor will recover to normal support and function after birth.

Knowing how to correctly perform a pelvic floor exercise is essential. Many women will perform them incorrectly with verbal instruction alone. Sometimes causing further damage.

Maintaining a strong pelvic floor at all stages of a women’s life is essential insurance against incontinence and prolapse in the menopausal and later years.