Symptoms that people with urinary incontinence experience include:
- Stress incontinence: leaking urine when coughing, sneezing, and exercising.
- Urgency urinary incontinence: not reaching the toilet in time.
- Postural urinary incontinence: leaking urine when changing posture.
- Over active bladder: regularly going to the toilet during day or night.
- Dribbling urine after been to the toilet.
- Feeling bladder has not completely emptied
What are your pelvic floor muscles?
The pelvic floor muscles are located along the floor of the pelvis. They support the pelvic organs and control the outlet (urethra, vagina, rectum) from them. These muscles can become weak and this may cause the leakage of urine. Like any other muscles in the body the more you use them the stronger they become.
What is pelvic floor physiotherapy?
Pelvic floor physiotherapy is the assessment and treatment of pelvic floor muscle problems. If you have only one or several of these symptoms, it is likely that you would benefit from improving your pelvic floor muscles.
Pelvic floor problems can occur at any age, to both men and women. The pelvic floor can be damaged or weakened by many of the normal things that happen to us through life. These can be natural events such as pregnancy, childbirth, the menopause and ageing. Other factors affect the pelvic floor, such as prostate surgery, gynaecological surgery, back injury, chronic constipation, chronic cough, obesity, heavy lifting or long periods of inactivity.
What is a pelvic floor examination?
The assessment process has two parts; the subjective and the objective.
The subjective part involves asking questions about personal details and how your problem is affecting your life. This helps the physiotherapist to understand the nature and severity of your symptoms.
The objective part is the vaginal physical examination. When doing an internal vaginal examination of the pelvic floor, the physiotherapist can feel the action of the muscle with a gloved finger inside your vagina, grade how strong it is, and how long you can hold it, and so design an individual exercise for your needs.
These examinations are very important to planning your treatment and provide the physiotherapist with a lot of information about your particular problem. They may not be necessary in every case. In situations where the client does not consent, the physiotherapist will in most cases be able to give valuable individual advice.
The examinations are done with sensitivity, attention to hygiene and according to professional guidelines. You are under no pressure to consent and may change your mind at any time. You may bring another adult with you to be present during the examination.
The risks associated with vaginal examination are for patients who currently have, or may have experienced the following:
- Have a history of miscarriages, are pregnant or who have been advised to avoid sexual intercourse whilst pregnant.
- Inflammation or infection of the vulva and vagina.
- Have, in the past 3 months, undergone pelvic surgery
- Psychosexual problems.
Can I say no?
It is understandable that some people may not want to be examined or may find the examination uncomfortable and want it to stop. Treatment is more effective with an exercise programme based on the vaginal examination.
However, the physiotherapist will still continue to give you the advice you need and encourage you to do your exercises, and will suggest alternative ways for you to assess your own technique and muscle contraction.
Patient’s symptoms may include:
- Stress incontinence
- Urinary incontinence
- Postural incontinence
- Nocturnal incontinence
- Coitial incontinence
- OAB wet/dry
Precautions and contraindications
- Pregnancy with a history of miscarriage or advice to avoid sexual intercourse
- Active infection or inflammation of the vagina/vulva
- Recent pelvic surgery/childbirth
- Psychosexual problems
- Refusal/ inability to consent
What the physiotherapy examination includes
- Obstetric history
- Gynaecologist history
- Past medical and surgical history
- Activities/ Lifestyle questions
- Bowel habit
- Bladder symptoms
- Quality of life
- Lumbo-sacral/pelvic region (musculoskeletal)
- Neurological (Dermatomes)
- Vaginal Assessment
Muscle assessment based on the ‘PERFECT’ acroym
P Performance (graded on oxford scale)
E Enduarnce (Time in seconds muscle contraction can be maintained)
R Repetitions (Number of times contraction can be repeated)
F Fast (Number of one second strong contractions)
E Elevation (Lifting posterior wall during a muscle contraction)
C Co-ordination (contraction of pelvic floor with transverse abs)
T Timing (synchronous involuntary contraction of the PFM on coughing)
How physiotherapy can help
The NICE guidelines recommend a programme of a least 3/12 to help strengthen pelvic floor muscles
Treatment is based on the PERFECT score findings which may conclude a loss of power, loss of co-ordination/timing, loss of endurance.
Pelvic floor muscle exercises prescription based on PERFECT score to be performed at least 3 times daily at for 5-6 times weekly
Biofeedback (digital, EMG, cones, mid stream stop), educator
Neuromuscular electrical stimulation for patients who are very weak, or need stimulation to engage PFM contraction.
Outcome measures are identified and used on each visit to measure results.