Pelvic floor disorders, such as urinary incontinence (UI) affect up to 37% percent of American women according to a recent study published in the Annals of Internal Medicine.¹ The Agency for Health Care Policy and Research reports that thirteen million people suffer with incontinence.² Urinary incontinence is a common form of PFD affecting men and women, young and old. Pelvic floor disorders may present as urinary incontinence, urinary urgency and frequency, pelvic organ prolapse, chronic pelvic pain, pain during pregnancy and postpartum. Women may experience urinary incontinence and pelvic pain problems across the lifespan, and men over the age of fifty may have problems with urinary urgency and frequency, and urinary incontinence. Pelvic Floor Dysfunction (PFD) may develop for a variety of reasons. Common scenarios in women are childbirth, trauma, neurologic disease, abuse or aging. In men, problems are usually related to issues with the prostate.

Urinary incontinence has many adverse effects. People will report psychological effects that leave sufferers feeling isolated, ashamed, and depressed.³ Older adults with UI are at an increased risk of falls.^4,5   UI has been associated with low back pain and respiratory disorders.^6,7

Physical therapists specially trained in the pelvic floor examination are ideally suited to evaluate and treat patients with PFD. Pelvic floor physical therapists skill and knowledge of the examination and treatment of the musculoskeletal system and the pelvic floor provides them with the tools to design a comprehensive rehabilitation program for the patient’s individual needs.

When a patient is referred to physical therapy for pelvic floor dysfunction his or her history and symptoms are discussed, medical tests results are reviewed and patient goals are established. The therapist will examine the patient’s posture for symmetry and alignment with abnormal findings in relation to the pelvis noted. The sacroiliac joint, hip joint and low back are also assessed. Strength of the abdominal muscles and lumbar spine are carefully examined, as they play an important role in lumbopelvic stability. The hip abductors and adductors, deep hip rotators, and levator ani of the pelvic floor are palpated to identify painful muscular trigger points, scar tissue, decreased myofascial mobility or shortened connective tissue which may contribute to pelvic floor dysfunction.

An internal pelvic muscle floor examination is recommended to evaluate the strength, endurance, and motor control of the pelvic floor muscles. Vaginal or rectal palpation, performed by the trained physical therapist, allows the most direct and accessible palpation of the pelvic floor muscles and coccyx. During the examination, the therapist will assess quality and strength of muscle contraction and relaxation, scar tissue and the condition of tissues and anatomical variances. The levator ani is assessed for power, endurance and its fast twitch fibers are assessed for quick contraction. Presence of a cystocele, enterocele and rectocele is noted.

The information gathered during the examination is utilized to design an individualized pelvic floor exercise program for the patient based upon their unique findings and symptoms. The physical therapist will design a rehabilitation program including exercises prescribed at an appropriate level of endurance and intensity based on the patient’s physical capabilities. The goal of the pelvic floor exercises is to increase the motor function, strength, and bulk of the muscles to close the sphincter, to improve urinary and fecal continence and to support the pelvic organs.

The comprehensive musculoskeletal examination allows the therapist to incorporate specific muscle training of weak core muscles into the rehabilitation program. The therapist may choose to utilize a variety of interventions in pelvic floor rehabilitation, such as the use of biofeedback and electrical stimulation intra vaginally or with external electrodes. Vaginal weights may be recommended for strengthening

Pelvic floor disorders such as urinary incontinence can cause much suffering, and often the suffering is silent. Patients are often embarrassed to tell their providers about this problem, thinking they may have to take medications or have surgery. Quality of life is often compromised. Pelvic floor rehabilitation has been recommended as the most effective non surgical intervention for stress urinary incontinence.⁸ Patients should be educated about the option of pelvic floor rehabilitation as a first line of intervention for UI and other pelvic floor disorders.

References:

¹ Lawrence JM, Lukacz ES, Nager CW, Hsu JW, Luber KM. Prevalence and co-occurrence of pelvic floor disorders in community-dwelling women. Obstet Gynecol. 2008 Mar;111(3):678-85.

² Overview: Urinary Incontinence in Adults, Clinical Practice Guideline Update. Agency for Health Care Policy and Research, Rockville, MD. March 1996. http://www.ahrq.gov/clinic/uiovervw.htm

³ Fonda D, Resnick NM, Kirschner-Hermanns R. Prevention of urinary incontinence in older people. Aged Care Services, Caulfield General Medical Centre, Caulfield, Victoria, Australia.

⁴ Teo JS, Briffa NK, Devine A, Dhaliwal SS, Prince RL. Do sleep problems or urinary incontinence predict falls in elderly women? Aust J Physiother. 2006;52(1):19-24.

⁵ Takazawa K, Arisawa K. Relationship between the type of urinary incontinence and falls among frail elderly women in Japan. J Med Invest. 2005 Aug;52(3-4):165-71.

⁶ Smith MD, Russell A, Hodges PW. Disorders of breathing and continence have a stronger association with back pain than obesity and physical activity. Aust J Physiother. 2006;52(1):11-6.

⁷ Eliasson K, Elfving B, Nordgren B, Mattsson E. Urinary incontinence in women with low back pain. Man Ther. 2008 Jun;13(3):206-12

⁸ Shamliyan TA, Kane RL, Wyman J, Wilt TJ. Systematic review: randomized, controlled trials of nonsurgical treatments for urinary incontinence in women. Ann Intern Med. 2008 Mar 18;148(6):459-73.

Kathleen Sinn, LPT is Center Manager with Brooks Rehabilitation - Lake Mary. 407-936-3800

Tags:

Bookmark:

Digg

Facebook

Technorati

Newsvine

Google

Related: