Incontinence

Updated 25 July 2016

Pelvic floor rehabilitation

As the name says, the pelvic floor is the floor of the pelvis and forms a hammock, or sling, upon which our internal organs rest.

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As the name says, the pelvic floor is the floor of the pelvis and forms a hammock, or sling, upon which our internal organs rest. It is responsible for supporting our insides, and keeping our holes closed (continence). It also forms an integral part of our central ‘core’ (the new buzzword in strength and flexibility fitness training).

The pelvic floor is susceptible to all kinds of damage; pregnancy and vaginal childbirth, menopause, prolonged lifting/ standing/ carrying, and ageing all contribute to weakness and laxity (looseness).

Signs of weakness
Usually, the pelvic floor has weakened considerably before we present with problems. Signs that our pelvic floor is not functioning properly include urinary leakage (especially when we cough, sneeze, laugh, run, jump; but also if we have to go, and we have to go now!), faecal incontinence (soiling and uncontrollable wind), and decreased sexual performance/ enjoyment/ awareness/ satisfaction.

Unfortunately, many of us opt immediately for a surgical correction. Whilst very effective, this route tends to be expensive, requires convalescence time, and has known complications. A large proportion of problems can be improved/cured by some simple pelvic floor rehabilitation. Easy, cheap and with no damaging side effects.

Probably one of the major pitfalls is establishing if we are, in fact, squeezing the right muscles, and doing it properly. Clenching the buttocks will give us nice pert rear-ends, but it wont help our pelvic floors. Nor will squeezing the knees together. Another problem is that we often forget to breathe. Stopping our flow of urine on the toilet is a good way of self-assessing if we can tighten these muscles.

If in any doubt, pay a visit to a pelvic dysfunction physiotherapist, who will do an internal vaginal examination to assess the muscle function. Often some simple advice and an exercise programme are enough to get you going. Occasionally more intensive muscle re-education and rehabilitation will be necessary.

Myths and confusion
A few myths and confusions addressed:

  • We have been told for years to stop our flow on the toilet to strengthen our muscles. If we can stop/ start we are using the right muscles, but we are doing it at the wrong time, and can actually cause some urinary problems. Do a quick check to see if you can stop your flow, and then practise these contractions off the toilet.
  • We have been told to do our exercises at red traffic lights. Please remember that we usually leak when standing, so doing all your exercises sitting down doesn’t really help.
  • Going ‘just in case’ does not improve our symptoms. In fact, going just in case can decrease our bladder volumes and make us need to go more often, and more urgently. Do not go to the toilet unless you need to.
  • Hovering (like little human helicopters) is futile. We can’t get funny diseases from toilet seats, and hovering prevents our bladders from emptying properly.
  • Limiting our fluids (if we are going out and worried about needing the toilet) makes it worse – the urine is stronger and irritates the bladder more.
  • Straining on the toilet (if constipated) can be damaging. As can pushing out the urine. We should take a few more minutes and allow ourselves to pass without bearing down.

Our pelvic floor responds best to the ‘little and often’ theory. It has to work all day, so doing a ‘workout’ will tire it. Rather, try to do a few squeezes at a time, and repeat numerous times a day. Hint: find a trigger e.g. every time you drink think “fluid in… fluid out!” and do a few squeezes! And remember: you brush your teeth everyday; doesn’t your pelvic floor deserve daily input? 

(Corina Avni, pelvic dysfunction physiotherapist, Kingsbury Medical Village, Cape Town, 2008, updated 2009)

 

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Prenevin Govender completed his MBChB at the University of Cape Town in 2001. He obtained his Fellowship of the College of Urologists in 2009 and graduated with distinction for a Masters in Medicine from the University of Cape Town in 2010. His special interests include laparoscopic, pelvic organ prolapse and urinary incontinence surgery. He consults full-time at Life Kingsbury Hospital in Claremont.

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