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Pelvic floor physiotherapy for stress urinary incontinence (SUI)

What is the Pelvic Floor?

The pelvic floor is a “hammock” of muscles that support the pelvic organs (the bladder and urethra, rectum and in women the vagina and uterus). The muscles extend from the sacrum (or tail bone) to the pubic bone at the front of the abdomen.

Weakening of the pelvic floor muscles can occur with:

  • Injuries sustained during pregnancy and childbirth
  • Pelvic surgery
  • Ageing
  • Chronic raised pressure on the pelvic floor which can be caused e.g. by
    • Being overweight
    • Chronic coughing
    • Chronic straining and heavy lifting

What are some of the potential effects of a weak Pelvic Floor in Women?

Weakness of the pelvic floor muscles in women can potentially cause and worsen problems with:

How does Pelvic Floor Physiotherapy work to treat Stress Incontinence?

By strengthening the muscles that support the bladder and the urethra, pelvic floor physiotherapy can treat problems with leakage due a rise in pressure in the abdomen (stress urinary incontinence). Both regular pelvic floor exercises as well as using a pelvic floor contraction at the time of a cough or other trigger to stress incontinence can significantly reduce leakage. In some women this can delay or avoid the need for surgical treatment for stress incontinence.

Pelvic Floor Physiotherapy

  • Strengthening the pelvic floor muscles with pelvic floor exercises (PFE) or physiotherapy is very useful in treating both urge incontinence as well as stress incontinence.
  • Exercising the pelvic floor muscles strengthens them and improves bladder control. It is crucial that the correct muscles are identified and strengthened. These are the same muscles that are used to stop the passage of wind or stop the flow of urine midstream (although this is NOT recommended to be done regularly- only as a technique to ensure that the correct muscles are being contracted). Many people have difficulty identifying their pelvic floor muscles are they are not visible externally. This is where a session with a pelvic floor or continence physiotherapist can improve the pelvic floor contraction technique and develop an individualised programme.
  • Two different types of exercises that strengthen the different types of muscle fibres in the pelvic floor (fast muscle contraction versus slow muscle contraction fibres) are taught.
  • These exercises can also be used at the time of
    • urgent need to urinate as an urge suppression strategy (see above).
    • Activities that cause stress incontinence e.g. coughing or lifting.
  • It usually takes about 6 to 8 weeks of performing regular pelvic floor physiotherapy with bladder retraining to see an improvement in symptoms with fewer leakage episodes and less urgency and frequency of urination. While some people may see improvements within even a couple of weeks, it can take 3 months or more to improve bladder control.

How are Pelvic Floor Exercises learned?

Correct technique is very important with pelvic floor physiotherapy. Many women have difficulty in identifying and contracting their pelvic floor muscles particularly as these muscles are hidden internally. This is where education by a physiotherapist specialising in PFE or a continence nurse specialist is very valuable in learning the correct technique with individualised teaching.

What if a Woman has difficulty in contracting her Pelvic Floor Muscles?

Other techniques are utilised by physiotherapists to help women identify and contract the pelvic floor muscles including biofeedback techniques and electrical stimulation therapy.

How effective is Pelvic Floor Physiotherapy in improving SUI in Women?

Pelvic floor exercises (PFE) can be very effective in treating stress incontinence especially in motivated and compliant people who are willing to commit to a training programme. Up to 75% of women can show an improvement in leakage with PFE.

How long does it take to see the effects of Pelvic Floor Physiotherapy?

The maximal benefit of PFE is seen when they have been performed for 3 to 6 months but many people will see improvement in their symptoms even after a few weeks. The best results are obtained when the exercises are carried out regularly over a prolonged period of time.