Pelvic Floor muscle exercises

Pelvic floor muscle training – more than reading a brochure

Pelvic floor muscle exercises form the basis of conservative management of stress incontinence, but they are only effective if performed correctly.

Authors of a recent evidence-based review 6 noted that the provision of adequate training is increasingly regarded as important and that verbal instruction alone is not enough for many women to successfully perform the exercises.

Patricia Neumann, the lead author of an Australian study on the costs and benefits of physiotherapy for stress urinary incontinence, agrees. “About one-third of women who are given a brochure about
pelvic floor exercises get the basic action wrong and do not do the exercises well on their own,” she says. She adds that she has seen patients who have been referred to surgery after having tried the
exercises and found them ineffective. Some of these women have then been referred to physiotherapy after failed surgery, only to find that correct pelvic floor muscle training improves their incontinence.

The benefits of first-line physiotherapy

Patricia Neumann’s study assessed the costs and benefits of physiotherapy for treating women with stress incontinence.

The women underwent an average of five physiotherapy sessions over six months. The sessions involved an assessment, instruction in the correct exercise technique by a physiotherapist trained in continence management and ongoing monitoring and encouragement.

Physiotherapy resulted in a 64% objective cure rate and there was a significant improvement in all outcomes immediately after completing the physiotherapy and at the 12 month follow-up assessment. The cost of the physiotherapy was around $300 per woman, compared to the estimated $4,000 to $6,000 for colposuspension surgery. The authors conclude, “These results provide evidence to support international recommendations that physiotherapy should be routinely implemented as first-line treatment before consideration of surgery.”

A pelvic floor muscle exercise training program

Patient referral to a physiotherapist trained in continence management ensures proper initial assessment of the problem and appropriate management. The initial assessment involves an internal examination to determine the strength of the pelvic floor muscles. Then, together with the GP, the physiotherapist can help determine the diagnosis of the condition, treat reversible causes and assess lifestyle factors, such as fluid intake. The physiotherapist can then focus on pelvic floor muscle training.

“Even once the patient has the right technique, they still need a training program,” says Patricia Neumann. “I use the analogy of the elite athlete who first needs to master the technique and then needs ongoing monitoring and supervision of their progress to obtain the right results.” After the intensive training, the exercises need to be incorporated into the patient’s lifestyle so that they’re undertaken throughout life, she explains. She adds, “Like any muscles, if you don’t use them, you lose them.”

Pelvic floor muscle exercise programs following childbirth – The Joanna Briggs Institute Systematic Review

A systematic review conducted in 2005 by the Joanna Briggs Institute 6 provides evidence that postnatal and antenatal pelvic floor muscle exercise programs improve the frequency with which
women perform the exercises, which in turn reduces the likelihood of urinary incontinence.

The JBI ‘Best Practice’ information sheet, derived from the systematic review, provides a number of key recommendations for health professionals dealing with pregnant and postpartum women:

• Ensure women are performing pelvic floor muscle exercises correctly.
• Encourage women to undertake both antenatal and postnatal pelvic floor muscle exercises.
• Pay particular attention to women with antenatal and postnatal urinary incontinence in providing advice and exercise instructions.
• Include a specific pelvic floor muscle exercise program in all antenatal and postnatal care, including at least two individual instruction sessions.
• Programs should be multi-faceted and not involve just the supply of printed information.
• Provide postpartum contact, particularly for women discharged early.
• Design realistic home programs that can be incorporated into the mother's daily routine.

6. The Joanna Briggs Institute Adelaide, Pelvic Floor Muscle Exercise. Technical Report, 2005; 9 (2): ISSN 1329-1874.