World Continence Week – The week that was…better late than never

In 2010, the total financial cost of incontinence (excluding the burden of disease) was estimated to be $42.9 billion.  This applies to the estimated 4.8 million Australians currently living with incontinence.  The prevalence of urinary, faecal and mixed incontinence is estimated to increase to over 6.4 million Australians by 2030.

Pelvic Floor Muscles

Your pelvic floor muscles are layers of muscles that support your pelvic organs from the tailbone (coccyx) to the pubic bone at the front (see diagrams below). Think of them like a trampoline…

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The superficial Rectus Abdominus (six-pack muscles) down to the deepest Transverse Abdominus muscle all have a role in providing stability (ie. stiffness/control) and support to our spine. The layers of the pelvic floor muscles work together with your abdominals, diaphragm and back muscles to support, stabilise and keep your lower back strong and pain-free. The pelvic floor also prevent us from letting one rip, leaking faecal matter  or urine.

Pelvic Floor Part 1 – The Pelvic Diaphragm – 3D Anatomy Tutorial

Pelvic Floor Part 2 – Perineal Membrane and Deep Perineal Pouch

Well done if you took the time to watch the anatomical tutorials posted on YouTube (Part 1 & 2 above).  You will now appreciate that the pelvic floor musculature is the ‘real deal’, meaning, it has a very complex job every single second of the day and it is massively influenced by our surrounding anatomy in the pelvis, lower back, tummy and the diaphragm which is involved in respiration (breathing).  Believe it or not, if it all goes ‘wrong’ with the pelvic floor than you could be unfortunate enough to have poorer sexual satisfaction (seriously), a lowered capacity to control your bladder/bowel, develop breathing problems and be at greater risk of developing persistent lower back pain.

Strengthening you pelvic floor muscles is crucial so you can regain control over your bladder, bowel, sexual function (erectile or pleasure), breathing mechanics and reduce the risk of lower back pain.  

It’s very common to have weakened pelvic floor muscles as a result of the following:

  • Chronic lower back pain (Men or Women)
  • Childbirth – vaginal or C-Section delivery (Women)
  • Overweight/obese (Men or Women)
  • Menopause (Women)
  • Prostate surgery (Men)
  • Abdominal or Gynaecological surgery (Men or Women)
  • Advanced age or Elite Athletes (Men or Women)

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Physiotherapy, Real Time Ultrasound (RTUS) and Incontinence

If you are one of the estimated 4.8 million Australians that suffer with incontinence or if you have lower back pain, had a baby (trauma), lost a prostate recently or have a breathing problem (asthma, anxiety) than there are plenty of inexpensive ways to manage it so you can get back to your normal everyday life. It can be a difficult, stressful and embarrassing time when you are unsure how to manage those unfortunate accidents.

bounceREHAB Physiotherapist, Matthew Craig, states that Pelvic Floor Training programs are always tailored to the individual.

We (Physiotherapists) use Real Time Ultrasound (RTUS) which is similar to the ultrasound technology used for looking at babies (RTUS) to see exactly what is happening inside with your tummy muscles and pelvic floor muscles. RTUS is an alternative to internal examination which can be uncomfortable for the patient and not feel very ‘natural’.  Once we can see that you are activating your pelvic floor and your deeper tummy muscles together, we will teach you how to improve the endurance of these importance muscles on a daily basis at home, driving or at work. No one around you will even notice that you are exercising. Then we will advance your understanding and technique to better co-ordinate the natural breathing cycle and synchronise your breathing and pelvic floor activation during static (easy) and dynamic (more physical) activities. Independent performance of active pelvic floor strengthening exercises without instruction in correct technique is often inadequate.

Training in the correct techniques for pelvic floor muscle exercises facilitates increasing muscle recruitment, reducing hypertonus ‘spasm’ and improving speed of muscle reaction to postural loads (Newman DK 2002 and Hay-Smith 2005).

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Even if you don’t have issues with incontinence there are many preventative strategies that can help you strengthen you pelvic floor. Here is a few – eating a varied diet with lots of fruit and vegetables, drink plenty of water, lead an active lifestyle with regular exercise and practicing good/sensible toilet habits. Most people who present to our physiotherapy clinic with pelvic floor weakness will not have progressed to having incontinence. They often present to us with ongoing frustration with musculoskeletal problems such as hip/pelvis pain or back pain with activities such as running, lifting, squatting or sitting. Despite attempting physiotherapy or intervention elsewhere they have failed to adequately address their pelvic floor weakness. This is a very common portrait of individuals seeking a second opinion at bounceREHAB Physiotherapy clinic in Pyrmont.

With the introduction of the Chronic Disease Management (CDM) Plans through Medicare you now have better access to cost-effective treatment for a Physiotherapist pelvic floor muscle assessment and any associated incontinence and erectile dysfunction. Talk to your General Practitioner (GP) about your eligibility for 5 physiotherapy sessions rebated by Medicare each calendar year. Medicare will provide you with an on-the-spot rebate $53 for each physiotherapy session at bounceREHAB provided that your GP is on board with this.

Click here for more information…http://www.health.gov.au/internet/main/publishing.nsf/content/mbsprimarycare-chronicdiseasemanagement

Plenty of high quality evidence exists for many pre-operative, post-operative and non-operative training of the pelvic floor. So much evidence now exists for Pelvic Floor Training that the APA (Australian Physiotherapy Association) have been strongly advocating the government (Medicare) to make ‘Pelvic Floor Muscle Training’ with Physiotherapists an entirely separate CDM Medicare item and private health insurance code. This will allow better long-term care and cost-effective outcomes for people with incontinence, or for those undergoing procedures that cause pelvic floor problems such as prostate/abdominal/gynaecological surgery or childbirth.

Pilates-Core Programs at bounceREHAB

bounceREHAB Physiotherapists run 7 Pilates-Core conditioning classes a week. The classes consist of movements that are evidence based and well-known for turning on and strengthening your ‘core’ and pelvic floor anatomy. At the same time, you will improve your core, abdominal, lower back and limb tone and strength. A large emphasis of our programs is on corrective activation and endurance of the pelvic floor muscles. It is important that the pelvic floor engages harmoniously with the ‘deeper’ pelvic and scapular muscles. We are aiming to restore a balance of strength between your back muscles (antigravity) and your front muscles (tummy).  We modify the movements according to your current problems, injury, pain level and goals. Our groups consist of people from all walks of life. They consist of competitive triathletes, sedentary office workers, new mums, dads, baby boomers, post operative orthopaedic patients to the extremes of cancer sufferers, survivors and thrivers.

We run specialised classes for Pregnant Mum’s-to-be with Matt who has the experience of fathering 2 young children. He understands the complications of pregnancy and the requirements needed for getting a safe, but ultra-effective conditioning workout. This class is run as a circuit utilising the very popular clinical Pilates reformer, floor or mat pilates exercises, TRX suspension ropes and resistance bands, neural stretches, swiss balls, light weights and Pilates circles. We utilise pregnancy props and aides (wedges) where necessary to make the experience or sidelying more comfortable.

So, there you have it! I trust that you have gained a little bit more insight on the topic of ‘pelvic floor’.

Should you have any questions related to the topic of continence, pelvic floor activation, rehabilitation, real time ultrasound imaging, physiotherapy or pilates-core classes please feel free to contact us via email admin@bouncerehab.com.au or over the phone (02) 95717 606.

Matthew Craig

B.App.Sci (Physiotherapy)

CSCS (Strength & Conditioning Specialist)

References:

  1. Hodges P & Sapsford R (2000): Contracting of the pelvic floor muscles during abdominal maneuvers.
  2. Hodges P (2007): Postural and Respiratory functions of the pelvic floor. J Neurourol Urodyn. 26(3):362-71
  3. Continence Foundation of Australia. www.continence.org.au