Article

Pelvic Floor Rehabilitation

Pregnancy and vaginal delivery have been considered main risk factors in the development of pelvic floor disorders and in the development of stress urinary incontinence.

In order to restore function of the pelvic floor muscles after childbirth, women in most industrialized countries have been encouraged to perform pelvic floor muscle rehabilitation.

A strong and well-functioning pelvic floor can build a structural support for the bladder and the urethra.

Postpartum pelvic floor muscle training has been demonstrated to be effective in the prevention and treatment of stress urinary incontinence in the immediate postpartum period.

The results also showed that the success of postpartum pelvic floor muscle exercise depended on training frequency and intensity.

Pelvic floor exercises using biofeedback, and electrostimulation techniques:

  • Have no side effects
  • Are non-invasive
  • Allow patients’ participation
  • Do NOT limit future treatment

Electrical Stimulation:

Transvaginal electrical stimulation is commonly used.

Intra vaginal electrical stimulation is a safe procedure.

It causes passive contraction of the pelvic floor musculature.

The mechanisms of action:

  • Increase muscle awareness, recruitment, strength and tone.
  • Inhibit involuntary detrusor contractions, increase bladder capacity and decrease the intensity of the urge sensation.

Although not well documented, electrical stimulation relieves symptoms of pelvic pain in some patients.

Indications:

  1. Pelvic floor muscle weakness
  2. Documented detrusor instability
  3. Normal sensation and reflexes
  4. Decreased anal sphincter control

Contraindications:

  1. Pacemakers
  2. Vaginal or urinary infections
  3. Pediatric patients
  4. Pregnancy
  5. Absent or diminished sensation: denervation of the pelvic floor

 

Biofeedback:

Biofeedback is a technique that uses graphs on a computer screen and sounds to help identify the muscles being trained.

It helps patients locate the pelvic muscles by changing the graph or sound when the patient squeezes or tightens the pelvic floor muscles.

It teaches the patient not to tighten other muscle groups such as the stomach muscles.

The computer records muscle activity (the contraction or strength) and displays it on the monitor.

Pelvic floor rehabilitation sessions with Electro-stimulation and Biofeedback are usually 30 minutes long.

To get the best results, the average number of sessions is 12.

Rehabilitation can be started 6 weeks after childbirth

Rehabilitation can also be done later in life