Presentation on theme: "Pelvic Floor Muscle training The role of general exercise"— Presentation transcript:
1Pelvic Floor Muscle training The role of general exercise Stephanie KnightAiredale General Hospital
2Introduction PFMT in treatment of incontinence Abdominal muscles and continenceThe role of exerciseDoes general exercise improve continence status?What should we tell patients?
3What do patients say? I leak when I run or jump I have stopped going to the gym because of leakageI can’t play in the park with my childrenI daren’t jump on the trampolineI don’t go to social functions/dancingWomen leak running for leisure or for the bus. I see a lot of serious fell running women in Yorkshire who are desperate to run without the need for a thick pad. A lot of women now are more aware of the cardiovascular benefits of exercise and join the gym, but every time they do an exercise class they leak, and they stop going to the gym because of the embarrassment. Even running around with children becomes difficult. A relatively new phenomenon is the trampoline in the back garden-women with small children are tempted to join in the tramolining and find they leak, this seem to then become a challenge and they are really keen to overcome this and be able to jump on the trampoline. Leaking prevents a lot of women even enjoying parties as any dancing makes them wet. Yorkshire has a lot of Morris dancing groups and dancing with the heavy clogs is a real impcat activity.
4Physical Exercise Prevention and therapy for many chronic diseases Exercise increases muscle strength & improves cardiovascular fitnessIs exercise a risk factor for incontinence?Can general exercise improve continence?So we all know exercise is good for you, it makes you fitter, slimmer and stronger. It helps prevent many chronic diseases. Can it cause incontinence/improve continence or does th type of exercise matter.
5Is leaking with exercise a common problem? 28% nulliparous female athletes reported incontinence (Nygaard et al.1994)Most common with high impact, jumping, running, trampoliningPossible “continence threshold”High incidence of UI in high impact sports (Jang et al. 2004)Describe the concept of a continence threshold
6Barrier to physical activity With some women the fact of leakage is a barrier to exercise. I think probably the trampolining should be reserved for the children but maybe mum has been on here first.
8Anatomy of the Pelvic Floor 3 Supportive LayersEndopelvic fasciaMuscle layer (Levator Ani & Coccygeus)Superficial perineal musclesAdditional urethral closure from striated urethral muscle, smooth muscle and vascular systemDescribe the role of PFM in maintaining continence
9Pelvic Floor Muscle Exercises Grade A evidence for improvement of stress and mixed urinary incontinence (NICE CG )NICE recommend vaginal assessmentNeed to be performed correctlyIncorrect technique may promote incontinence (straining/Valsalva/using other muscles)
10How do PFM exercises work Increase urethral pressureElevate bladder neckNarrow the levator hiatus in AP & transverse directionPrevent descent of pelvic organsIncrease “stiffness” of PFMImprove timing and coordination (the “Knack”)Improve endurance/reduce fatigueBo K. 2004
14Abdominal muscle training Indirect training of PFM via abdominal muscle training (Sapsford 2001)Abdominals co-contract with PFMNo additional benefit of PFM + TrA training(Dumoulin et al. 2003)No RCT’s to show PFM can be trained indirectly (Hay Smith et al. 2009)“Paula” method also not effective(Bo et al. 2011)
15Anatomical position Unable to provide pelvic organ support Unable to increase urethral closure pressureUnable to prevent bladder neck/urethral descentPotential to increase incontinence
17PilatesPilates Method is an exercise system focused on improving flexibility and strength for the total bodyThe Pilates method relies on strengthening core postural muscles and developing body alignmentExercise instruction should always start with pelvic floor contractionNo claims to treat incontinence
18Working togetherIn normal activity PFM & TrA show synergistic activity to stabilise the spineIntra-abdominal pressure also increasesLee & Lee 2004If continent urethral closure pressure increases simultaneously with IAPIf PFM weak stress leak occursMuscle imbalance“Timing” is important
19PFMT vs Pilates exercise Instructors focus on Abd, back,adductors, PFMHypothesis: Pilates strengthens PFM if taught in conjunction62 women little or no pelvic floor dysfunction2 groups: PFMT/PilatesStrength measured with perineometer in both groupsPFM symptoms/QoL improved in both-no significant differenceCulligan et al. 2010
20Obesity and incontinence Grade A evidence that obesity increases risk for incontinence (Subak et al. 2009)Weight loss can improve continence status(Subak et al. 2002)Exercise promotes weight loss!
21Intensive PFM training SupervisedMaximal contractions?Train for functionEncourage long term adherenceMake it FUN!Combine with other exercisesVaginal examination to ensure correct contractionNICE CG
22Adherence PFMT is long term commitment Need fun ways to maintain motivationUsing other muscle groups can improve concordance
27In conclusionNo evidence that abdominal or physical exercise alone improves continence statusPFMT does improve continenceTeach correct PFM contraction to combine with general exercisesWeight loss importantAny fun activity to improve long term adherencePatients need motivation