Presentation on theme: "Stephanie Knight Airedale General Hospital. PFMT in treatment of incontinence Abdominal muscles and continence The role of exercise Does general."— Presentation transcript:
Stephanie Knight Airedale General Hospital
PFMT in treatment of incontinence Abdominal muscles and continence The role of exercise Does general exercise improve continence status? What should we tell patients?
I leak when I run or jump I have stopped going to the gym because of leakage I can’t play in the park with my children I daren’t jump on the trampoline I don’t go to social functions/dancing
Prevention and therapy for many chronic diseases Exercise increases muscle strength & improves cardiovascular fitness Is exercise a risk factor for incontinence? Can general exercise improve continence?
28% nulliparous female athletes reported incontinence (Nygaard et al.1994) Most common with high impact, jumping, running, trampolining Possible “continence threshold” High incidence of UI in high impact sports (Jang et al. 2004)
3 Supportive Layers Endopelvic fascia Muscle layer (Levator Ani & Coccygeus) Superficial perineal muscles Additional urethral closure from striated urethral muscle, smooth muscle and vascular system
Grade A evidence for improvement of stress and mixed urinary incontinence (NICE CG40 2006) NICE recommend vaginal assessment Need to be performed correctly Incorrect technique may promote incontinence (straining/Valsalva/using other muscles)
Increase urethral pressure Elevate bladder neck Narrow the levator hiatus in AP & transverse direction Prevent descent of pelvic organs Increase “stiffness” of PFM Improve timing and coordination (the “Knack”) Improve endurance/reduce fatigue Bo K. 2004
Three layers Deepest layer Transversus Abdominis (TrA) TrA is part of core stability complex Synergist of PFM
Indirect training of PFM via abdominal muscle training (Sapsford 2001) Abdominals co-contract with PFM No 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)
Unable to provide pelvic organ support Unable to increase urethral closure pressure Unable to prevent bladder neck/urethral descent Potential to increase incontinence
Pilates Method is an exercise system focused on improving flexibility and strength for the total body The Pilates method relies on strengthening core postural muscles and developing body alignment Exercise instruction should always start with pelvic floor contraction No claims to treat incontinence
In normal activity PFM & TrA show synergistic activity to stabilise the spine Intra-abdominal pressure also increases Lee & Lee 2004 If continent urethral closure pressure increases simultaneously with IAP If PFM weak stress leak occurs Muscle imbalance “Timing” is important
Instructors focus on Abd, back,adductors, PFM Hypothesis: Pilates strengthens PFM if taught in conjunction 62 women little or no pelvic floor dysfunction 2 groups: PFMT/Pilates Strength measured with perineometer in both groups PFM symptoms/QoL improved in both-no significant difference Culligan et al. 2010
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!
Supervised Maximal contractions? Train for function Encourage long term adherence Make it FUN! Combine with other exercises Vaginal examination to ensure correct contraction NICE CG40 2006
PFMT is long term commitment Need fun ways to maintain motivation Using other muscle groups can improve concordance
No evidence that abdominal or physical exercise alone improves continence status PFMT does improve continence Teach correct PFM contraction to combine with general exercises Weight loss important Any fun activity to improve long term adherence Patients need motivation