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Stephanie Knight Airedale General Hospital.  PFMT in treatment of incontinence  Abdominal muscles and continence  The role of exercise  Does general.

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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:

1 Stephanie Knight Airedale General Hospital

2  PFMT in treatment of incontinence  Abdominal muscles and continence  The role of exercise  Does general exercise improve continence status?  What should we tell patients?

3  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

4  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?

5  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)

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8  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

9  Grade A evidence for improvement of stress and mixed urinary incontinence (NICE CG )  NICE recommend vaginal assessment  Need to be performed correctly  Incorrect technique may promote incontinence (straining/Valsalva/using other muscles)

10  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

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12  Three layers  Deepest layer Transversus Abdominis (TrA)  TrA is part of core stability complex  Synergist of PFM

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14  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)

15  Unable to provide pelvic organ support  Unable to increase urethral closure pressure  Unable to prevent bladder neck/urethral descent  Potential to increase incontinence

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17  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

18  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

19  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

20  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!

21  Supervised  Maximal contractions?  Train for function  Encourage long term adherence  Make it FUN!  Combine with other exercises  Vaginal examination to ensure correct contraction NICE CG

22  PFMT is long term commitment  Need fun ways to maintain motivation  Using other muscle groups can improve concordance

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27  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


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