1. Physiotherapy Below the Belt Pelvic Floor Exercises Joan Perkins Physiotherapist

2. Overview The Multi Functional Pelvic Floor The Multi Functional Pelvic Floor Anatomy Anatomy Types and Causes of Urinary Incontinence Types and Causes of Urinary Incontinence Impact of Chronic Diseases Impact of Chronic Diseases Identify, Ensure Correct Technique and Functionally Train Pelvic Floor Identify, Ensure Correct Technique and Functionally Train Pelvic Floor Where to access help Where to access help

3. Multi-Functional Pelvic Floor Water works control Water works control Support Pelvic Organs Support Pelvic Organs Bowel Function Bowel Function Intra-Abdominal Pressure Intra-Abdominal Pressure Sexual Role Sexual Role Sacro-Iliac Joint Stability Sacro-Iliac Joint Stability

5. Pelvic Floor Muscle Pubo rectalis Pubo rectalis Pubo coccygeus Pubo coccygeus Ilio coccygeus Ilio coccygeus Muscles and connective tissue work together Peri urethral ligament Peri urethral ligament Pubo urethral ligament Pubo urethral ligament

6. Pelvic Floor Muscles Broad flat muscle sheets that support pelvic organs Broad flat muscle sheets that support pelvic organs Sphincteric actions that contribute to Continence Sphincteric actions that contribute to Continence Provide Sacro coccygeal stability and Core stability Provide Sacro coccygeal stability and Core stability Concentric / Isometric Muscle Contraction Concentric / Isometric Muscle Contraction

7. Types of Urinary Incontinence Stress Incontinence Stress Incontinence – Urethral Hypermobility – Intrinsic Sphincter Deficiency

9. Urge Incontinence

11. Causes of Urinary Incontinence Pelvic Floor Muscles can become loose and weak Pregnancy / Labour / Menopause Pregnancy / Labour / Menopause Straining / Constipation Straining / Constipation Heavy Lifting Heavy Lifting Age Age Obesity Obesity Asymptomatic Women Asymptomatic Women Inherited Factors Inherited Factors Young, elite, female athletes Young, elite, female athletes High Impact Frequent, Intense Training High Impact Frequent, Intense Training Abdominal Curl-Ups Abdominal Curl-Ups

12. Chronic Diseases affect Urinary Incontinence Neurological Diseases – PD, MS, Stroke Neurological Diseases – PD, MS, Stroke –COPD –Arthritis –OP –LBP –Diabetes

13. PFM’s Identify Correct Muscles Identify Correct Muscles Ensure Correct Technique Ensure Correct Technique Co-Contraction PF and TA Co-Contraction PF and TA Functional Training Functional Training

14. Pelvic Floor Complex Complex Multifunctional Multifunctional Unique Unique Anatomically variable Anatomically variable Not necessarily optimal in sports women and asymptomatic women Not necessarily optimal in sports women and asymptomatic women

15. Where to get help? Continence Physiotherapist Continence Physiotherapist –Concord Hospital Joan Perkins on 9767 6183 Australian Physiotherapy Association Australian Physiotherapy Association –www.physiotherapy.asn.au www.physiotherapy.asn.au Continence Nurse Continence Nurse CFA Hotline CFA Hotline –1800 330 066 CFA Resource Catalogue CFA Resource Catalogue –Pamphlets