pelvic floor muscle rehab for pelvic organ prolapse floor...pelvic floor muscle rehab for pelvic...
TRANSCRIPT
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Pelvic Floor Muscle Rehab for
pelvic organ prolapse
Tracy O’Mahony (MISCP)
Senior Physiotherapist
(Womens and Mens Health)
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What’s prolapsing?
Uterine prolapse
Cystocele
Rectocele
Rectal prolapse
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Treatment for pelvic organ
prolapse
Physiotherapy
Pessary
Physiotherapy + pessary
Surgery
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Physiotherapy
Pelvic floor exercises
Advise
Education
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Pelvic floor exercises
place your hand on your
tummy at belly button level
pelvic floor muscle contraction
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How to rehab the Pelvic Floor
Muscles
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Pelvic Floor Muscle rehab
often thought as:
“tightening”
“lifting”
“Squeezing”
“holding”
“stopping and starting flow of
urine”
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BUT
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Smith et al (2005)
- Loaded continent & incontinent
♀ with an unexpected weight in
standing
- Continent ♀: PFM &
abdominals contract
simultaneously
- Incontinent ♀: greater raw PF &
signif greater raw Ext. Obliq
EMG activity
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- Incontinent ♀, PFM activity
seemed insufficient to maintain
continence with increased
External Oblique activity
- So, rehab with initial focus on
increasing PFM strength is
counter – productive
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Rehab of the “CORE”
Active Components of the core:
• Respiratory Diaphragm
• Pelvic Floor Muscles
• Transversus Abdominus
• Segmental Multifidus
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Bond Girls again!
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Correcting the patternWhat happened to your
abdominals earlier ?
1. Posture / positioning
2. “Let go” of abdominals
3. Abdominal breathing
4. Pelvic floor muscle contraction
5. Co – ordinate PFMC with
expiration
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Exercise Positions
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All 4’s
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Gym Ball
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Functional
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Gym
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Advise for reducing strain on
the pelvic floor
• Posture
• Toileting position
• Avoid constipation
• Avoid prolonged standing
• Avoid heavy pushing, pulling
and lifting
• Maintain a healthy body weight
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posture
Sitting
Standing
Sleeping
In / out bed
Ergonomics for work and home
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Constipation
• Never ignore an urge to stool
• Toileting position
• Adequate fluid intake
• Adequate exercise
• Diet
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Toilet positioning
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Treatment plan for all patients
includes:
• Individual pelvic floor muscle
exercise programme
• Bladder re- training
• Advise / education
• Setting realistic goals
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PILATES
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Sessions 1st visit – 1 hour
- Detailed subjective exam
- General posture and movement
Assessment
- Internal exam if consent
- Manual therapy if indicated
- Set realistic goals
- HEP and advise
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Subsequent visits every 2 – 6
weeks
Continue until improves or
plateaus
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Practical Information
Initial visit (1 hour) €65
Subsequent visits (30–45 mins)
€45
No waiting lists
Late evening and early morning
appointments available
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Referrals
Self referrals accepted (except
Faecal and men)
Referral letter desirable
• Reason for referral
• All PMH (medical and surgical)
• Current meds
• Treatment / investigation results
to date
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Other Symptoms associated
with Pelvic Floor Muscle
Dysfunction
1. Incontinence
- Urine, Faeces, Flatus
- Stress, Urgency, Mixed
- Male, Female (all ages)
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2. Pelvic organ Prolapse
3. Pelvic Pain Syndromes:
Dyspareunia, Vaginismus,
Vulvodynia, Anorectal Pain /
Anismus, chronic pelvic pain
syndrome
- Male and female (all ages)
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4. Constipation
Male and Female
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Pregnancy related Pelvic
girdle dysfunction
Back pain
Hip pain
Buttock pain
Leg pain
Pubic symphysis pain
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Pregnancy related PGP
signs
Difficulty turning in bed
Difficulty on stairs
Difficulty walking
Difficulty in / out car
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Signs of Pelvic Floor Muscle
Dysfunction
1. Hypotonic and weak
2. Hypotonic and strong
3. Hypertonic and weak
4. Hypertonic and strong
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