Physiotherapy for Incontinence in Women and Men
How to get started?
You start with an initial assessment to determine your needs. From there we help you to get back on track with movement and exercise.
At Shelbourne Physiotherapy we can provide you with a consultation using our real time ultrasound unit. This machine can accurately visualise muscles like your pelvic floor, deep abdominals and hip tendons, via pictures taken through a sound head that we place on your abdomen or pelvis (like when you see a baby in the womb). It can allow us to determine if you are able to switch on the muscles when you think you are and also to help provide live feedback to help retrain recruitment if you are not.
Who can benefit from the use of real-time ultrasound?
Ultrasound physiotherapy can be used for any muscle retraining. The most popular conditions that can be assisted by real time ultrasound physiotherapy include:
- Lower Back Pain - Transversus Abdominus & Multifidus
- SIJ Pain
- Pregnancy back pain
- Pelvic instability
- Hip Pain - Gluteal tendinopathy
- Core Exercises
- Pelvic Floor
- People with Stress/UrinaryBladder/Fecal Incontinence- both men and women
Pelvic Floor Muscle Strength Program
Shelbourne Physiotherapists are passionate about Women's Health. Holly Mallari has post-graduate training in Continence and Pelvic Floor Muscle Rehabilitation. It is very important if you have incontinence or prolapse issues that you are managed by a physiotherapist that has these post-graduate qualifications.
Conditions commonly treated by Pelvic Floor Physiotherapist include;
• stress urinary incontinence
• urge incontinence (overactive bladder)
• mixed urinary incontinence
• pelvic organ prolapse (POP)
• pelvic girdle pain (pelvic instability) ante-and postnatal
• low back pain with incontinence
Management strategies may include;
• teaching pelvic floor muscle contraction correctly via vaginal examination
• real-time ultrasound biofeedback to teach optimal motor control of the pelvic floor muscles
• individual targeted pelvic floor strength exercise program
• clinical pilates program to help bridge the gap between pelvic floor exercises in day to day pelvic floor function
• discussion of lifestyle change to help best manage the problem
• assessing how diet and fluid intake may influence their problem
• bladder training
• relaxation of the pelvic floor
• optimal defecation dynamics
Evidence supports Pelvic Floor Muscle Strength Training
The Good news is that in 2010 the Cochrane Collaboration (which puts all relevant studies together) published a review, Pelvic floor muscle training vs. no treatment, or inactive control treatments for Urinary Incontinence in women, which analysed the effectiveness of pelvic floor strengthening in stress, urge or mixed urinary incontinence.
The conclusion of this analysis was the strongest level of evidence available, which is Level 1/Grade A evidence that pelvic floor strengthening should be offered as the first line of treatment for stress, urge or mixed urinary incontinence.
In Britain the National Institute of Health recommends that all women with Stress Urinary Incontinence (SUI) considering surgery should undertake pelvic floor strengthening education from a Pelvic Floor Post Graduate trained Physiotherapist. Those clients who are unable to effectively strengthen their pelvic floor muscles to significantly reduce the symptoms of SUI are then considered for surgery.
Pelvic Floor Research
43% of subjects with incontinence and prolapse depressed their pelvic floor on ultrasound when instructed to lift (straining strategy)
Changes after Pelvic Floor Muscle strength training (RCT);
• Correct motor control action of the pelvic floor muscles (PFM)
• Increased muscle (PFM) thickness
• Decreased vaginal opening
• Shortened muscle (PFM) length
• Elevated the position of the bladder and rectum
• Increase maximal urethra closure (wee tube)
• Reduced vaginal opening and muscle length at maximum Valsalva indicating increased pelvic floor muscle stiffness
• Inhibition of detrusor (bladder) contraction (Obstetrics & Gynaecology(2010) Hoff Braekken)
Pelvic Floor muscle training versus no training, or inactive control treatments, for urinary incontinence in women
Victoria Physiotherapist Holly Mallari has received special post graduate training and can help you. To contact Holly Mallari please call 250-598-9828 and to contact Holly please call our Cook Street Clinic at 250-381-9828.