Pelvic Floor Rehabilitation / Therapy Also Known As Pelvic Muscle Rehabilitation

• Do you leak urine when you cough, sneeze, exercise, or lift something?
• Do you leak urine when you feel a strong urge to go but cannot get there in time?
• Do you have to urinate frequently during the day or get up several times each night?
• Do you have an uncomfortable feeling of bulging, dropping, or pressure in your vagina?
• Do you notice any decrease in vaginal sensation?

The average bladder capacity is 10 to 20 ounces although this decreases some with age. Generally, a bladder should empty every 3 to 6 hours, or 4 to 6 times in 24 hours. It is not normal to need to hurry to the toilet if you have normal bladder function.

The pelvic floor muscles (PFM) are at the bottom of the pelvis and are shaped like a sling. This ‘sling’ is attached to the tailbone in the back and pubic bone in the front. The muscles support the bladder and also form the sphincter surrounding the urethra that controls urination. The urethra, vagina, and anus pass through small openings in this muscles group. The ‘PFM’ help maintain pressure within the urethra, which in turn prevents urine leakage and if strong, can reduce or alleviate involuntary bladder contractions associated with overactive bladder. These muscles may lose strength or become damaged due to childbirth, surgery, aging, illness, or deconditioning.

Physical floor therapy helps with muscle reconditioning. We help patients develop an individualized program for improving the function and strength of the pelvic floor. Pelvic floor exercises can help strengthen these muscles and thus help control urinary problems. Electrical stimulation of ‘PFM’ may also be utilized to strengthen and improve the function of the pelvic floor. Our equipment performs both biofeedback and electrical stimulation and measures which muscles are contracting during pelvic floor rehab exercises. We utilize this information to stimulate areas of weakness. It is also useful for treating fecal incontinence, mild pelvic descent, irritative voiding, some pelvic pain, and some sexual dysfunction.

Patients must participate in and comply with the exercises, behavior changes, and treatments. A vaginal/rectal EMG sensor measures the electrical activity of the muscles during relaxation and contraction. After the initial assessment (approximately one hour), patients are assigned daily exercises to be performed at specific intervals. Initial evaluation is normally followed by three to four weekly visits (30 to 45 minutes each) and subsequent follow-up. A typical schedule might be comprised of an initial visit, then a weekly visit for the next three weeks, the 4th visit two weeks later, a 5th visit two weeks after that, the 6th visit three weeks later, the 7th visit after three more weeks, and one or two visits a month after that. Progressive scheduling is likely to result in better outcomes when treatment is completed. The scheduling is dependent on the results of therapy, the patient’s motivation, compliance, and severity of pelvic floor dysfunction.