Photo: woods wheatcroft photography

Pelvic Floor Support

English: Anatomy of Urinary bladder

The pelvic floor is a group of muscles that attach in front of the pelvis at the pubic bone and extend to the back of the pelvis attaching at the tail bone or coccyx.  These muscles lay between the legs.  These muscles play an important role providing trunk stabilization as they always are contracting during standing, walking, and moving arms in front of the body or over the head.  They support the organs of the pelvic cavity which consist of the bladder, uterus, and rectum in women and the bladder, prostate, and rectum in men.  Compressive forces such as coughing, sneezing, or bowel movement will increase the pressure on the pelvic floor muscles four fold.  Gravity also is ever weighing on these muscles and increases with jumping activities such as gymnastics, volleyball, running, aerobics, and basketball.

Urinary or fecal incontinence may occur due to weakening of these muscles.  Incontinence is not normal at any age.  Night time voiding is also only normal 1x/night under age 65 and 2x/night over 65 years of age.  Night time voiding more than 1-2 times is also the result of muscle weakness.  Like any other muscle in the body, these muscles can be strengthened in 8-12 weeks with proper instruction and regular exercise.  Stress urinary incontinence occurs with laughing, coughing, running and jumping, or pressure upon these muscles.  Urge urinary incontinence occurs when women have a strong urge to void that they cannot delay.  This is often associated with a “trigger activity” such as arriving at home, jingling the house keys just prior to unlocking the front door, or hearing running water.  This is caused by bad habits that is easily corrected.  Men have total urinary incontinence for 6 months or more following prostate cancer and removal.  If they attend PT prior to surgery to strengthen the pelvic floor muscles incontinence is greatly reduced.  The 2 brave souls who called me regarding fecal incontinence had their “leaking” resolved by eliminating excess Vitamin C from their diet.

Treatment for urinary or fecal incontinence is very successful and easy.  Evaluation consists of assessing the strength of the pelvic floor muscles via pelvic exam.  Treatment consists of patient education regarding how the bladder functions.  The bladder is designed to hold 2 cups of urine, but we get our first signal to void when it is half full.   We should wait until the signal is strong and we can’t wait any longer otherwise our tolerance for holding 2 cups will decrease.  We use a Biofeedback machine which, via an internal electrode, gives the patient an auditory and visual display of the strength and length of their contraction.  Exercises begin with lying down without gravity then progress to sitting then standing.  Electric stimulation is also used to increase muscle strength and decrease inappropriate muscle activation seen in urge incontinence.  Of course the home program of strengthening the hip internal and external muscles as well as the pelvic floor muscles is the most important.

Mary Boyd, MS, PT is the owner of Mountain View Physical Therapy and a member of the Sandpoint Wellness Council.  She can be reached at 290-5575 or on the web at: www.SandpointPhysicalTherapy.com for questions.

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