pelvic floor mm exercise

[mumujen]

Hi all, just wonder if anyone has ever treated female with urinary stress incontinence? do you use myofeedback as a adjunct with pelvic floor mm exercise?it'll be great if anyone can share more about the Rx for incontinence in female! Thanks.

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[perfphysio]

The Myotrac group did some excellent studies in 1997 in Canberra in Australia on this specific topic. It was a sound clinical trial and you should look to them to provide some outcome data. They we aiming to develope rehab programs using myofeedback. The parent company is a Canadian one called "thought technologies"

[bender]

Last time I worked in a big hospital department with women's health physios who had years and years of experience, (ie 3 years ago), the majority of incontinence cases treated, made progress once they had learnt how to do pelvic floor exercises properly. These were taught in the first instance after, and during the course of, an internal assessment of the muscles without the use of myofeedback. I don't know why this equipment was not used. I did not have the knowledge then to be asking questions. I am only now getting back into the area myself.

[lv76]

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[tournesol]

To P.T.:

Have you instructed her to contract when these events occur (i.e. just before the actual sneeze and a few seconds after)? Also, she could be having high tone issues, which could have given the sense of weakness previously. Are you in a position to check her tone level with biofeedback? I find with my patients that once the strength is there they need instruction for the functional application of the strength, and sometimes many cues for the follow through/ compliance with this. I have had some patients, including one referred this week, with stress UI and had I not performed biofeedback I would have taken it as solely muscle weakness and not found her hypertonicity. So, of course, I am now treating that hypertonicity with eventual progression/ blending with PFM strengthening. Best of luck, and please keep us posted!

[sidney43]

I have found over many years that accurate and well performed PF exercises together with anticipatory bracing of the pelvic floor before coughing etc, is the only cure for genuine stress incontinence. However the key word is accurate. Internal assessment is vital to check tone and muscle action. If you cant do that your self, find someone who can and will give you the results. the other factor which may help is strong retraining of the transverse abdominal muscle group which will help to position the PF muscles so that their contraction is effective. good luck and keep us posted

[eils]

Yes I agree that precise voluntary activation of the pelvic floor and TA with integration into functional and more challenging positions and ADLs and education about the 'knack' / anticipatory bracing is beneficial for genuine SUI. I remember an article by Kari Bo (BMJ 1999;318:487–93) where training of the PFMs was superior to electrical stimulation and vaginal cones in
the treatment of genuine SUI.
As hypertonicity can often be missed in a diagnosis of solely PFM weakness I think that eccentric lengthening/ relaxation of the pelvic floor should also be a component of PFM exercises.
Best of luck and Thanks