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Pelvic floor therapy is indicated for persons who have problems with
the pelvic floor musculature. The most well-known problem is involuntary
urine loss or incontinence, but other complaints during urination, prolapse
of the pelvic floor, pain during sexual congress, and pain in the pelvis/
lower abdomen can be caused by poorly functioning pelvic floor muscles.
Incontinence remains the most common problem treated in a physical therapy
setting. Pelvic floor therapy is also appropriate for the other pelvic
floor complaints.
Incontinence is a widespread problem among the Dutch population and occurs
at any age and in both men and women. The best evidence for the pervasive
nature of this condition is the extensive sale of incontinence material
at drugstores. Every drop of urine or bowel movement involuntarily lost
is considered incontinence and because the subject is rather sensitive,
almost no one is incontinent but “occasionally less than dry.”
From these examples it is obvious that incontinence is a phenomenon that
affects many people, but because it is embarrassing, many sufferers do
not seek help for a long time. The average duration of complaints is two
to seven years before consulting a general practitioner, usually to find
out if incontinence material can be reimbursed by insurers. Most people
are thus surprised to learn that there are often treatment options available.
After the initial examination by the GP, the person is often referred
to a pelvic floor therapist for further treatment. In 70-80% of the referred
cases, a dramatic improvement or complete elimination of the complaints
occurs after treatment.
The pelvic floor therapist performs an extensive intake evaluation with
the client to determine if it is a case of stress incontinence (loss of
urine during situations of high intrathorax pressure such as sneezing
or jumping) or of urge incontinence (inability to retain urine during
full bladder situations or during walking, standing up or standing still)
or a combination of both situations. During the intake the client is asked
to fill in a schedule of when and how much fluid is ingested, when and
how often one urines, and when and in what situation the incontinence
occurs. This schedule gives insight into habits intended to limit the
incidence of incontinence which actually contribute to a greater risk
of bladder infections and dehydration.
The therapy can consist of bladder training which attempts to change
the amount of fluid intake and frequency of urination, and emphasizing
the complete emptying of the bladder. Additionally, pelvic floor therapy
teaches the client to control the pelvic floor musculature, where the
contraction and relaxation of the muscles is important as well as the
training of the strength, endurance and explosive use of these same fibers.
The therapist supervises the treatment in the clinic and supplements this
with a home exercise program (HEP). The HEP is extremely important because
a half-hour of exercise per week at the practice is not sufficient to
increase the strength and endurance of the pelvic floor.
The pelvic floor training can be augmented by biofeedback whereby a sensor
is inserted to measure the contraction of the muscles and is helpful during
training the tightening and relaxing of the intrapelvic muscles. Because
of the invasive nature of this method, it is applied only when the non-invasive
pelvic floor therapy yields unsatisfactory results. The use of weights
internally can also help strengthen the pelvic floor.
With full client compliance, six to nine in-practice treatments over
a three month period are usually sufficient to resolve the problem.
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