Role of the pelvic floor muscles:
- Support the pelvic viscera.
- Prevention of loss of urine, gas and faeces with increase in intra-abdominal pressure eg cough, sneeze, bending, laugh, lift.
- Prevent worsening of prolapse
- Detrusor inhibition (the smooth muscle pump of the bladder).
- Be able to relax to empty your bladder and bowel properly.
- Sexual function (sensory awareness).
- Support of the pelvic floor during defaecation.
- Stability of the pelvis and the lumbar spine via co-contraction with diaphragm, transversus abdominis & multifidus.
- PFMT up to 30/day, gentle, no breath holding, hold for 10 secs
- Visualization if poor sensory awareness- patients can use a photo of the model of the pelvic floor muscles to get the brain involved.
- Functional bracing and then do safe abdominal exercises to add some increased resistance to the pelvic floor muscles
- Electrical stimulation
- Vaginal weighted cones –not a good idea when there’s prolapse or overactive pelvic floor muscles (levator spasm), pelvic pain
Role of Transversus Abdominis (TA – Deep tummy muscles)
- Co-contracts with PF ms
- Significance if draw in with TA muscles get increased tightening of an internal PF muscle (pubo-rectalis) and the anus (EAS) :
- Helps hold up prolapse
- But can cause a problem with defaecation if it doesn’t release (Pelvic dyssynergia: young women, elite athletes, wind instrument players can’t evacuate)
- Useful if urgency with bowel/poor gas control get increased closing force which increases the time to make the toilet
- Co-contracts with multifidus:
- Significance: Many patients with prolapse may have concurrent back pain which may be helped with strengthening/better activation of multifidus
- Diaphragm
- Significance: Breath awareness and correct breathing pattern very important for good muscle activation and coordination of muscles. If you breathe with a poor pattern then your diaphragm can descend and make intra-abdominal pressure worse.
- Thinking PHYSICS
- Vagina is a hernia portal
- With every action from ABOVE there must be a reaction from BELOW ie. decrease the forces down the vagina by BRACING or tightening your muscles with increased intra-abdominal pressure to give support from the levator ani and also with defaecation dynamics
- Think about my CHOOK- what is that? (Picture to come soon)
Can I repeat- always be aware about doing some down-training of the pelvic floor muscles – especially if you have prolapse and are ‘clenching’ the muscles all the time to help hold the prolapse up. A good time to do this is before and after you have voided urine or had a bowel motion to help ensure there is adequate relaxation of the muscles.
Getting closer to the end of this series of prolapse blogs.
Next to come in the next couple of blogs:
Step 4: Managing bowels well
Step 5: Move safely, avoid heavy lifting and repetitive bending AND always undertake ‘pelvic-floor safe’ exercising
And most importantly it is very important to have supervised help from your prolapse mentor to ensure you are contracting your muscles in a correct manner