We often see advertisements for panty liners or adult sanitary garments. The awareness of incontinence in the public eye is definitely increasing but at times is being promoted as a normal part of ageing, whereas in fact it may be experienced by younger people, both men and women. Indeed, there are cases where incontinence may be due to significant neural dysfunction often requiring medical intervention, or it may be related to dysfunction of the pelvic floor musculature requiring surgery. In many cases however, incontinence is related to weakness of the pelvic floor musculature (PFM) or the lesser known hyperactivity (or overuse) in the pelvic floor muscles. In these cases, men and women of all age groups may be affected.
Let’s look at general weakness initially. This may be from de-conditioning and reduced fitness of the entire body, it may be related to over stretching or tearing of the PFM during childbirth, or a pelvic torsion injury. We should aim to educate the client on the correct technique for contracting and lifting PFMs. It is important to make a thorough assessment of the client and ensure that they are not actually bearing down onto the PFM such as a Valsalva manoeuvre. Assessment can be performed by observation of the accessory muscles about the lumbo pelvic girdle (gluteals, obliques or adductors), observation of the rise or fall of the lower abdominal muscles, through Real Time Ultrasound or by guided cueing with digital examination.
Hypertonic PFM are overactive at all times and do not allow regular relaxation to occur. If contracted all of the time but slightly skewed in the alignment, then the PFM do not close and may allow a small degree of incontinence. This can be difficult to detect and may sometimes require specialist assessment by a women’s health physiotherapist.
If the PFM are weak, then gentle and carefully guided Pilates exercises are the key to engaging the transversus abdominus and the pelvic floor muscle groups correctly and in harmony. Together these two muscle groups form the basis of the core contraction, and when challenged with more advanced exercises, will develop strength and endurance.
When considering the hypertonic PFM, we must realise that they are acting in an overactive way. So our goal will be to firstly relax the muscles and then develop dynamic function. Again Pilates exercises may be used where specific muscles groups require lengthening and relaxing, allowing the neuromuscular system to better process PFM sequencing.
So continence issues may present in the form of too weak or too active. Either way a correct assessment needs to be performed initially to determine the actual state of the PFM and their ability to contract without load. Pilates exercises may then be introduced under a specific and supervised program, so that the client can correct their PFM technique and then work on improving functionality and endurance.
Jen Guest Bach App Sc (Physiotherapy)
Senior Educator Polestar Pilates Education
Image credit: Vampy1
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