Evidence-Based: Physical Therapy Pelvic Floor

CLINICAL IMPLICATIONS OF LEVATOR FUNCTIONAL ANATOMY

Pelvic muscle exercise has been shown to be effective in
alleviating SUI in many, but not all, women.
Having a patient cough with a full bladder
and measuring the amount of urine leakage is quite
simple. If the muscle is normally innervated and
is sufficiently attached to the endopelvic
fascia, and if by contracting her pelvic muscles before
and during a cough a woman is able to decrease that
leakage, then simply learning then and how to use
her pelvic muscles may be an effective therapy.

If this is the case, then the challenge
is for the subject to remember to use this skill during
activities that transiently increase abdominal pressure.
If the pelvic floor muscle is denervated as a result of
substantial nerve injury, then it may not be possible
to rehabilitate the muscle sufficiently to make pelvic
muscle exercise an effective strategy. In order to use the
remaining innervated muscle, women need to be told
when to contract the muscles to prevent leakage, and
they need to learn to strengthen pelvic muscles.

A stronger muscle that is not activated during the time
of a cough cannot prevent SUI. Therefore, teaching proper
timing of pelvic floor muscles would seem logical as part
of a behavioural intervention involving exercise. The
efficacy of this intervention is currently being tested in a
number of ongoing randomized controlled trials. In addition,
if the muscle is completely detached from the fascial
tissues, then despite its ability to contract, the contraction
may no longer be effective in elevating the urethra or
maintaining its position under stress.

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