Pelvic Floor Muscles : Strenthening Exercise 2021

Pelvic Floor Muscles : Strenthening Exercise 2021
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Pelvic Floor Muscles

IT is sheath of musculofascial structure occupying the out let of pelvis and it includes all the tissues from the skin of   perineum below to the superior fascia of levator ani muscle above.

ANATOMY:

It is pierced by three canals :

  • Urethrea
  • Vaginal
  • Anal canal

STRUCTURE OF PELVIC FLOOR:

  • Skin of perineum
  • Urogential region
  • Superficial perineal pouch
  • Deep perineal pouch
  • Levator ani muscles

 

NERVE SUPPLY

  • 4th sacral nerve
  • Pudendal nerve
  • Inferior hemorrhoids nerve

 

PELVIC FLOOR MUSCLES 

 

SUPERFICIAL

Superficial transverse

Bulbocavernous muscles

Ischiocavernous muscle

Urethral sphincter

External sphincter

 

DEEP

Levator ani muscle

Pubocaccygeus

Ileococcygeus

Ischiococcygeus

 

FUNCTIONS:

Closure of pelvic outlet.

Support to the pelvic organs and viscera.

Selps in coughing sneezing and lifting activities.

Helps in micturation ,defection ,partunition by raising the intra -abdominal pressure.

Controls the sphincteric action of urethra vagina and rectum.

 

PELVIC FLOOR EXERCISES:

Pelvic floor muscle contractions can be confirmed by

Vaginal examination by physiotherapist

Self examination by patient

Hand an perineum by physiotherapist patient

Perineometer

Stop and perineum by physiotherapist patient

Perineometer

Stop and start mid stream urine

Foley’s catheter /tampon

During intercourse

EMG

Biofeedback

Teaching pelvic floor contraindications

Visualization

A  large simple diagram of the pelvis, pelvic organs levator ani muscles helps to show three openings

It also helps to show the lifting and gripping action muscles

 

LANGUAGES

Words and images are chosen  which are easily understand ask the patient tc.

Stopping /passingurine.

Stopping /passing /breaking wind.

Blowing off /parking.

Stopping diarrhea /shit /poo.

Trying to stop from leaking /wetting your pants.

Gripping to stop with a tampon falling out.

Gripping your partners penis.

 

STARTING POSITION (for sensory feed back )

Sitting on a hand chair ,learning forwards to support forewarms on kness with thighs  and feet together is theinitial starting position

 

DURATION AND REPETITION OF CONTRACTION :

During the 1st session the patient is asked to hold a contraction strongly untill she feels the muscles weakening.

The duration is timed and recorded.

Then long and strong contraindications are repeated on after the other.

Also check for contraindications of other muscles like gluteus ,hip adductors ,abdominal muscles.

 

GENERAL ADVISE

– The patient is advised to countract the pelvic floor before sneezing ,coughing or laughing cause a strong desire to void this is called as counter bracing.

 

CONTRACTIONS AND RELAXATION

Ask the patient to contract the  pelvic floor during

Passage of urine

To stop/passwind

To stop diarrhea

Quick contraction of pelvic floor by hold and relax technique can be used.

Elevator exercise:ask the patient to imagine going up in an elevator and contract her pelvic floor by gradually increasing the intensity as the lift goes up by by and floor and then to relax gradually as the lift comes down by floor.

Pelvic tilting with rotations in supine position.

About 8-12 fast contractions followed by 3-4 slow -short contractions can be done .

 

PELVIC MUSCLES STRENGTHENING EXERCISES

 

Perineometer:

Kegal device is a pneumatic device which helps to measure the pressure inside the vagina and to motivate the women

To practice pelvic floor exercises.

A compressible air filled rubber cuff was inserted into the vagina which is connected to a manometer by a rubber tubbing

Ask the women to contract her pelvic floor several times and note the highest reading in the dial also note the length

of time for which she could hold her contrctions .

It is useful as biofeed back and for motivation.

Take care that intra abdominal pressure is not measured rather than pelvic floor.

 

b. Foley’s catheter /tampon:

An air filled catheter is inserted into the vagina and the patient is asked to contract and hold the catheter against the traction  given by the therapist.

 

c.Vaginal cones :

It consists of 5-9 small cones o r cylinders ranging from 10 gm to 100gm.

They are made up of lead coated with plastic and a nylon string attached at one of tapered ends.

It is a size of  a tam pon.

The lightest cone is retained or 15 min without slipping progression is made to the next.

The helps to activate the motor units to support the cones and to increase woman’s awereness of her ability to contract the pelvic floor muscles voluntarily.

 

d . Interferential therapy :

This improves the women’s cortical   awerness and the ability to perform voluntary contraindications.

Position is in 1/2 lying position with hips and knees slightly flexed.

The electrode position should be such that the interferaence occurs at the pudendal and pelvic.

 

e. Low frequency muscle stimulation.

Faradism (surged)is used in re-education of pelvic floor muscles.

Levator  ani muscles can be contracted using vaginal or anal electrode.

Pulse width :0.1-7m/s.

Frequency:0,5-40hz.

 

f. Pelvic tilting exercises

Pelvic rolling.

Pelvic rocking with circular motion.

Postural correction by pelvic tilting in standing.

 

g. Lengthening of hip adductors :

Contract-relax techniques in cross leg sitting by pushing the knees to the floor.

Modified squatting.

Stretching  activities.

 


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