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.
It is pierced by three canals :
- Anal canal
STRUCTURE OF PELVIC FLOOR:
- Skin of perineum
- Urogential region
- Superficial perineal pouch
- Deep perineal pouch
- Levator ani muscles
- 4th sacral nerve
- Pudendal nerve
- Inferior hemorrhoids nerve
PELVIC FLOOR MUSCLES
• Superficial transverse
• Bulbocavernous muscles
• Ischiocavernous muscle
• Urethral sphincter
• External sphincter
• Levator ani muscle
• 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
• Stop and perineum by physiotherapist patient
• Stop and start mid stream urine
• Foley’s catheter /tampon
• During intercourse
• Teaching pelvic floor contraindications
• 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
• 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.
– 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
• 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.
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.