Pelvic floor is the most important area from the gynecology physiotherapy aspect, to be worked upon. It is the area that requires specific exercises as the muscles of pelvic floor are not contracted by normal exercises.
Pelvic Floor Anatomy
The pelvic floor consist of muscles that forms the fgure of eight around the vagina and anus. These muscles forms a basket that support bladder, uterus and intestines. The pelvic floor consist of both voluntary and involuntary muscles. These muscles contracts for quiet a shorter period and tend to fatigue quickly, as compared to other muscle groups.
It can be utilized in large no. of conditions as a primary modality or as an adjunct to different exercise protocols or electrotherapy modalities (TENS, IFT, SWD etc)
- Urinary incontinence : Pelvic floor exercises in the form of Kegel’s protocol is the primary modality in the management of stress, urge, or mixed, urinary incontinence.
- Pelvic prolapse
- Incontinence : Can be used as primary modality in post – prostatectomy urinary incontinence.
- Erectile dysfunction : as an adjunct to the standard treatment.
The Kegel’s Approach
Initially, a female must be aware of the sensation of pelvic floor contraction. There are different methods that can be utilized to build the awareness of the muscle contraction.
During the visit to Gynecologist
When asked she needs to squeeze her vagina around the fingers of the doctor. You will be able to appreciate the amount of force that you are generating and can also ask the doctor to give you the feedback.
During the visit to Physiotherapist
Same thing can be done while your visit to the physiotherapist, for incontinence o r for any other problem.
It can be done all alone.
During the Coitus
It can be done by contracting the pelvic floor muscles and tighten the vagina around the partner’s penis.
Intentionally stop the urine flow while urinating. This must not be done when the bladder is full as it may leads to pelvic muscle strain. Once the awareness is build then the exercises can be practiced anywhere you feel comfortable e.g. driving a car, working on computers,watching television.
These exercise can be than progresed in many different ways i.e.number of repetitions, change in position, bladder distention.
Initially, one needs to do only 5-8 repetitions (as per the protocol followed at Paschim Vihar Physiotherapy clinic). Then can be increased to 60 repetitions at one time. It can also be progressed in terms of time of single hold. Start thiese exercises with 1-2 counts hold then, progression can be made to 10 count hold. Care must be taken against holding the breath.
Initially,it can be performed in Crook lying position which can be progressed to sitting and then standing which is the most difficult position to exercise the pelvic floor musculature.
In the beginning , Kegel’s exercises must be done with the empty bladder. This is easier as well as will not put any stress on the pelvic floor musculature, whish ere already weak. Then it can also be practiced with partially distended bladder. Avoid doing Kegel’s exercises when the bladder is full which may strain the pelvic floor muscles.