What is Pelvic Floor Rehabilitation?

Pelvic Floor (Muscle) Rehabilitation is a non-invasive, non-surgical treatment for Pelvic Muscle Dysfunction.  Pelvic Muscle Dysfunction may include any group of clinical conditions that includes Urinary Incontinence, Fecal Incontinence, Pelvic Organ Prolapse, sensory and emptying abnormalities of the lower urinary tract, defecatory dysfunction, sexual dysfunction, and severe chronic pain syndromes,  (including vulvodynia).  The two most common and definable conditions that can benefit from a Pelvic Muscle Rehabilitation program are Urinary Incontinence and Fecal Incontinence.

Urinary Incontinence (UI) is the loss of bladder control.  Symptoms can range from mild leaking to uncontrollable wetting.  While it can occur with any age group, it becomes more common with age.  Women experience UI twice as often as men.  Approximately one person in ten over the age 65 has experienced UI.  In general, there are three classifications of Urinary Incontinence that can benefit from a Pelvic Muscle Rehabilitation program.

A Pelvic Muscle Rehabilitation program incorporates a variety of treatment techniques for Urinary or Fecal Incontinence which may include:

Electromyography (EMG) measures the muscles response to electrical activity produced by innervation or the nerve’s stimulation of the muscle.  This test is used to help detect neuromuscular abnormalities during contraction and inhibition of the muscle.  For pelvic muscle rehabilitation, Electromyography (EMG) is a method of assessing and treating pelvic muscle dysfunction.  Pelvic muscle rehabilitation may assist muscles that have increased tension even when the patient or clinician cannot detect it.  This is particularly true of pelvic floor muscles as denervation damage may lead to an impaired sensation.  High levels of resting activity and muscle spasms may only be visualized using EMG.  Muscle training that utilizes EMG may improve the effectiveness of muscle relaxation efforts while strengthening weak pelvic muscles and reducing pain.  Usually, a sensor is placed in the vagina or rectum to “pick-up” pelvic muscle activity.  External patch electrodes around the perineum can also be used.

Rectal pressure measures the resting and squeeze pressure of the anal sphincter muscles and is the most accurate way of documenting strength gains during a pelvic muscle rehabilitation program.  Rectal pressure is the only method of measuring internal sphincter resting tone in the anal canal.  Measurement of resting tone provides an assessment of the internal anal sphincter function.

Electrical stimulation can be used to assist in strengthening very weak pelvic floor muscles by involuntarily (passively) contracting the pelvic floor muscles through the transmission of electrical impulses to the pelvic muscles.  This stimulation heightens the patient’s perception and awareness of pelvic muscle activity and strengthens the muscles.  Additionally, a targeted frequency of electrical stimulation can be used to calm an overactive bladder.  The stimulation is delivered to the muscle using an intracavity (internal) vaginal or rectal sensor.  Electrical stimulation is often the first step in a pelvic muscle rehabilitation program if the pelvic floor muscles are very weak or when there is little awareness of a pelvic floor muscle contraction.  For most pelvic muscle dysfunctions, electrical stimulation does not need to be used long term.  Most research shows that once the patient can perform an effective voluntary muscle contraction with moderate strength, transitioning to an unassisted pelvic floor strengthening program is sufficient for maintaining muscle strength.

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