Christopher Maher Urogynaecologist

Phone: (07) 3876 7272

Treatment of Urinary Stress incontinence - Conservative

PELVIC FLOOR EXERCISES

Pelvic Floor Muscles.
The pelvic floor muscles (levator ani) are a group of muscles which pass from the pubic bone to the tailbone, forming a sling which assists in supporting the pelvic organs. These muscles pass either side of the urethra, vagina and anus and contribute to the closing pressure of these outlets. Healthy muscle tone and strength can help to prevent and manage the symptoms of urinary and faecal incontinence and urogenital prolapse.

How to contract your pelvic floor.
Imagine you are trying to stop the flow of urine. Draw up the muscles around your vagina and urethra. You should feel some lift and squeeze. Draw in strongly and try to hold for a few seconds before you release. Keep your spine straight and breathe normally as you do this. You may be aware that you lower abdomen draws in gently as you contract your pelvic floor. This is normal.

How to exercise your pelvic floor muscles.
Do the same action as before, only this time more gently. This gentle lift you should be able to hold for longer. Hold this gentle contraction for as long as you are able – aim for a minute or several minutes. Repeat this gentle vaginal lift as often as you can throughout the day, but always remember to have good posture at your lower back when you do.

Brace with your pelvic floor muscles when you lift, laugh, cough, sneeze or exercise to support your pelvic organs against the increased intra-abdominal pressure of these activities.

Avoid constipation because straining to defaecate can stretch the nerves and muscles of the pelvic floor leading to weakness.

Good Bladder Habits will help your bladder control to stay normal.

• Drink 1.5 to 2 litres of fluid a day (water is best)
• Avoid "just in case visits" to the toilet- only empty your bladder when you need to
• Do pelvic floor exercises every day
• Avoid constipation
• Do some general exercise 3 times a week (walking is great)
• Stay in the healthy weight range

by Janelle Greitschus, Physiotherapist

Vaginal cones were popularised in the 90’s. They are especially beneficial in women who have trouble contracting the correct muscles. If a women can hold the cone in the vagina she is contracting the correct muscles. The cone should be retained in the vagina twice a day for 15 minutes. There are five vaginal cones in graduated weights from 15 to70grams. When the women has on two successive occasions held the cone in place she graduates to the next weight.

Electrical stimulation is taught by your physiotherapist and a probe is placed in the vagina to stimulate ( 50 Hz) the nerves to contract the pelvic floor muscles. Usually done at home twice a day for 15mins. The equipment can be hired from your physiotherapist. The efficacy of the treatment is no higher than that of Pelvic floor exercises alone. It is useful in women unable to contract their pelvic floor muscles.

A variety of surgical options exist for the surgical correction of urinary stress incontinence including:

• Anterior colporrhaphy (repair)
• Bladder neck suspensions: Burch colposuspension, Marshall Marchetti Krantz procedure
• Slings: pubovaginal slings, TVT.
• Transurethral injections: collagen, macroplastique

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