There is incredibly strong scientific evidence that shows Pelvic Floor Muscle Training (PFMT) is a fantastic and effective form of treatment for many pelvic floor dysfunctions, including urinary incontinence or pelvic organ prolapse. However, all of the research that has studied this is performed using participants who are able to correctly and voluntarily contract their pelvic floor. And of course, you need to be able to properly contract the pelvic floor if you want to train it and see positive results!
The problem with this?
Only about 50% of women are able to properly contract their pelvic floor!
In other words, 1 in 2 women cannot perform a proper ‘Kegel’, even with written or verbal instruction, with common errors including contraction of other muscles (abdominals, gluteals, adductors), pelvic movements, breath holding and straining.
So, how can we ensure that these women can effectively train their pelvic floor muscles and reap the enormous benefits associated with PFMT?
Enter Physiotherapy.
A brand new research study is currently in press which looked at three different approaches to best teach how to do a proper pelvic floor muscle contraction in order to then strengthen the muscles.
The study, published here, had four groups:
- A control group who received only written and verbal instruction on how to properly perform a contraction
- A group that used intravaginal electrical stimulation (where an external electrical impulse creates a muscle contraction)
- Vaginal palpation (where a trained physiotherapist facilitated a contraction via hands-on palpation of the muscle)
- Vaginal palpation with an added posterior pelvic tilt
What they Looked at:
Researchers looked primarily at the ability of the participants to properly perform a pelvic floor muscle contraction (measured by using what is called the MOS scale – the way physiotherapists measure the strength of a muscle), and then secondarily at whether or not urinary incontinence was improved. Participants were then placed in one of the four above groups for eight weeks.
Results?
Though all groups did improve with urinary incontinence, vaginal palpation with or without the posterior pelvic tilt was the most effective intervention for facilitating voluntary PFM contraction in women compared with electrical stimulation or a control group!
What does this mean?
When you have a trained physiotherapist work with you when you aren’t able to properly engage your pelvic floor muscles they can use hands-on techniques – including vaginal palpation – to create a proprioceptive stimulus that makes it much easier to learn how to properly engage the muscles and facilitate a correct contraction of the pelvic floor.
How does this work?
Simply put, the hands on aspect of working with a physiotherapist helps your neuromuscular system to adapt through what is called motor learning. In other words, by having that proprioceptive stimulus together with practice and feedback from your therapist, changes in your central nervous system occur which results in the production of a new motor skill: aka, the ‘Kegel’!
Once these neuromuscular adaptions occur, you can then participate in PFMT to work on the strength, endurance, and coordination of your pelvic floor and benefit from the many positives of doing so!
Moral of the Story?
Physiotherapy is an incredibly important part of women’s and pelvic health. We know pelvic floor dysfunctions can be treated and prevented with proper pelvic floor muscle training, but in order to be able to complete this training it is essential that women are able to properly contract their pelvic floor.
Physio can help.
Article Highlights:
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Training the pelvic floor muscles is essential for the treatment of pelvic floor dysfunctions
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However, nearly 50% of women cannot properly perform a pelvic floor muscle contraction, or ‘Kegel’ even with verbal or written instructions
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Working with a physiotherapist who utilizes hands on vaginal palpation with or without other treatment methods improves learning and facilitates proper pelvic floor muscle contractions
Cassie Dionne, PT 