Pelvic floor therapy is a relatively new modality in urology that has demonstrated good success with a variety of pelvic floor conditions. It has been shown to be helpful in stress incontinence, urge incontinence, chronic vaginal pain, interstitial cystitis, prevention of vaginal prolapse, and others. it is also useful in male incontinence, especially after radical prostatectomy for prostate cancer.
Pelvic floor therapy covers a variety of exercises all designed to strengthen and improve pelvic floor muscles. It can involve three aspects under different names.
Kegel exercises can help to improve pelvic organ prolapse, depending on the severity, and may slow progression of the condition. Success of these exercises depends in part on proper execution. First, the patient must be able to locate the correct muscle group by stopping or slowing the flow of urine without tensing leg muscles, or the patient can visualize squeezing the rectal muscles as if to prevent a bowel movement.
There are two types of Kegel exercises:
- Quick contractions – rapidly tighten and relax the sphincter muscle
- Slow contractions – contract the sphincter muscle and hold to a count of 3, gradually increasing to a count of 10
Exercises should be performed 10 to 15 times per session, at least 3 times each day.
Biofeedback may be used with Kegel exercises to reinforce proper technique. Patients visualize and identify the pelvic floor and abdominal muscles that are contracted during the exercises.
A simple instrument records small electrical signals that are produced when the muscles contract. The signals are instantly converted into audio and/or visual signs that help patients gain greater control over urinary and bowel muscle activity. Weak muscles can be activated on demand, tense muscles can be relaxed, and muscle activity can be coordinated using biofeedback.
Neuromuscular electrical stimulation (NMES) may be used, in some cases, to retrain and strengthen weak pelvic floor muscles, which can improve bladder control. Electrical stimulation of nerves in the pelvic area (e.g., the pudendal nerve) causes pelvic floor, urethral and anal sphincter muscles to contract. A probe is inserted into the vagina and a current is passed through the probe at a level below the pain threshold, causing a contraction. The patient is instructed to squeeze the muscles when the current is on. After the contraction, the current is switched off for 5 to 10 seconds. Treatment sessions lasts approximately 20 to 30 minutes.
The use of Kegel exercises, biofeedback, and electrical stimulation often are taught and monitored by specialty trained personnel.
In our office, PFT is administered once a week for anywhere from six to ten weeks depending on patient response and results.
Points to Remember
- No injections or drugs are administered
- You can drive yourself to and from the office
- You can return to normal activity right after the therapy
- No diet or activity restrictions
- It is important to continue the exercises at home
Medicare does cover the treatment, commercial insurance needs pre-approval before the treatment starts.
For men who have post prostatectomy incontinence