Women’s Health Physiotherapy Information and advice for women ppt

Types of incontinence • Stress leakage with effort/exertion lifting, running, jumping or with sneezing/coughing • Urge leakage with or immediately preceded by urgency often you can’t m

Women’s Health Physiotherapy Information and advice

for women

Women’s Health Physiotherapy

This booklet is designed to help you better understand some of your gynaecological problems and symptoms It contains advice and exercises which will form the basis of your physiotherapy treatment.

As part of your assessment your physiotherapist may complete a vaginal examination This will be fully discussed with you at your appointment.

If you would like any further information after reading it, please contact: Women’s Health Physiotherapy

Ground Floor, Lift Bank C

Chelsea and Westminster Hospital

369 Fulham Road

London

SW10 9NH

T: 020 3315 8404

Notes

How common is urinary

incontinence?

Estimates vary—about 10–30% of all

women have some incontinence but

only a quarter of these women seek help

Types of incontinence

• Stress leakage with effort/exertion

(lifting, running, jumping) or with

sneezing/coughing

• Urge leakage with or immediately

preceded by urgency (often you can’t

make it to the loo in time)

• Mixed leakage associated with

urgency and with exertion/effort/

sneezing/coughing

Other urinary problems

• Frequency—complaint of urinating

too often in the daytime (more than

8 times/24 hours)

• Urgency—sudden, compelling desire

to urinate which is hard to put off

• Nocturia—getting up at night one or

more times to urinate

• Combination of all three problems

Facts and figures

Normal bladder size/volume

400–600mls

Recommended fluid intake

1.5–2 litres/24 hours

3–4 pints/24 hours

Average n° of times to pass urine

4–8 times/24 hours

Average n° of times to open bowels

From 3 times/24 hours to 3 times/week

Food and drink that may irritate the bladder and increase your urgency

to urinate

• Coffee/tea (caffeine)

• Carbonated (fizzy) drinks, especially those with caffeine

• Alcohol

• Citrus juice (eg orange/grapefruit)

• Low fluid intake (concentrated urine)

• Some spicy foods

• Nicotine

Drinks that do not irritate the bladder

• Water

• Squashes in water

• Fruit teas

• Herbal tea

• Decaffeinated coffee/tea

• Non-citrus fruit juices (eg apple)

Advice for patients with urgency and/or urge incontinence

1 Try to reduce alcohol, fizzy drinks (especially Coca-Cola) and caffeine intake (or drink decaffeinated tea/ coffee)

2 Aim to drink three pints or 1–2 litres

of fluids each day, water is best

3 Try to avoid going to pass urine ‘just

in case’—only go if you need to

4 When you get the urge to urinate, try

to ‘hang on’—here are some tips: a) Keep calm—don’t panic b) Stand still or sit down c) Cross your legs

muscles

e) Wait until the urgency passes

(10–20 seconds), then carry on

with your activity

5 Try to delay going to the toilet,

gradually extending the time between

voids, up to three hours

6 If you get up in the night to empty your

bladder, don’t drink after 8:30pm

7 You will have good days and bad days

to start with but don’t give up

Pelvic organ prolapse

If you have been diagnosed with a

prolapse please read the following

information

A prolapse occurs when one or a

combination of the pelvic organs—uterus,

bladder or bowel—lose their normal

support and move out of position

Normal

Uterine prolapse Rectocele (uterus) (bowel)

Cystocele Enterocele (bladder) (small bowel)

Causes of prolapse include:

• Pregnancy and childbirth

• Ageing and menopause

• Weak pelvic floor muscles

• Constipation

• Heavy lifting

• Obesity

• Large fibroids

Symptoms include:

• Sensation of a ‘lump’ or ‘something coming down’

• Pressure, heaviness or pain in the vagina

• Backache

• Difficulty emptying the bladder/bowel

• Repeated urine infections

• Discomfort during sexual intercourse

Managing a prolapse:

• Practice pelvic floor muscle exercises regularly

• Brace (squeeze) your pelvic floor prior to coughing, sneezing, straining, running, jumping or lifting

• Avoid heavy pushing/pulling/lifting/ heavy housework

Uterus

Peritoneum Bladder

Small bowel

Large bowel Urethra

Vagina

• Avoid high-impact exercise (ie

jogging, aerobics etc) or exercise

that increases the pressure in the

abdomen (sit-ups or rowing)

• Try to avoid long periods of standing

without a break

• Avoid straining to empty your bowels,

eat a balanced diet and drink enough

fluids to prevent constipation

• Avoid smoking and chest infections—if

you get a chest infection, seek prompt

treatment to minimise coughing

• Lose weight if you need to because

this will reduce the pressure on your

pelvic floor muscles

• Sexual intercourse will not make

your prolapse worse but may be

uncomfortable—try using a vaginal

lubricant or varying positions

Opening your bowels

The following position and techniques

to open your bowels should stop you

from straining:

Position

• Legs apart

• Lean forward

• Forearms resting on knees

• Back straight

• Feet up on stool (knees a little higher

than hips)

Action

• Relax your jaw (mouth open, teeth apart)

• Bulge your lower tummy forward and make your waist wide—a pear shape

• Feel your back passage relax

• Maintain this position breathing gently

as you open your bowels

Tips to help with constipation

If you suffer from constipation or strain to open your bowels you may be weakening your pelvic floor muscles further

• Be sure to drink a minimum of 1.5–2 litres of fluid a day—try to make water

a large percentage of this

• Eat plenty of fibre (eg fresh fruit and vegetables, cereals, wholemeal breads and pasta)

• Eat breakfast after getting up and don’t miss meals during the day

• Don’t delay going to open your bowels after you have felt the urge—you are less likely to strain if your body is ready

• Give yourself time to go—do not rush

• Keep active—exercise encourages regular bowel habits

• If constipated try using natural products (eg prune juice, linseed plus, dried fruit)

Pelvic floor exercises

What is the pelvic floor?

The pelvic floor consists of layers of

muscle and ligaments that stretch like

a hammock from the pubic bone in

front to the end of the backbone and

from side to side (see diagram) Firm,

supportive pelvic floor muscles help to

hold the bladder, womb and bowel in

place, and to close the bladder outlet

and back passage

How does the pelvic floor work?

The muscles of the pelvic floor are kept

firm and slightly tense to stop leakage

of urine from the bladder and wind or

faeces from the bowel When you pass

water or have a bowel motion the pelvic

floor muscles relax

Afterwards, they tighten again to

restore control The muscles should

also squeeze when you laugh, cough or

sneeze so as to help you avoid leaking

In addition, they have an important

sexual function for both yourself and

your partner during sexual intercourse

What weakens the pelvic floor muscles?

• Pregnancy/childbirth

• Repeated straining when opening your bowels (constipation)

• Overweight

• Chronic cough

• Menopause (hormonal changes)

• High impact exercise/heavy lifting

• Medical problems Weak muscles give you less control and you may leak urine, especially with exercise or when you laugh, cough, lift

or sneeze

How can I strengthen my pelvic floor muscles?

Exercising the pelvic floor muscles (at any age) can strengthen them so that they once again give support This will improve your bladder control and improve or stop leakage of urine Like any other muscles in the body, the more you use and exercise them, the stronger the pelvic floor muscles will be

How to perform pelvic floor exercises

Sit comfortably with your knees slightly apart

Now imagine you are trying to stop yourself passing wind from the bowel

or trying to stop the stream of urine You

do the exercise by squeezing and lifting the muscles, closing and drawing up the front & back passages

Bladder

outlet

Urethra

Vagina

Bladder

Uterus (womb)

Spine

Rectum Anus Pelvic floor

muscles

Exercising your pelvic floor muscles

should not show at all ‘on the outside’

You should not pull in your tummy

exces-sively, squeeze your legs together, tighten

your buttocks-or hold your breath

There are two types of exercises:

• Slow (squeeze and lift)—Hold the

squeeze for as long as you can, up to

10 seconds, then release and rest for

four seconds (repeat 5–10 times)

• Fast—follow this with up to 10 quick

strong contractions which will help

your muscles react quickly when you

laugh, cough, sneeze, exercise or lift

Try to do these slow and fast squeezes

at least 3–5 times a day

Where do I do these exercises?

You can do your pelvic floor exercises anywhere—lying/sitting/standing—but it

is not advisable to do them on the toilet while urinating

It takes time for muscles to get stronger You are unlikely to notice any improve-ment straight away so stick at it

You will need to exercise regularly for several months before the muscles gain their full strength

Your physiotherapist will be able to check whether you are doing these exercises correctly and progress them

as appropriate for you

Notes

369 Fulham Road London

SW10 9NH

Main Switchboard

+44 (0) 20 8746 8000

Website

www.chelwest.nhs.uk

February 2011

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