1. Rationale to give to patients8
PFMT is very effective for helping stress incontinence (no need to strengthen tummy muscles) Most women can learn how to do them With practice, your pelvic floor muscles may contract automatically when you need them to stop leakage After initial strengthening training, you can move to maintenance exercises
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2. Instructions for learning the correct pelvic floor muscle contraction8
Your pelvic floor muscles go from the base of spine to the front pubic bone and act as a sling to support your pelvic organs To contract these muscles you need to squeeze your vagina and then lift up inside Hold the squeeze and lift for as long as you can, count in seconds, then let go Do not hold your breath and do not squeeze your buttocks Stopping your urine mid-flow is not advised for pelvic floor training, though this can be helpful to check you have learnt how to contract your pelvic floor
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3. Clinical examination of pelvic floor contraction9
Obtain consent to perform a vaginal examination and offer chaperone Assess evidence of pelvic organ prolapse or pelvic mass Assess pelvic floor strength by asking patient to contract pelvic floor muscles during digital vaginal examination Assess using modified Oxford grading scheme9
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Grading
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Muscle response
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0
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Nil
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1
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Flicker
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2
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Weak
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3
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Moderate
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4
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Good with lift
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5
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Strong
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4. Pelvic floor exercises
Ask how many squeeze, lift, and holds a woman can do in a row and for how long She may need to build up this strength and hold time, aiming to reach at least two sets of eight maximal contractions with 8-second hold two or three times a day It may take 12–16 weeks of exercising to see an improvement in symptoms
Maintenance: Two sets of eight maximal contractions with 8-second hold daily or at least 3 days per week |
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5. The Knack (or counterbracing) technique10
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Women can also practise performing a single ‘quick’ squeeze and lift for use before and during any activities, for example, coughing, sneezing, or lifting, that triggers their stress urinary incontinence (SUI)
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6. Online resource for healthcare professionals and patients
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