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Pelvic Floor Rehabilitation

8 February 2024

Aging is accompanied by a functional decline, including the functioning of sphincters, the muscles that enable continence and evacuating. They are part of pelvic floor structure.

Incontinence is common among women and the most common pathology of the pelvic floor. Prevalence was found to increase with age.

Here are some things you can do if you feel your continence declines:

  1. A physiotherapist examination and assessment, including function assessment and internal examination to assess the pelvic floor condition.
  2. Pelvic floor muscle training to strengthen it and improve continence.
  3. Practice of various techniques to hold back evacuation.
  4. In case of inconsistence due to function decline: proactive evacuation at a predetermined time and proper evacuation habits.
  5. Keep comfortable clothing you can easily take off (for example, pants with elastic waistbands).
  6. Adjust the environment so the older adult can reach the toilet easily and safely, especially at night: adjust the height of the bed, use of walking or mobility aids, installation of night lighting and clear signage in the corridor, etc.
  7. It is recommended to avoid using diapers as much as possible and establish drinking, eating and evacuating habits. When using diapers or other absorbent products, it is important to maintain hygiene to avoid urinary tract infections and jock itch.
  8. Regulate bowel activity to prevent constipation.

Aging is accompanied by a functional decline, including the functioning of sphincters, the muscles that enable continence and evacuating. They are part of pelvic floor structure.

What is the pelvic floor?

A hammock-like network of ligaments and muscles. It is located at the lower part of the pelvic in both women and men and helps “pad” it from the inside.

The abdominal organs are located on these muscles, as well as three systems:

  • The lower urinary tract: bladder and urinary duct.
  • The sexual and reproductive system: the uterus, fallopian tubes, and ovaries. The cervix is connected to the vagina.
  • The lower gastrointestinal (GI) tract: rectum and anus.

Pelvic floor functions

  1. Supporting internal organs.
  2. Voluntary sphincter muscle control (the pelvic floor muscles surround the vagina and anus).
  3. Part of the sexual function.

As we grow older, our muscles weaken and become less elastic. It can lead to problems such as difficulty holding back, pelvic organ prolapse, and urinary incontinence.

Urinary incontinence is the most common problem of the pelvic floor in women. The prevalence of the phenomenon increases with age.
Urinary incontinence negatively affects the quality of life in several ways: mobility impairment, sexual function impairment, emotional distress, and risk of depression.

Studies have found that urinary incontinence is associated with functional decline in older women. It may be functional incontinence—difficulty to reach the toilet in time, undress quickly enough, or sit safely on the toilet. NICE found between urinary incontinence and falls. It may be a two-way link: function decline may lead to urinary incontinence and vice versa. Men and women who suffer from incontinence tend to be more active to be around a toilet, and the intense activity itself is a risk factor for falls.

Studies about women in medical and community institutions found that incontinence, and mostly urge urinary incontinence (UUI), is a risk factor for falls in older adults. The studies also found a link between UUI and recurring falls (V. Morris, 2007).

Sphincter problems may be embarrassing, and some patients avoid reporting them, which is shame. It is important to report them to caregivers, as the involvement of several professionals can bring good results and improve the quality of life.

Physiotherapy for urinary incontinence and for pelvic floor rehabilitation is recommended as an initial treatment by all professional establishments and can be received at any age.

What can you do?

  1. A physiotherapist examination and assessment, including function assessment and internal examination to assess the pelvic floor condition.
  2. Pelvic floor muscle training to strengthen it and improve continence.
  3. Practice of various techniques to hold back evacuation.
  4. In case of inconsistence due to function decline: proactive evacuation at a predetermined time and proper evacuation habits.
  5. Keep comfortable clothing you can easily take off (for example, pants with elastic waistbands).
  6. It is time to adjust the environment so the older adult can reach the toilet easily and safely, especially at night: adjust the height of the bed, use of walking or mobility aids, installation of night lighting and clear signage in the corridor, etc.
  7. You may rely on caregivers (assistants/nurses) that will help the older adult evacuate at predetermined times, regardless of whether the older adult feels the need to evacuate at a specific time. This method can reduce the number of cases of inconsistence by 50%.
  8. Instruct the staff to help older adults with evacuation as quickly as possible.
  9. It is recommended to avoid using diapers as much as possible.
  10. Regulate bowel activity to prevent constipation.
  11. When using diapers or other absorbent products, it is important to maintain hygiene to avoid urinary tract infections and jock itch.

Conclusion

As a link was found between mobility, incontinence, and falls, we should treat them as parts of the issue and not as separate problems.

Professional literature indicates that by improving mobility and walking speed, we can reduce the number of cases of incontinence, especially when the use of medications for treating UUI is not recommended.

Consider a multi-faceted treatment, including pelvic floor rehabilitation and mobility improvement, as another tool that can help prevent falls in older adults.