SUPERVISED PELVIC FLOOR MUSCLE TRAINING

  Pelvic Floor Muscle Training (PFMT) should be offered as first line treatment for pregnant and non-pregnant women with stress, urge, or mixed incontinence, and/or pelvic organ prolapse, according to the International Consultation on Incontinence, RACGP, RANZCOG, USANZ, and the Australian Commission on Safety and Quality in Healthcare. These recommendations are based on the grade A level 1 NHMRC evidence that exists for the effectiveness of pelvic floor muscle training for women with incontinence and POP. 

A properly trained Continence and Pelvic Floor Physiotherapist will:

• ensure that pelvic floor muscle training is being done correctly, This will often require a V/E or P/R exam. About 25% of women who are handed a brochure or just given verbal instructions will perform a pelvic floor contraction incorrectly, and this can make their problem worse.
• supervise the necessary five visits over 3-6 months of training, 
• provide electrical stimulation and biofeedback where necessary, 
• fit continence or support pessaries if appropriate, and 
• advise on lifestyle modifications to complement PFMT.

Women's, Men's, and Pelvic Health Physiotherapists usually have postgraduate qualifications in this specific area of practice. Kylie and Marieke each have a Postgraduate Certificate in Continence & Pelvic Floor Rehabilitation and Kylie also has a Postgraduate Diploma in Manipulative (Manual) Therapy.

More information and patient resources for conservative management of SUI can be found here: https://www.racgp.org.au/your-practice/guidelines/handi/interventions/musculoskeletal/pelvic-floor-muscle-training-for-urinary-incontinence/

More information and patient resources for conservative management of POP can be found here: https://www.racgp.org.au/your-practice/guidelines/handi/interventions/musculoskeletal/pelvic-floor-muscle-training-for-pelvic-organ-prolapse/

Women with incontinence spend an average of 10yrs with symptoms before they seek help. You can help to identify these patients by asking a simple question at any regular health check-up (antenatal check, 6 week postnatal check, cervical screening, diabetes check, etc}: 

‘Many women in your situation can have bladder leakage. Has this happened to you in the last 3 months?”

You could follow-up with: 

“Has this happened with coughing, sneezing, straining, or exercise?” (Stress Incontinence), and

“Did it happen because you couldn’t get to the toilet fast enough?” (Urge Incontinence)

A survey of 415 middle-aged women revealed that 60% are willing to pay for treatment even if they do not have health insurance cover: https://www.alswh.org.au/images/content/pdf/other_reports/Incontinence%20Substudy%20Final.pdf

However, for those who are eligible for a Chronic Disease Management Plan, a Medicare rebate does apply. Five physiotherapy sessions over 4-6 months is usually sufficient to achieve a significant improvement or cure: https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1467-842X.2005.tb00220.xs