Pelvic Floor Stimulation

Pelvic floor stimulation, also known as pelvic floor electrical stimulation (PFES), is a form of therapy that uses electrical impulses to stimulate the muscles of the pelvic floor. The pelvic floor is a group of muscles that support the organs of the pelvis, including the bladder and rectum, and are responsible for controlling urinary and bowel function. PFES is often used to treat a variety of conditions related to pelvic floor dysfunction, such as urinary incontinence, fecal incontinence, and pelvic pain. PFES is typically administered using a small device that delivers electrical impulses to the pelvic floor muscles through adhesive pads placed on the skin. The electrical impulses mimic the signals that the brain sends to the pelvic floor muscles to contract and relax, which helps to strengthen and re-educate the muscles. This can lead to improved muscle tone, increased blood flow, and reduced muscle spasms.

One of the most common forms of PFES is Transcutaneous Electrical Nerve Stimulation (TENS). TENS uses a small device that sends electrical impulses through the skin to stimulate the nerves and reduce pain. This type of therapy is often used to treat chronic pain conditions such as lower back pain, pelvic pain and vulvodynia.

Another form of PFES is Interferential Current (IFC) therapy, which uses high-frequency electrical impulses to stimulate the deeper layers of muscle tissue. This therapy can be used to alleviate pain, improve muscle strength, and promote healing. IFC therapy is often used to treat conditions such as muscle spasms, strains, and sprains.

PFES is also useful in treating urinary incontinence, which is a common problem among women, especially after pregnancy or childbirth. The electrical stimulation can help to strengthen the pelvic floor muscles, which can improve bladder control and reduce the frequency and urgency of urination.

PFES is also used to treat fecal incontinence, which is a condition characterized by the inability to control bowel movements. The electrical stimulation can help to improve muscle tone in the rectal area and increase awareness of the muscles, which can improve bowel control.

Pelvic floor stimulation is considered to be a safe and effective treatment option for a wide range of conditions related to pelvic floor dysfunction. It is non-invasive, painless, and has few side effects. Furthermore, it can be used in conjunction with other treatment options, such as physical therapy, to enhance their effectiveness.

It’s important to note that PFES is a medical treatment and should only be administered by a licensed healthcare professional. Patients should consult with a healthcare professional before starting any form of PFES to ensure that it is safe and appropriate for them.

The pelvic floor muscles are inner muscles which aren’t noticeable either when relaxed or tensed. They make up a wide stretch of muscle sandwiched between the legs stretching from side to side under the floor of the pelvis from the pubic bone in front to the coccyx behind, which is the foot of your spine at the rear.

The pelvic floor holds all your internal organs, bladder, womb, bowel and uterus in position. The openings from your bladder (urethra), your bowels (rectum) and your womb (vagina) all exit through here. To maintain a strong pelvic floor, you have to work it.

Pelvic floor muscles are used for a number of reasons. It’s used to stop flatulence and when “holding on” with your bowels. It also supports the bladder to allow it to remain closed and halt the flow of urine. It has an influential sexual role, serving to multiply sexual stimulation for both of you during sexual intercourse. It actively tightens when you cough or sneeze to help stop any urine escape. When the muscles aren’t contracting properly you may suffer from a leaking bladder and an sudden or uncontrollable desire to urinate which is described as urinary incontinence
The effects of weakened pelvic floor muscles may include urinary or bowel incontinence. Both of these can be helped by therapeutic strengthening of these areas.

Stout pelvic floor muscles should support the extra weight of a growing baby, assist in the second part of labor and, by improving your circulation, help in repairing the perineum between the anus and vagina following birth. These areas can turn out to be weaker for many mothers when combined with with pregnancy, childbirth, aging, and being overweight.
Pelvic floor or Kegel techniques as they are sometimes referred help to return the muscles strength and stamina. When done repeatedly, these movements can help to avoid stress incontinence and maybe prolapse in later life.

Your pelvic floor muscles, as well as those of your abdomen, are important in helping to keep things moving so that your body is able to efficiently remove waste material. There are many factors that can weaken these muscles and this can lead to incontinence. Appropriate exercises can correct the problem — unfortunately many pelvic floor exercises are incorrectly carried out and actually add to the problem. This article provides the correct exercises to strengthen your pelvic floor muscles.

The rectum and anus receive what has passed through the large intestines (colon) and is ready to be eliminated. The material that passes through the colon needs to be relatively wet, bulky and soft rather than being ‘dried’ out and hard and difficult to pass. As well as this their needs to be plenty of bulk which places gentle pressure on the colon wall and this stimulates it into further appropriate action – moving the stool along towards the rectum and anus and exit.

The rectum, anus and pelvic floor muscles are an important part of the elimination process and need to function well. The pelvic floor muscles support the rectum and anus and keep these at the correct angle. They hold the anal sphincter in the best possible position to empty the rectum and they also have other roles to play. The pelvic floor muscles can be separated into lifting, opening and closing muscles. These muscles all have a role to play in the elimination process with the opening and closing muscles being used at the actual time of going to the toilet.

The lifting muscles support the organs in the pelvis as we move about and exert ourselves during the day — walking, standing, lifting, sneezing and toileting. They help keep the rectum and bladder in the ‘right place’ so that we can pass urine and feces efficiently and without straining. They give support during childbirth and are important in love making. They can be damaged or weakened by:

• Childbirth
• Straining to pass stools — particularly because of constipation
• Spinal problems
• Chronic coughs and sneezing
• Being overweight

A part of the lifting muscle is called the deep supporting sling. It surrounds the urethra (the passage from the bladder), the vagina and the anus. This muscle works when we get the feeling of lifting the vagina or anus. Like any muscle group the pelvic floor muscles respond well to exercise programs designed to improve function. These muscles need to be ‘found’ and then be worked before you can go to the toilet without straining. The deep support sling will not have good tone in the months following childbirth — whereas the opening and closing or quick actions muscles will still be maintained. This can be very confusing to mothers who have been told to squeeze their muscles in post-natal classes.

The exercises outlined below will teach you how to use the muscles around your waist to support your pelvic floor when you exert yourself or wish to defecate. The exercises are organise around the following:
• muscle awareness — feeling it working
• finding the exercise limit — so that you can maximize the sling support
• learning to force the maximum and thus take it to a higher level

Muscle awareness

Muscle awareness can be a problem for about 1/3 of women. When women are asked to squeeze up they actually bear down instead. This is the wrong action and it may actually cause more muscle weakness. Before you can build up the strength of your pelvic floor muscles you have to find out whether they are working. To do this sit on the toilet with you knees wide apart. Start the flow of urine and then try to stop it. It should stop dead and not just slow down to a trickle.

Women who ‘leak’ urine while coughing or sneezing usually have weak pelvic floor muscles.

Another way of finding out if the muscles are working is to look at them while trying to squeeze them up. You will need a mirror to do this. Prop yourself up on a bed — half sitting/half lying position. Men will need to move their penis and scrotum out of the line of vision. Watch the whole perineum as well as the anus as you ‘squeeze and lift’ and just see what happens. Everything should move in an upward direction – away from the mirror. The anus should pucker up like a purse-string being pulled tight. If they don’t seem to be working try this. Pull up as though you were about to pass wind and someone important (like the Queen or the president) has just walked into the room. Squeeze up to stop the wind from passing and making a loud and embarrassing noise. Don’t worry if you seen to be squeezing the front passage as well — it is difficult to work one without the other. Now try to hold the squeeze for a few seconds. Men seem to have less trouble than women recognizing that their pelvic floor muscles are working.

For women who have weak pelvic floor muscles (if you ‘leak’ urine while coughing or sneezing) it will probably be necessary to use your fingers to feel the muscles contracting. Prop yourself on the bed in the position described above. Use, suitably cleaned or gloved, index and middle fingers of your right or left hand (whichever suits you).

Moisten the inserting finger with a little lubricating jelly (not Vaseline or face cream as these can irritate the lining of the vagina). Gently slide your fingers into your vagina, pull your muscles up as though you need to pass water and you can’t find a toilet. Can you feel the movement? If not try the ‘stopping your wind from making a loud noise in front of the Queen or President routine’ – described above. At the same time as you are doing the ‘stop the wind’ exercise, imagine that a pin is about to prick your bottom. After you have felt the changes to the area when you are have done these exercises feel what happens when you cough — feel that downward pressure? Gently bear down as though you were going to use your bowels and feel the downward movement again. This is the opposite feeling to when you are doing the floor contraction exercises properly! Now immediately squeeze up again. You should feel a definite lifting movement — it should be upward and inward. When you can feel the muscles contracting — no matter how small the movement seems to be, you are ready to begin the exercise program.

Finding the exercise limit

When you are aware of the muscles, draw up the deep supporting sling muscle around the urethra, vagina and the anus and hold this for as long as you can — 5 – 10 seconds. Initially only hold this for a few seconds. They need to be strengthened and build their ‘staying power’. Having felt the muscles lift and contract you now need to feel just how long you can hold the contraction and lift. Weak muscles need time to recover after each contraction so you should rest for about 10 seconds between contractions.

Increasing the strength and endurance

No matter if you are able to lift the sling for 5, 10, 20 or 30 seconds only do a set of four repetitions at any one time. Gradually increase the time that you hold and lift – thus increasing your endurance. Do many sets during the day. You may need to use your fingers to assess and reassess your progress.

The increased tone and support you will gain should be sufficient to help your pelvic floor cope with bursts of heavy exertion such as controlling sneezes or lifting groceries or other objects.

In contrast to the lifting sling muscles the opening and closing muscles need to be used many more times in succession. To work these muscles you need to tighten them quickly, then, let them go. Do not tighten your buttocks. If you stand ‘pigeon-toed’ with your knees together, it will be easier to feel the sphincter muscles and harder for you to use your buttock muscles.

Keeping the pelvic floor muscles in good working order is important for effective elimination of wastes. This process can be assisted by ensuring that the material that enters the rectum and anus from the colon is relatively wet, bulky and soft rather than ‘dryed’ out and hard and difficult to pass. This will limit the straining that occurs and will limit the strain placed on the pelvic floor muscles. As well as straining at stool there are other reasons for weakened pelvic floor muscles — for women this is childbirth but it can also include being overweight, having spinal problems and chronic coughs.

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