1. PELVIC FLOOR Theory update Theory update Workshop Workshop

2. What is the pelvic floor? large sling (or hammock) of muscles large sling (or hammock) of muscles attached to pelvic side walls, pubic bone in front and coccyx behind attached to pelvic side walls, pubic bone in front and coccyx behind openings from bladder (urethra), bowels (rectum) and womb (vagina) all pass through PF openings from bladder (urethra), bowels (rectum) and womb (vagina) all pass through PF

3. Female PF

5. Male PF

7. Types of incontinence Stress – most common overall, more women - pregnancy, childbirth, menopause Urge – “overactive bladder”, commonest in men and older people Mixed – symptoms of both stress & urge

8. PF weakness Constipation Constipation Chronic cough Chronic cough Pregnancy and vaginal delivery Pregnancy and vaginal delivery Prostate operations Prostate operations Being overweight Being overweight Lack of general fitness Lack of general fitness Heavy lifting Heavy lifting

9. Emptying the bladder Bladder messages brain as it fills To empty: brain sends two signals: 1. To detrusor muscles to contract 2. To outlet valve to open

10. Normal frequency 4 to 6, up to 8 times a day 4 to 6, up to 8 times a day once or twice at night once or twice at night increased frequency (without incontinence) a sign of overactive bladder (or too much tea!) increased frequency (without incontinence) a sign of overactive bladder (or too much tea!) bladder can hold a pint bladder can hold a pint bladder retraining bladder retraining

11. Exercise 1 - women Tighten the muscles around your back passage, vagina and front passage and lift up and squeeze inside as if trying to stop passing wind and urine at the same time Tighten the muscles around your back passage, vagina and front passage and lift up and squeeze inside as if trying to stop passing wind and urine at the same time Don't squeeze your legs together or tighten your buttocks Don't squeeze your legs together or tighten your buttocks If lower stomach muscles tighten at the same time that is OK If lower stomach muscles tighten at the same time that is OK Do not to hold breath: breathe normally Do not to hold breath: breathe normally 10 contractions held for 10 seconds each 10 contractions held for 10 seconds each 4 seconds rest between contractions 4 seconds rest between contractions 3 times a day 3 times a day

12. Exercise 2 - women 10 quick contractions, drawing in the pelvic floor and holding for just one second before releasing 10 quick contractions, drawing in the pelvic floor and holding for just one second before releasing Aim to do one set of slow contractions followed by one set of quick contractions three times a day Aim to do one set of slow contractions followed by one set of quick contractions three times a day

13. habit link doing them to some everyday activities link doing them to some everyday activities exercise diary? exercise diary? before and during activities that are likely to make you leak – the “knack” before and during activities that are likely to make you leak – the “knack”

14. Exercise for men Tighten and draw in strongly the muscles around the anus and the urethra all at once. Lift them up inside. Hold for 10. Tighten and draw in strongly the muscles around the anus and the urethra all at once. Lift them up inside. Hold for 10. Repeat 10 times Repeat 10 times Then 10 fast Then 10 fast i.e. same as women minus reference to vagina! i.e. same as women minus reference to vagina!

15. Biofeedback - female Techniques that increase knowledge of own body (sight, touch, sound etc) Techniques that increase knowledge of own body (sight, touch, sound etc) Mirror Mirror Partner Partner Touch between vagina and back passage Touch between vagina and back passage Thumb inside vagina Thumb inside vagina

16. Biofeedback - male Touch behind scrotum Touch behind scrotum Mirror – see scrotum and base of penis lift Mirror – see scrotum and base of penis lift

17. Other advice Reduce caffeine/fizzy drinks/alcohol for urgency Reduce caffeine/fizzy drinks/alcohol for urgency Aim to give up smoking (cough) Aim to give up smoking (cough) Drink 3-4 pints a day Drink 3-4 pints a day Avoid constipation – 5 portions of fruit & veg Avoid constipation – 5 portions of fruit & veg Avoid weight gain Avoid weight gain

18. URGE Bladder retraining Bladder retraining Record volume drank, Volume of urine, frequency Record volume drank, Volume of urine, frequency Goals – longer duration or greater volume Goals – longer duration or greater volume Sit on a hard seat or across a tightly rolled towel. This puts pressure on the pelvic floor muscles. Sit on a hard seat or across a tightly rolled towel. This puts pressure on the pelvic floor muscles. five quick squeezes of pelvic floor muscles -sends a message to bladder which helps calm it down five quick squeezes of pelvic floor muscles -sends a message to bladder which helps calm it down Distract the mind – 13 times table! Distract the mind – 13 times table!

19. Surgery for URGE Bowel wall into bladder wall (catheter) Bowel wall into bladder wall (catheter) Botox injections! Botox injections!

20. Medication STRESS: duloxetine (Yentreve™) - increasing the “tightness” of the valve in the urethra STRESS: duloxetine (Yentreve™) - increasing the “tightness” of the valve in the urethra URGE: oxybutinin (Lyrinel, Kentera), propiverine (Detrunorm), tolterodine (Detrusitol), trospium chloride (Regurin), solifenacin (Vesicare) and darifenacin (Emselex) URGE: oxybutinin (Lyrinel, Kentera), propiverine (Detrunorm), tolterodine (Detrusitol), trospium chloride (Regurin), solifenacin (Vesicare) and darifenacin (Emselex)

21. Thank you The Continence Foundation: www.continence-foundation.org.uk