Pelvic Floor Exercises for the Elderly You don’t have to wear your leotard! Continence Foundation of Australia SA Branch Conference 2015 Friday 15 th May.

Pelvic Floor Exercises for the ElderlyYou don’t have to wear your leotard!

Continence Foundation of Australia SA Branch Conference 2015Friday 15th May 2015Magarey Room, Adelaide Oval

Annette Innes Continence & Women’s Health Physiotherapist

Elderly?Conventionally, “elderly” has been defined as a

chronological age of 65 years old or older, while those from 65 through 74 years old are referred to as “early elderly” and those over 75 years old as “late elderly.” However, the evidence on which this definition is based is unknown….

Are muscle changes in ‘the elderly’ ageing or disuse?

Strategies will be different for active elderly, community home based and Residential low and high care categories

And the Pelvic floor….

The Pelvic Floor• You don’t have to get on the floor• It is a large area•Many don’t know it or• Try to hard or• Don’t quite get it right

PELVIC FLOOR MUSCLES LARGE Area

THE PELVIC FLOOR4 Layers - Peritoneum to Pubic Hair

Endopelvic Fascia Pelvic Ligaments, Collagen types, characteristics of fascia

Levator Ani Muscles Up to 12mm thick –Bernstein Fibre type I 70%, type II 30% important in function and retraining, characteristics of

voluntary muscles –training, disuse, specificity.Perineal Membrane, EAS External Genital Muscles –Important in sexuality

A dynamic structure more like a trampoline than a hammock or sling

diaphragm

Pelvic floor Urogenital (levator) hiatus

Abdominal muscles

IAP

IAP

(Neumann)

Pfm needs to be tensioned, springy and reactive

Pelvic Floor TrampolinePart of “The Core”

Functions of the Pelvic FloorSupport of pelvic organs – prevents prolapse of Bladder, Uterus, BowelResponsible for continence of bladder and bowelReflex contraction with increased abdominal pressure eg cough, sneeze, laugh, jump, bending and other exercisesDetrusor (muscle in bladder wall) inhibition – allows bladder filling and prevents urge incontinenceFaecal Sensation and guideSexual sensation –vaginal shape and firmnessFoetal guide during birth

Pelvic Floor Muscle Exercises

• For men too!•Squeeze and lift•Suck up inside•Men feel the penis and the scrotum lift•The opposite of pushing out a baby or a poo•Encourage automatic brace when standing •Give own program

Types of IncontinenceStress Urinary Incontinence cough, sneeze activities which increase intra-abdominal pressure No Bladder contraction Weak muscles, poor timingUrge Incontinence associated with urgency, frequency, Nocturia Bladder contraction General weakness and lack of muscle tone associated with de novo UI Worse with poor mobilityOverflow Incontinence Obstruction RetentionReflex Incontinence – Spinal cord or brain injuryFaecal Incontinence faecal consistency – constipation or loose motions Or is it poor timing and positioning

Incontinence: Prevalence and CostPrevalence Cost2010: 4.8 million Australians over

15 yrs including at least 128,473 living in Residential Aged Care

In the Community: 4.2 million – Urinary 1.3 million – Faecal Over 50% of women with

incontinence living in the community are under 50 years old

2010 $42.9 billion or approx $9,014p/p with incontinence

Includes: Health system $270.8 million Personal expenditure $191.2 million

(70% pads, 17% laundry) Productivity loss $34.1 billion Res Aged Care $1.6 billion (32% of RAC

Subsidy) Informal care (loved one) $2.7billion

Deloitte Access Economics (2011)The economic impact of incontinence in Australia. Independently prepared for the Continence Foundation of Australia

How can we help elderly men and women optimise their pelvic floor function?Some questions to consider……………..

Some elderly people are continent. Why?Can incontinence be reversed?Can pelvic floor muscles be trained when you are

old?Is it a downhill slide?Inactivity leads to...?Constipation can lead to double incontinence$$ savings can be made by improving incontinenceOther benefits of improving incontinence.....What can we do? Personalised plans following assessment

THANK YOU!

References

Du Moulin MF, Hamers JP, Ambergen AW, Halfens RJ 2009 ‘Urinary Incontinence in older adults receiving home care diagnosis and strategies’ SCAND J CARING SCI, Vol. 23(2), pp. 222-30.

Good PS, Burgio KL, Richter HE, Markland AD 2010 ‘Incontinence in older women’ JAMA, Vol. 303(21),pp. 2172-81.

Kraus SR, Bavendam T, Brake T, Greibling TL 2010 ‘Vulnerable elderly patients and overactive bladder syndrome’ DRUGS AGING, Vol.27(9), pp. 697-713.

Norton, PA 1993,’Pelvic floor disorders: the role of fascia and ligaments’ CLINICAL OBSTETRICS AND GYNECOLOGY, Vol. 36, No.4, pp. 926-938.

Sherburn M, Bird M, Carey M, Bø K, Galea MP 2011 ‘Incontinence improves in older women after intensive pelvic floor muscle training: an assessor-blinded randomized controlled trial’ NEUROUROL URODYN, Vol. 30(3), pp. 317-24.

Sherburn M, Guthrie JR, Dudley EC, O’Connell HE, Dennerstein L 2001 ‘Is incontinence associated with the menopause?’ OBSTET GYNECOL, Vol .98(4), pp. 628-33

Simard C, Tu le M 2010 ‘Long-term efficacy of pelvic floor muscle rehabilitation for older women with urinary incontinence’ J OBSTET GYNAECOL CAN, Vol. 32 (12), pp. 1163-6.