Pelvic Floor Rehabilitation for Urinary Incontinence

What is Pelvic Floor Rehabilitation?

This treatment aims to restore the function and capacity of the pelvic floor muscles and other structures via exercise, voluntary movements and other techniques that re-establish the “strength” of contractions and tissue tone, thus reducing urinary issues.

The pelvic floor is a kind of support comprising a series of muscles, ligaments, tendons and fascias that ensure the position of organs like the bladder, intestines, urethra and, in women, the uterus.

These structures are elastic, ideally very firm and are able to move and contract. These movements are necessary so that urine, faeces and gases are not expelled involuntarily.

Besides these characteristics, these muscles and other structures contribute to sexual sensitivity and stimulation in both sexes and also help to achieve erections and ejaculation.

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What is the Pelvic Floor Rehabilitation Procedure?

It is essential that the pelvic structures relax so that the muscles are not always contracted, which can harm the functions of the pelvic floor.

The opposite is also essential, i.e. if the muscles are always relaxed and cannot contract, the right degree of urinary continence cannot be achieved. It is therefore important to re-establish the normal function and capacity of the pelvic muscles via physiotherapy.

Physiotherapy in Pelvic Floor Rehabilitation

Physiotherapy of the pelvic floor is important. Patients use specific techniques to minimise the consequences of the causes leading to incontinence – both in men and women.

Besides encouraging bodily awareness, manual manipulation techniques are used to recruit different muscle groups, correct posture, etc.

In addition to exercises and methods, suggestions are made about changing habits and behaviours. This may involve, for example:

Behavioural and dietary changes;
Ingestion of liquids at the recommended daily quantity and intervals;
Control of toilet visits – 6–8 urinations per day.

The most important effort is not just made during physio sessions. It is essential that patients do exercises by themselves at home during the day and outside physio, as the results depend heavily on individual effort.

Kegel exercises

These were created by Arnold Kegel and are designed to develop strength and the normal functioning of the pelvic floor in the aim of mitigating urinary symptoms, incontinence in particular. These exercises often also improve sexual performance.

The exercises are simple and based on squeezing and releasing the muscles in the pelvic, perineal and perianal region. They should be done every day to ensure the tissue is strengthened and toned and to achieve the results intended.

Electrostimulation and Biofeedback

In addition to “classical” physio exercises and techniques, it is essential to complement pelvic floor rehabilitation with electrostimulation and biofeedback.

The former consists of stimulating the pelvic muscles with very low voltage “micro shocks” that stimulate their development, tone and contraction capacity.

With biofeedback, the aim is to teach patients to contract the right muscles at the right time so that they can do so at times when leakage occurs, thus avoiding incontinence.

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What is the Post-Treatment?

Patients receive advice from physiotherapists to continue and motivate pelvic muscle strengthening exercises at home.

This advice includes the frequency with which the exercises should be done, how long the recommended contractions should be held, how often to repeat them and other key points.

This process is entirely the patient’s responsibility, so the results depend heavily on the amount of effort and dedication expended daily.

Dr. José Santos Dias

Clinical Director of the Instituto da Próstata

Bacherlor's Degree from the Faculty of Medicine at the University of Lisbon
Specialist in Urology
Fellow of the European Board of Urology
Autor dos livros "Tudo o que sempre quis saber Sobre Próstata", "Urologia fundamental na Prática Clínica", "Urologia em 10 minutos","Casos Clínicos de Urologia" e "Protocolos de Urgência em Urologia"

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