Journal of the association of chartered physiotherapists in women's health vol:99 pages:30-34
Urinary continence is the result of co-ordinated interactions between several body mechanisms. Failure of these interactive systems results in incontinence. This can be documented with simple clinical or instrumental measures.
Digital palpation of the pelvic floor muscles (PFMs) allows the evaluation of the tone, strength and coordination of the superficial and deep parts of the PFMs. Speed of contraction and endurance are also vital elements of the overall assessment.
Incontinent patients often have problems with the co-contraction between the PFMâs and abdominal muscles. Muscle contractions are inspected during voluntary and reflex contraction (e.g. coughing). An inward displacement of the perineum and a contraction of the deep abdominal muscles are considered to be normal (i.e. co-ordinated). A downward movement of the perineum and outward movement of the abdominal wall are considered to be uncoordinated. Incontinent women exhibit more pronounced coordination problems between the PFMâs and abdominal muscles during coughing then during voluntary contractions.
A clinical evaluation and inspection of PFM function (tone, strength, coordination, speed of contraction and endurance) as proposed is always necessary to teach a woman to improve the contraction of the PFMs during training.