【Health Lecture】How much do you know about pelvic floor rehabilitation

In order to ensure the popularization effect of learning health knowledge in the "2024 China Elderly Health Knowledge Competition", the organizer has collected various health science articles suitable for the elderly from various hospitals, and we will share them through the "Health Lecture" column. Today, Mr. Ye Miao, deputy director of the Second Department of Physical Therapy (PT2 Department) of the China Rehabilitation Research Center, brought us: "How much do you know about pelvic floor rehabilitation", and welcome elderly friends to learn. Whether it is a simple squat to lift objects in daily life, or putting on your favorite running shoes to start running on a pleasant weekend, or picking up the long-lost skipping rope and doing aerobic exercise to burn calories, when you lift, run, jump, etc., have you ever encountered an inappropriate and embarrassing phenomenon-"leakage"? Yes, this kind of leakage behavior has a professional name, called "stress urinary incontinence", which is a kind of pelvic floor dysfunction disease.

Pelvic floor dysfunction is a defect and injury disease of the pelvic floor support tissue. It has many clinical manifestations, including stress urinary incontinence, pelvic organ prolapse, vaginal relaxation, sexual intercourse pain, etc. Regardless of the manifestation of pelvic floor dysfunction, it is quietly and profoundly interfering with our emotions, hindering our social interaction, and reducing our quality of life. If you are aware of its existence, and if you still have a strong will to "defeat" it, then take action! First, let us know the pelvic floor. The pelvic floor muscles, located around the anus and vagina, extend from the sacrum to the pubic bone, and from the ischium on one side to the ischium on the other side. Like an elastic "net", it supports the uterus, vagina, rectum, bladder and other pelvic organs, keeps them in the correct position, and participates in controlling the corresponding functions of these organs. However, this "net" has to withstand various tests in life. For example, while the birth of a new life brings beauty and hope, it also brings physical hardships to mothers - the pelvic floor function is damaged during pregnancy and childbirth. The results of the epidemiological survey on urinary incontinence in my country show that pregnancy and childbirth are the first independent risk factors for pelvic floor damage and defects. As time goes by, when mothers gradually enter old age, the decline of estrogen during menopause will deal another blow to the "net" of the pelvic floor. In this process, the "net" gradually loosens, and pelvic floor function problems gradually emerge.

Now, is there any way to help solve this problem that troubles many women? In 2011, the European Association of Urology (EAU) proposed a diagnosis and treatment guideline for urinary incontinence, which listed Kegel exercises as the first-line conservative treatment for various types of urinary incontinence and recommended strengthening professional guidance. Kegel exercises, also known as Kegel exercises, are a type of exercise that repeatedly stretches the pelvic floor muscles and can effectively improve pelvic floor function. So how do you do Kegel exercises?

First, we need to learn to contract the pelvic floor muscles correctly: if we palpate them ourselves, the boundaries of the pelvic floor muscles on both sides are between the ischial tuberosities (the hard bones under the buttocks on both sides when we sit on a chair), the front boundary is the pubic symphysis, and the back boundary is the coccyx. This position feels soft, which is the pelvic floor muscle in a broad sense. Now please empty your bladder, concentrate, and take a deep breath in the form of abdominal breathing. At this time, your hands should be able to feel the pelvic floor "pushing out" downwards; then take a deep breath and exhale all the air. At this time, you should be able to feel that the pressure exerted on your hands by the pelvic floor is reduced. This is the movement law of the pelvic floor muscles with breathing: when you inhale, the diaphragm descends, pushing the pelvic organs downward, and the pelvic floor muscles sink with it; when you exhale, the diaphragm rises, and the pelvic floor muscles also rise with it. When we palpate our own pelvic floor muscles, the most natural biofeedback is formed. Our hands can feel the contraction and relaxation of the pelvic floor muscles, which can be very helpful in the learning stage of pelvic floor muscle training.

If the feeling of pelvic floor contraction is still unclear, and you can't find the feeling of lifting up and relaxing down, you might as well change your posture and start from lying down with your hips raised. Because in this position, gravity can gently pull the pelvic floor muscles to help them contract better. During the entire pelvic floor muscle training process, as the muscle strength and muscle contraction feeling improve, you can try the following posture advancement methods: lying down (support your hips with a pillow), lying flat, and lying down (support your back with a pillow).

Now that we know how to correctly contract the pelvic floor muscles, how do we stick to Kegel training? Before exercise: empty your bladder, keep your mood happy, relax your body, choose a position that suits you, you can sit, stand or lie down, and focus on the pelvic floor muscles you have found before. Adjust your breathing during exercise: tighten for 1-3 seconds when exhaling, feel the perineum and anus, tighten and pull up from the outside to the inside and from the bottom to the top, relax for 1-3 seconds when inhaling, and gently put down the lifted pelvic floor muscles. Train in different time periods every day, and the total training time should be 15-30 minutes. You can also perform slow muscle fiber contraction training that alternates between contraction for 5~10s and relaxation for 5~10s. The specific frequency and intensity can be adjusted appropriately according to your physical strength, and the training process should not cause discomfort. Learn to relax after exercise: you can stop exercising and rest directly after fatigue, or relax in the frog position with the help of a yoga mat, or adjust your breathing to help relax the pelvic floor muscles. Improving pelvic floor function through Kegel training is not a matter of overnight. It requires our active participation. Only with unremitting efforts can we reap the final beauty. Let Kegel exercise become a beautiful and meaningful "persistence"!

Author: Ye Miao, Wan Lingfang

Image: Qianku.com

About the first author

Ye Miao is deputy director of the Physical Therapy Department II (PT2 Department) of the China Rehabilitation Research Center, a master's student in health care at the International University of Health and Welfare in Japan, deputy chief therapist, lecturer and teaching officer at the School of Rehabilitation Medicine of Capital Medical University, and instructor at the Beijing Standardized Training Base for Rehabilitation Therapists.

Member of the Popular Science and Health Education Working Committee of the Chinese Medical Education Association, member of the Physical Therapy Committee of the Chinese Rehabilitation Medicine Association; member of the Rehabilitation Engineering Professional Committee of the Beijing Rehabilitation Medicine Association. He has published 4 articles in domestic core journals as the first author, participated in the publication of 5 SCI articles and several articles in domestic core journals.