How are pelvic floor exercises performed in the treatment of neurogenic bladder?

Updated: Dec 06, 2018
  • Author: Bradley C Gill, MD, MS; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Answer

Individuals who benefit the most from pelvic floor exercises tend to be young, healthy, and able to identify the levator muscles accurately.  These rehabilitation exercises may be used for urge incontinence as well as mixed incontinence. For urge incontinence, pelvic floor muscle exercises are used to retrain the bladder. When the patient contracts the external urethral sphincter, the bladder automatically relaxes, so the urge to urinate eventually subsides. Strong contractions of the pelvic floor muscles will suppress bladder contractions. Whenever patients feel urinary urgency, they may try to stop the feeling by contracting the pelvic floor muscles. These steps will provide the patient more time to walk slowly to the bathroom with urinary control.

By regularly training the external sphincter, patients can gradually increase the time between urination from 1-3 hours. Patients should begin to see improvement in 3-4 weeks. Thus, this technique may be used for urge symptoms, urge incontinence, and mixed incontinence (stress and urge incontinence). Patients should practice contracting the levator ani muscles immediately before and during situations when leakage may occur. This will condition the external sphincter instinctively to contract with increases in abdominal pressure or when the need to urinate is imminent. This is known as the guarding reflex. When the patient tightens the external urinary sphincter just as a sneeze is about to occur, the involuntary urine loss is thwarted. By squeezing the levator ani muscles when the sense of urgency arises, the sensation of impending bladder contraction will dissipate. By making this maneuver a habit, patients will develop a protective mechanism against stress and urge incontinence.


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