Hypotonicity, or weak pelvic floor muscles, contribute to urinary and fecal incontinence, as well as pelvic organ prolapse.
When the pelvic floor muscles are weak, they need to undergo a structured strengthening program that does not include just doing a few Kegels at the kitchen sink or the stop light. These are often the instructions that men and women get from their medical practitioners. On the opposite side of the scale, patients are also told that they need to do up to 1000 repetitions per day, which has no basis in exercise science. Please follow this link to get a written description of how to perform a Kegel if you are a Woman, or a Man. However, please remember that the majority of people cannot find these internal muscles without at least one consultation with a physiotherapist. There are an increasing number of Pelvic Health Physiotherapists available in Ontario. They must be specially trained in internal palpation.
The Cochrane Collaboration 2010 concluded that Physiotherapists with specialized training in pelvic floor rehabilitation (using internal examination to teach the exercises) should be the first line of defense, before surgical consultation, for stress, urge and mixed incontinence in women.
When strengthening your pelvic floor with the guidance of a physiotherapist, the research shows that it is 80% effective. This means for every 10 patients that would be appropriate candidates for surgery (sling repairs, TVT) only 2 require surgery after physiotherapy treatment.
In Britain, the National Institute of Health has declared that every person considered for surgical correction of stress incontinence should first be seen by a pelvic health physiotherapist for conservative care. Only those that are not able to strengthen their pelvic floors sufficiently with exercise alone are then considered for surgery.
The evidence and research supports this approach, especially with ongoing concerns with regards to the potential negative effects of having a sling repair. Surgery should always be approached conservatively and carefully.