Fall in Love with Your Pelvic Floor

By Iman Akef Khowailed PT, MPT, MPH, DSc
About half of us have pelvic floor issues!

Many of us don't know how strong their pelvic floor is! And we don't train our pelvic floor either. Well, that's why the prevalence of at least one form of pelvic floor dysfunctions PFDs (urinary incontinence, pelvic organ prolapses or fecal incontinence) has been reported to be as high as 46%. Involuntary leakage of urine is a common symptom that affects 1 in 3 women. Childbirth-related pelvic floor trauma seems to play a significant role. Evidence has shown that there is high correlation between the postnatal pelvic organ prolapse and vaginal delivery. However, often these are ASYMPTOMATIC which means you don't feel any symptoms after your first vaginal delivery. It is then crucial that we must prepare for this silent dysfunction and be proactive to prevent PFM dysfunction. The scientific community believes that successful management of PFDs hinges on retraining the pelvic floor muscles. Good news is and recently Transabdominal ultrasound has been used to assess dynamic muscle activity.
You can now assess your pelvic floor, with a Transabdominal Ultrasound!

A standardized bladder filling protocol will be used prior to imaging to ensure that you have fluid in your bladder to allow clear imaging of the base of the bladder. Then you will be tested in a lying position with your hips and knees flexed to 60 degrees (Figure 1). The ultrasound transducer will be placed transversely in the midline of your suprapubic region. The amount of bladder base movement on ultrasound will be measured and considered as an indicator of PFM function (Figure 2A and 2B). It will take about 5 minutes.
Fig 1. Set up for the ultrasound measurement
What to expect during the measurement?

You will be asked to perform three voluntary PFM contractions for 10s each; and each image will be captured at the point of maximal displacement. Displacement will be measured as the distance between the two points marked in millimeter (mm) (Figure 2A & 2 B).
Fig 2A. Bladder base during resting position.
Fig 2B. Bladder base displacement during PFM contraction
How to read your results?

Compare your results to a stratification model for PFM function. If your bladder base displacement falls

From 0 mm to 0.18 mm bladder base displacement, then it is very weak
From 0.18 mm to 0.33 mm bladder base displacement, then it is weak
From 0.33 mm to 0.53 mm bladder base displacement, then it is strong
and above 0.53 mm bladder base displacement, then it is very strong.

Now, you have a reference baseline data as an objective method for a clinical measure and we can establish an appropriate plan of care. This data will help to identify if you are at risk for developing PFDs and we can perform life-long pelvic floor exercises to reinforce the pelvic floor.
Fig 3. Normative pelvic floor muscle parameter in women

Nygaard I, Barber MD, Burgio KL, et al. Prevalence of symptomatic pelvic floor disorders in US women. Jama. 2008;300(11):1311-1316.

Khowailed, I. A., Disney, H., & Lee, H. (2020). Gender-specific differences of normative values of pelvic floor muscle function in healthy adults population: an observational analytical study. Women Health, 1-11. doi:10.1080/03630242.2020.18074

Sherburn M, Murphy CA, Carroll S, Allen TJ, Galea MP. Investigation of transabdominal real-time ultrasound to visualize the muscles of the pelvic floor. The Australian journal of physiotherapy. 2005;51(3):167-170.

Ashton-Miller JA, Delancey JO. On the biomechanics of vaginal birth and common sequelae. Annual review of biomedical engineering. 2009;11:163-176.

Bower WF, Chase JW, Stillman BC. Normative pelvic floor parameters in children assessed by transabdominal ultrasound. The Journal of urology. 2006;176(1):337-341.
Iman Akef Khowailed PT, MPT, MPH, DSc
September 2021: Single Leg Balance with Ball Toss
Exercise video courtesy of sharecare.com

  • Stand on the right leg

  • Flex the hips, knees, and ankles to assume a shallow squat

  • Maintain the knee behind the toes and in line with the foot

  • Hold this position, toss a ball to someone and have them pass it back

  • Repeat multiple times on each leg
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