Pelvic Floor Retraining
Pelvic Floor Retraining (PFR) is an electrical stimulation therapy that allows for retraining of pelvic floor muscles to facilitate better relaxation to treat bladder overactivity or to facilitate better contractility to treat stress urinary incontinence. PFR is one treatment that can be used for both bladder overactivity and stress urinary incontinence in men and women.
PFR is simple and safe with no risks; some patients are excited by the prospect of this holistic approach that engages the patient in their own healing and avoids medications and surgery.
PFR can also be used to treat post-prostatectomy incontinence in men who have undergone surgical removal of the prostate. Some studies show that pre-operative PFR before surgical removal of the prostate results in quicker recovery of urinary control after radical prostatectomy and better overall urinary control.
Description of Pelvic Floor Retraining
PFR is an in-depth evaluation and treatment of the pelvic floor muscles. These studies are important in assessing problems of loss of urinary control or frequency of urination. This evaluation involves placing a small probe into the rectum to measure the pressure in the abdomen. There will also be EKG-type electrodes taped to the area near the rectum and thighs. These electrodes measure the electrical activity of your pelvic floor muscles. The probe and EKG leads are placed with the patient on an exam table.
Once in position the probe and EKG leads will be connected to special computerized transducers so that our computer can measure the function of your pelvic floor muscles.
This assessment can tell us a great deal about how your pelvic muscles work.
During your first PFR session you will be given a rectal probe. This rectal probe is yours and you will need it for all of your PFR sessions. You must remember to bring this probe back with you at each of your PFR sessions.
Typically, PFR is delivered in six weekly sessions in the office and each session generally lasts 30-60 minutes. During these sessions you will feel gentle electrical stimulations of the pelvic floor muscles. You will also receive instructions and learn how to make a more effective pelvic muscle contraction to prevent urine loss and you will also learn how better to relax pelvic muscles to decrease frequency, urgency, and urge incontinence.
Some patients may find that the benefits of PFR wear off after 6-12 months. In this event you can consider repeating the treatment sessions.
Pelvic Floor Rehabilitation
Your first visit with our physician assistant and medical assistant will take approximately 1 hour. At your first visit the physician assistant will take a health history, discuss pelvic floor retraining and answer any questions. Following this, the medical assistant will carry out the therapy session. You will be given an exercise prescription following your training session each week to complete until your next visit. This will be based on the measurements taken during the session based on the amount of work your muscles are capable of performing.
A brief exam will be necessary to ensure that you are able to properly contract the target muscles. Following the examination muscle testing of the pelvic floor muscle will be performed. This procedure is not uncomfortable.
In females this is completed using two steps:
- A small sensor is placed in the rectal opening and you will be asked to tighten the rectal muscle as if you were holding back gas. The reason for these instructions is that all of the pelvic floor muscles attach onto the rectum. Therefore it is easier to contract the larger muscle of the rectum and it automatically tightens the rest of the muscles which control bladder leaking or urinary frequency and urgency.
- A small sensor like a tampon is placed in the vagina and the same instructions are given as above.
In males the measurements and stimulation are accomplished in the same fashion but by utilizing small rectal probes.
The muscle testing is important because no two people are exactly alike. The level of exercise that we recommend will be based on the muscle testing. If too many exercises are performed it may actually fatigue the muscle and make it ineffective. If not enough exercises are performed the muscle will not improve.
Additional treatments, which may be incorporated, are:
- Stimulation to the muscle. This is done using the vaginal sensor in women, which is inserted like a tampon and a small rectal probe in men. You will feel a gentle tapping sensation and feel the muscle contract but this is not uncomfortable for most people. This is the same type of therapy used for other muscles in the body to help them get stronger more quickly. It also helps those people who have difficulty with urgency and frequency by helping decrease inappropriate bladder contractions.
- Dietary habits will be reviewed. We find that some patients have bladders that are very sensitive to certain types of drink or foods. Dietary changes may be recommended to help decrease your symptoms.
We find 75-80% of the patients we see will attain significant improvement or cure with this type of therapy alone. As with any form of treatment there are some patients who do not benefit from non-surgical therapy. We recommend appointments every one to two weeks initially depending on your symptoms or progress. The average number of visits is 6-8. There are some people that require less visits and of course those who sometimes require more. A change in your symptoms should be noticed in 3-4 visits if non-surgical therapy is going to be successful for you. This does not mean you will be cured in 3-4 visits but you should notice gradual progress. Improvement is usually noted on your muscle tracings before you notice an improvement in your symptoms. Remember loss of bladder control did not occur overnight. We are working with the same muscles that have become weak so success does take some time and most importantly it requires specific exercises and recommendations be followed. Occasionally we will also recommend medications if we feel they are warranted.
As stated above you will be given an exercise prescription following your training session. This will change from week to week depending on how your muscles are responding to the therapy. Also, you will be given your vaginal/rectal probe following treatment. These probes are intended for multiple session use by one patient and are yours for the duration of the therapy. Thus, it is your responsibility to bring the probe to each appointment.
We encourage our patients to continue any vacations or travels you may have planned. Instructions may be given to keep your status of rehabilitation until you can return. Follow-up visits usually take 30 minutes.
If you need to reschedule your appointment we ask when possible to do so 24 hours in advance. We look forward to seeing you at your visit.
