A physiotherapist will conduct a thorough assessment, which may include taking a detailed history, assessing posture, breathing patterns, and performing an internal (vaginal or rectal) examination to evaluate the strength, endurance, coordination, and tenderness of the pelvic floor muscles.

Physiotherapy interventions include:-

• Pelvic Floor Muscle Training (PFMT) / Kegel Exercises:
  • Mechanism: These exercises directly target the pelvic floor muscles, which support the bladder, uterus, and bowel. Strengthening these muscles improves their ability to contract and provide support, preventing leakage.
  • Physiotherapy Role: Crucially, many people perform Kegels incorrectly. A physiotherapist teaches the correct technique for isolating and contracting these muscles, ensuring they are lifted and squeezed effectively without engaging other muscles (like glutes or abs). They also guide on holding contractions for appropriate durations (endurance), performing quick flicks (fast twitch), and integrating these contractions into functional activities.
• Biofeedback:
  • Mechanism: This technique uses a device (often an internal sensor) to provide real-time feedback on pelvic floor muscle activity. The patient can see or hear their muscle contractions on a screen.
  • Physiotherapy Role: Biofeedback helps individuals better understand how to correctly activate and relax their pelvic floor muscles, which is especially beneficial for those who struggle to “feel” the muscles.
  • Electrical Stimulation (E-stim):
  • Mechanism: Gentle electrical currents are delivered to the pelvic floor muscles. This can help re-educate weak muscles, improve muscle awareness, and, for urge incontinence, may help calm an overactive bladder.
  • Physiotherapy Role: Used as an adjunct, particularly when muscle weakness is significant or when patients have difficulty initiating voluntary contractions.
•  Bladder Training:
  • Mechanism: This behavioral technique aims to re-train the bladder to hold more urine and reduce the frequency and urgency of urination.
  • Physiotherapy Role: Guiding patients to gradually increase the time between bathroom visits, manage urges effectively, and follow a voiding schedule. A bladder diary is often used to track fluid intake, urination frequency, and leakage episodes.
• Bowel Management and Defecation Dynamics (for Fecal Incontinence):
  • Mechanism: Addresses issues like constipation, straining, and improper bowel emptying techniques that can worsen fecal incontinence.
  • Physiotherapy Role: Providing education on proper toilet posture, fiber intake, fluid intake, and strategies to avoid straining. Biofeedback may be used to improve coordination of the anal sphincter and pelvic floor muscles during defecation.
• Education and Lifestyle Modifications:
  • Mechanism: Certain lifestyle factors can aggravate incontinence. Addressing these can significantly improve symptoms.
  •  Physiotherapy Role: Educating patients on:
  • Dietary changes: Avoiding bladder irritants like caffeine, alcohol, artificial sweeteners, and acidic foods.
  • Fluid intake: Ensuring adequate, but not excessive, hydration.
  • Weight management: Excess weight puts added pressure on the bladder and pelvic floor.
  • Constipation management: Straining during bowel movements can weaken pelvic floor muscles.
  • Smoking cessation: Smoking can lead to chronic cough, which stresses the pelvic floor.
  • Proper lifting techniques: To avoid excessive intra-abdominal pressure.
• Core and Hip Strengthening:
  • Mechanism: The pelvic floor works in conjunction with other core muscles (transverse abdominis, diaphragm, multifidus) to provide stability and support.
  • Physiotherapy Role: Incorporating exercises that strengthen the entire core, which indirectly supports pelvic floor function and improves overall body mechanics.
•  Manual Therapy
  • Mechanism: If there is excessive tension or hypertonicity in the pelvic floor muscles (which can also contribute to incontinence or pain), manual release techniques may be used.