Pelvic floor exercises Booklet

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Pelvic Floor Muscles and Continence

A resource to assist health professionals access information about

pelvic oor muscle exercises for continence

Developed by theHome and Community Care (HACC)/

Medical Aids Subsidy Scheme (MASS) Continence Project

August 2010


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ISBN: 9781921707018

Copyright

© The State of Queensland, Queensland Health, 2010

The Queensland Government supports and encourages the dissemination and exchange of information. However, copyright protects this document. The State of Queensland has

no objection to this material being reproduced, made available online or electronically, but only if it is recognised as the owner and this material remains unaltered.

Disclaimer:

Queensland Health has made every effort to ensure this information is accurate. However Queensland Health accepts no responsibility for any errors, omissions or inaccuracies

in respect of the information contained in the material provided by the Home and Community Care (HACC)/Medical Aids Subsidy Scheme (MASS) Continence Project, nor is the

provision of this material by the HACC/MASS Continence Project to be construed as any representation that there are no other materials or information available in relation to the

information provided. Further, Queensland Health accepts no responsibility to persons who may rely upon this information for whatever purpose.

HACC/MASS Continence Project

Medical Aids Subsidy Scheme

PO Box 281

CANNON HILL QLD 4170

Phone (07) 3136 3631

Email: [email protected]

HACC/MASS Continence Project Team 2010

Christine Leech, OT, Senior Project Ofcer

Audrey Burgin, Continence Nurse Advisor, Project Ofcer

Lesley Osbourne, Executive Support Ofcer

Review of Journal Articles: Alyssa Tait, Physiotherapist


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Table of Contents

Introduction ........................................................................................................ Page 2

Websites ............................................................................................................ Page 3

Books ................................................................................................................. Page 6

Education Resources......................................................................................... Page 11

Journal Articles .................................................................................................. Page 13


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Introduction

This resource has been developed to support health professionals to access resources and information about pelvic oor muscles and

continence. The document does not purport to be a complete list, and readers requiring more information are encouraged to undertaketheir own data base search. In particular, there have been innumerable journal articles and books written about the pelvic oor. We are

grateful for the input of physiotherapists for their assistance in limiting the journal articles and other resources listed in this document to

those that are particularly useful.

The information in this resource is specically for health professionals. Readers are referred to the Continence Foundation of Australia for

client resources on pelvic oor muscle education, which can be accessed via www.continence.org.au or the National Continence Helpline

on 1800 33 00 66.

Private publications and websites available on this topic have not been listed in this resource, but may be relevant for health professionals.

If you identify a resource which may be suitable for inclusion in a future edition of this “Pelvic Floor Muscles and Continence” resource,

please provide the details to the HACC/MASS Continence Project team at [email protected]


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Websites

1. Australian Department of Health and Aged Care: HealthInsite

This Australian Government website aims to improve the health of Australians by providing easy access to quality information.The website has an A-Z of health topics with an extensive data base of direct links. It also contains information on conditions anddiseases, health and wellbeing, life stages and events, and Australian health services. There is a link to information on pelvic oor muscles.The website provides access through HealthInsite to public summaries of the Cochrane Collaboration’s reviews of the evidence.

www.healthinsite.gov.au/topics/Pelvic_Floor_Muscles

2. Australian Government Department of Health and Ageing

This website provides links to government and other websites for both the public and health professionals. Enter “pelvic oor” in thekey words box for information, fact sheets, publications and contacts.

www.health.gov.au

3. Australian Government Department of Health and Ageing: National Continence Management Strategy

The National Continence Management Strategy is an initiative of the Australian Government Department of Health and Ageing.

This website provides information for health professionals, service providers and researchers on bladder and bowel problems.There are numerous links to other continence related websites, including sites providing support and help. The website includes thecontact details for the National Continence Helpline, and has a link to pelvic oor information. There are brochures for English and nonEnglish speaking people, and Aboriginal and Torres Strait Islander people. Information is provided on incontinence with links to factsheets, publications, contacts, support and help. Go to health professionals/service providers/researchers headings in the web site.

www.bladderbowel.gov.au


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4. Australian Physiotherapy Association (APA)

This website has information for health professionals and the general public and on incontinence and pelvic oor muscle exercises.

www.physiotherapy.asn.au/index.php/groups/continence-and-womens-health

5. Bladder and Bowel Foundation (B&BF) United Kingdom

This website has information on continence symptoms, treatment and pelvic oor muscle exercises for women and men. It discusses doing the

exercises as part of the daily routine. Follow the web site prompts of bladder, healthy bladder and pelvic oor exercises to access information.

www.bladderandbowelfoundation.org

6. Continence Foundation of Australia (CFA)

The Continence Foundation of Australia raises awareness of, and advocates on behalf of, people with bladder and bowel problems andtheir carers. The website provides information on available resources, links to other websites and a phone contact for the National ContinenceHelpline. The helpline is a nation-wide free service staffed by a team of continence advisors, who provide condential advice regardingbladder and bowel control. For specic information on pelvic muscles, go to “continence information” and select “living with incontinence”and “pelvic oor muscle exercise” for links to information and resources for health professionals.

www.continence.org.au/site/index.cfm?display=112842

7. Queensland Government Queensland Health

This website has information for health professionals and the general public on pelvic oor muscle exercises. Type in the search words“pelvic oor muscle exercises” in the search engine to link to the information available.

www.health.qld.gov.au


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8. The Royal Women’s Hospital Melbourne

This website provides general women’s health information and includes urogynaecology and gynaecology fact sheets from A - Z.The Physiotherapy Department has information about pelvic oor anatomy and exercises and includes a step by step guide to pelvic oormuscle exercises.

www.thewomens.org.au/PelvicFloorExercises

9. West Australian Government Department of Health Population Health Unit

This website has information on a range of health topics. Go to ‘Health topics A - Z’, select ‘W’ then ‘women’s health’ to nd a brochure onpelvic oor muscle exercises for women, which includes clear, easy to read information on the pelvic muscles at work, signs and symptomsof weak muscles, self help, exercises and maintaining strong pelvic oor muscles.

www.population.health.wa.gov.au


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Books

Abrams, P., Cardozo, L., Khoury S., & Wein, A. (Eds.). (2009). Incontinence: 4th International consultation on incontinence

(4th ed): Health Publication Ltd.

This book contains comprehensive information on incontinence and pelvic oor dysfunction, and is compiled by multidisciplinary expertsin clinical practice from international locations.

Bent, A., Cundiff, G., & Swift, W. (2007). Ostegard’s urogynecology and pelvic oor dysfunction (6 ed.). Philadelphia: London:Lippincott Williams & Wilkins. Chapter 1 - 3, 9.

This book provides information on female pelvic oor dysfunctions, including urinary incontinence, other lower urinary tract conditions,

disorders of the anus and rectum, and disorders of pelvic support. The book reviews relevant anatomy, describes clinical examination anddiagnostic tests, and provides current information on the diagnosis, physiology, and medical and surgical treatment of specic disorders.

Bø, K., Berghmans, B., Van Kampen, M., Morkved, S., & Artibani W (Eds.). (2007). Evidence-based physical therapy for the pelvicoor: Edinburgh: London et al: Churchill Livingstone.

This book has a focus on bridging science and clinical practice. The conservative treatment of physical therapy is discussed withevidence based background information supporting practice.

Bourcier, A., McGuire, E., & Abrams, P. (Eds.). (2004). Pelvic oor disorders: Michigan: Elsevier Saunders.

This book offers multidisciplinary guidance on the diagnosis and management of the full spectrum of pelvic oor disorders.It covers conservative management of the lower urinary tract including pelvic oor muscle exercises


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Carrière, B. (2002). Fitness for the pelvic oor: New York: Thieme.

This book highlights that, while it is common to exercise many parts of the body to stay t, very little attention is paid to exercising the pelvicoor. The book provides treatment ideas and options, including pelvic oor muscle exercises.

Carrière, B., & Feldt, C. (Eds.). (2006). The pelvic oor: Stuttgart: New York: Thieme.

This book enhances the understanding of the structural and functional signicance of the pelvic oor. It provides treatment suggestionsand a multifactorial approach to the topic.

Davila, G., Ghoniem, G., & Wexner, S. (Eds.). (2006). Pelvic oor dysfunction: A multidisciplinary approach: Florida: Springer.

This book comprehensively examines aspects of evaluation and therapy of female pelvic oor dysfunction. It focuses on urinary incontinence

and other voiding dysfunctions, including faecal incontinence and other distal gastroenterological problems, genital and rectal prolapse,and other recognized pelvic oor problems.

Dorey, G. (2006). Pelvic dysfunction in men. Diagnosis and treatment of male urinary incontinence and erectile dysfunction. A textbook for physiotherapists, nurses and doctors: John Wiley & Sons.

Aimed primarily at specialist continence physiotherapists, continence advisors and urology nurses, this textbook includes chapterscovering the male pelvic oor, anatomy and physiology of the lower urinary tract, urinary incontinence, pelvic pain in men, conservativetreatment, medication, faecal incontinence and male sexual dysfunction. It includes an extensive review of the literature up to 2005 on

post-prostatectomy treatment and treatment of sexual dysfunction. The subjective and objective physiotherapy assessment is coveredchronologically, to enable the clinician to conduct a meaningful investigation and arrive at a logical diagnosis.


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Dornan, P. (2003). Conquering incontinence: A new and physical approach to a freer lifestyle: Australia: Allen & Unwin.

This book takes a comprehensive approach to incontinence, and includes a thorough description of the structures of organs, muscle andtissue requiring retraining to overcome incontinence. The author uses professional practice background as a physiotherapist to develop aninnovative physical program and series of exercises to improve bladder control. The author also offers useful encouragement and personalinsights into broader issues of incontinence and erectile dysfunction.

Ghoniem, G., & Davila, G. (Eds.). (2006). Practical guide to female pelvic medicine: Florida: Informa Health Care. Chapter 1.

This book is a practical guide highlighting the varying forms of pelvic oor disorders. Included are chapters on the pathophysiology of thefemale pelvic oor, the evaluation and diagnosis of problems, the practical management of symptoms, and the complications that can arisefrom surgical and medical treatment.

Henry, M., & Swash, M. (1992). Coloproctology and the pelvic oor (2nd ed.): Butterworth-Heinemann Ltd: Oxford.

This is a classic textbook in the eld of coloproctology that covers a range of topics from embryology to investigations to pelvic oorfunction. It is highly recommended for a more detailed study of the pelvic oor, especially with reference to rectal function.

Home and Community Care (HACC)/Medical Aids Subsidy Scheme (MASS) Project (2010). First steps in the management ofurinary incontinence in community-dwelling older people: A clinical practice guideline for primary level clinicians (registerednurses and allied health professionals) (3rd ed.): Australia: Queensland Health. Section 11.5.5.2.

This clinical practice guideline is written for primary level nurses and allied health professionals to assist in the initial assessment andmanagement of urinary incontinence, this is an essential reference for all clinicians working with people who have urinary incontinence.This evidence based clinical practice guideline is designed to inform health professionals about urinary incontinence.


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Home and Community Care (HACC)/Medical Aids Subsidy Scheme (MASS) Project. (2008). Second steps in the management ofurinary incontinence in community-dwelling older people: A clinical practice guideline for clinicians with a special interest inincontinence (2nd ed.): Australia: Queensland Health. Sections 10 -12.

This clinical practice guideline is written for secondary level clinicians who have undergone post-graduate training in continence, or whohave a special interest and experience in continence management. Section 10 provides evidence based information on pelvic oor muscle

training, while section 12 covers adherence issues relating to pelvic oor muscle rehabilitation management.

Kenway, M., & Goh, J. (2009). Inside Out: The essential women’s guide to pelvic support: Brisbane Australia: Healthy FitSolutions Pty Ltd.

This book by a Queensland based physiotherapist provides a guide for improving pelvic support, bladder control and staying active, andshows tness exercises that will not damage the pelvic oor. It is available from www.pelvicoorexercise.com.au

Laycock, J., & Haslam, J. (2007). Therapeutic management of incontinence and pelvic pain: Pelvic organ disorders: Springer.Chapter 8.

This book provides a practical clinical introduction to the assessment and conservative treatment of pelvic oor disorders in both men and women.It is primarily written for physiotherapists dealing with incontinence and pelvic oor disorders, but is a useful reference for all health professionals.

O’Dwyer, M. (2010). Hold It Sister: The Condent Girl’s Guide to a Leak Free Life: Australia: Redsok

This fully referenced book by a Queensland based physiotherapist covers pelvic oor topics for all life stages, including pregnancy, childbirth,activity, gym and sport, menopause, pelvic pain, prolapse and pelvic surgery. It is suitable for clinicians and their clients.


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Petros, P. (2004). The female pelvic oor: Function, dysfunction and management according to the integral theory: Australia: Springer.

This book examines the underlying theory of the function, dysfunction and management of the pelvic oor. Integral theory is an interrelatedand dynamic anatomical framework for understanding pelvic oor function and dysfunction, which emphasises the role of the connectivetissue of the vagina and supporting ligaments in both function and dysfunction.

Rashid, P., Doyle, A., & Hibbard, V. (2007). Bladder care: Your self help guide (2nd ed.): Australia: Uronorth Group. Pages 19 - 27, 104 - 106.

Designed to simplify the understanding and treatment of common bladder problems, this book contains a section on pelvic oor musclestrength and exercises.

Schussler, B., Laycock, J., Norton, P. & Stanton, S. (Eds.) (1994). Pelvic foor re-education: Principles and practice: London:Berlin: Springer. (3rd ed.). Chapter 4.

This book provides a detailed summary of the clinical assessment and management of pelvic oor disorders. Beginning with theories onthe anatomy and possible causes of pelvic oor damage, the text describes the importance of evaluation before determining the type oftreatment required.

Stephenson, R., & O’Connor, L. (2000). Obstetric and gynaecological care in physical therapy (2nd ed.): SLACK Incorporated.Chapters 2 - 4.

This book is written for physiotherapists and has topics on women’s health care in physiotherapy, anatomical considerations, maternal

physiology, postpartum care, special pregnancies (including high risk and women with chronic illness and disabilities), evaluation andtreatment of pelvic oor dysfunction, and the aging female’s needs.


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Education Resources

Continence Foundation of Australia (Victoria). (2008). Pelvic oor muscles: A consumer education resource for health

professionals.

This resource kit includes a booklet, ipchart, manual with PowerPoint slides and a CD-ROM. The kit has been jointly developed by

the CFA and the Australian Physiotherapy Association. The aim is to assist health professionals to educate the community about pelvic

oor muscles and their role in bladder and bowel health. Order from the National Continence Helpline on 1800 33 00 66 or through

www.continence.org.au

Continence Foundation (New Zealand). (2008). Understanding your pelvic oor

This DVD provides information for women, and discusses good bladder habits, types of incontinence, healthy bowel habits, pelvic oor in

sexual function. Order through [email protected]

Home and Community Care (HACC)/Medical Aids Subsidy Scheme (MASS) Continence Project. (2010). Pelvic oor muscle

exercise instruction and best toileting position for optimal bowel function DVD

This DVD shows a specialist physiotherapist demonstrating positioning for pelvic oor muscle exercises with two older people.

It also includes a section showing the best toilet position for bowel function. Running time: 25 minutes. Order through

[email protected]


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Prostate Cancer Foundation of Australia (2009). Pelvic Floor Exercises for Men DVD

This DVD, presented by Associate Professor Pauline Chiarelli, provides insight into the location and structure of pelvic oor muscles,

and demonstrates how to exercise them effectively. It aims to help men understand their pelvic oor muscles and to improve continence

pre and post prostate cancer treatment. Included in the DVD is a visually explicit demonstration on how the penis and scrotum appear

when the pelvic oor muscles are being exercised correctly. Order through www.prostate.org.au

Yates, L., & Ross, F. (2008). The core and the foor. Your complete post-pregnancy education and exercise programme DVD

Professionally designed by a women’s health physiotherapist, midwife and personal trainer, this comprehensive DVD comprises two parts;

an evidence based, peer reviewed education component that provides information on the pelvic oor, abdominals, posture and back care

(42 minutes) and an exercise section (52 minutes). Exercises using a t-ball specically target both core and pelvic muscle strength,

and include pilates, tai chi and yoga principles. While originally designed for post-pregnancy, the low-impact beginner, intermediate and

advanced home based exercise program messages may be appropriate for women of all ages. Order through www.lit.com


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Assessment of Pelvic Floor Muscle Function

Bø, K., and Sherburn, M. (2005): Evaluation of female pelvic oor muscle function and strength. Physical Therapy 85 (3): 269-282.

Frawley, H. (2006). Pelvic oor muscle strength testing: commentary. Australian Journal of Physiotherapy, 52 , 307.

Frawley, H.C., Galea, M.P., Phillips, B.A., et al. (2006). Reliability of pelvic oor muscle strength assessment using different test positions

and tools. International Urogynecology Journal and Pelvic Floor Dysfunction17 (4):365-371.

Lang, J., Brown, H., & Crombie, E. (2007). Assessment of the anal sphincter muscle: Comparison of a digital and a manometric technique.Physiotherapy, 93, 121-128.

Neumann, P., Blizzard, L., Grimmer, K., et al. (2004). Expanded paper towel test: an objective test of urine loss for stress incontinence.Neurourology and Urodynamics, 23, 649-655.

Peschers, U., Gingelmaier, A., Jundt, K., et al. (2001). Evaluation of pelvic oor muscle strength using four different techniques. International

Urogynaecology Journal, 12, 27-30.

Thompson, J., O’Sullivan, P., Briffa, K., & Court, S. (2004). Transabdominal and transperineal ultrasound: a study of reliability and validity. Paper presented at the Proceedings of the joint ICS/IUGA meeting. To access this paper, go to www.icsofce.org, click on ‘meetings andcourses’, ‘ICS Annual Meetings’ then ‘ICS/IUGA 2004 (Paris)’ then ‘search’. Enter the surname of the rst author in the box next to ‘abstractsearch’ and select the desired article.

Journal Articles

This journal article list, while not comprehensive, provides health professionals with a number of pertinent articles from peer-reviewed

journals about pelvic oor muscle function and exercises. Readers are encouraged to source additional literature on this topic as required.


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Tunn, R., Paris, S., Fischer, W., et al. (1998). Static magnetic resonance imaging of the pelvic oor muscle morphology in women withstress urinary incontinence and pelvic prolapse. Neurourology and Urodynamics, 17 (6), 579-589.

Whittaker, J., Thompson, J., Teyhen, D., et al. (2007). Rehabilitative ultrasound imaging of pelvic oor muscle function. Journal of Orthopaedic& Sports Physical Therapy, 37 (8), 487- 498.

Effects of Pelvic Floor Muscle Training: Trials

Bø K, Fleten C., & Nystad, W. (2009). Effect of antenatal pelvic oor muscle training on labour and birth. Obstetrics and Gynecology,113 (6):1279-1284.

Choi, H., Palmer, M., & Park, J. (2007). Meta-Analysis of pelvic oor muscle training: Randomized controlled trials in incontinent women.Nursing Research, 56 (4), 226-234.

Diokno, A., Sampselle, C. M., Herzog, A., et al. (2004). Prevention of urinary incontinence by behavioural modication program: A randomized, controlled trial among older women in the community. The Journal of Urology, 171, 1165-1171.

Hay-Smith, E., & Dumoulin, C. (2006). Pelvic oor muscle training versus no treatment, or inactive control treatments, for urinaryincontinence in women. Cochrane Database of Systematic Reviews (Issue 1. Art. No.: CD005654. DOI: 10.1002/14651858.CD005654).

Herbison, P., Plevnik, S., & Mantle, J. (2002). Weighted vaginal cones for urinary incontinence. Cochrane Database of Systematic Reviews (Issue 1. Art. No.: CD002114. DOI: 10.1002/14651858.CD002114).

Norton CC, Cody JD, Hosker G. Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. CochraneDatabase of Systematic Reviews 2006 , Issue 3. Art. No.: CD002111. DOI: 10.1002/14651858.CD002111.pub2.

Stillman, B.& Chase, J. (2006). Strengthening of the pelvic oor muscles using transcutaneous magnetic nerve stimulation: A review ofthe literature. Australian and New Zealand Continence Journal, 12 (4), 31-40.


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Effects of Pelvic Floor Muscle Training: Theory and Physiological Studies

Bø, K. (2004). Pelvic oor muscle training is effective in treatment of female stress urinary incontinence, but how does it work? InternationalUrogynaecology Journal, 15, 76-84.

Bø, K., Kvarstein, B., & Nygaard, I. (2005). Lower urinary tract symptoms and pelvic oor muscle exercise adherence after 15 years.Obstetrics and Gynecology, 105 (5), 999-1005.

Bump, R., Hurt, W., Fantl, J., et al. (1991). Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. AmericanJournal of Obstetricians and Gynaecologists, 165 (2) 322-329.

Grewar, H., & McLean, M. (2008). The integrated continence system: A manual therapy approach to the treatment of stress urinaryincontinence. Manual Therapy, 13(5), 375-386.

Hulme, J. (2000). Research in geriatric urinary incontinence: Pelvic muscle force eld. Topics in Geriatric Rehabilitation, 16 (1), 10-21.

Kelly, M., Tan, B., Thompson, J., et al. (2007). Healthy adults can more easily elevate the pelvic oor in standing than in crook-lying: An experimental study. Australian Journal of Physiotherapy, 53, 187-191.

Miller, J.M., Sampselle, C., Ashton-Miller, J., (2008): Clarication and conrmation of the Knack maneuver: the effect of volitional pelvicoor muscle contraction to preempt expected stress incontinence. International Urogynecological Journal and Pelvic Floor Dysfunction,19(6), 773-782.


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Interaction among Pelvic Floor Muscles, Abdominal Muscles and the Diaphragm

Bø K, Mørkved S, Frawley H, et al. (2009). Evidence for benet of transversus abdominis training alone or in combination with pelvic oormuscle training to treat female urinary incontinence: a systematic review. Neurourology and Urodynamics Feb 3 [Epub ahead of print]

Bø, K & Borstad, E (2003). Urodynamic assessment during pelvic oor muscle and transversus abdominis contraction. Proceedings of theInternational Continence Society (ICS), 33rd Annual Meeting, Florence, 5-9 Oct, p 484-485.

Bø, K., Sherburn, M., & Allen, T. (2003). Transabdominal ultrasound measurement of pelvic oor muscle activity when activated directly orvia a transversus abdominis muscle contraction. Neurourology and Urodynamics, 22 (6), 582-588.

Bø, K., & Stein, R. (2003). Needle EMG registration of striated urethral wall and pelvic oor muscle activity when activated directly or viaa transversus abdominus muscle contraction. Neurourology and Urodynamics, 22, 582-588.

Hodges, P.W., Sapsford, R., & Pengel, LHM. (2007). Postural and respiratory functions of the pelvic oor muscles. Neurourology and

Urodynamics, 26, 362-371.

Neumann, P., & Gill, V. (2002). Pelvic oor and abdominal muscle interaction: EMG activity and intra-abdominal pressure. InternationalUrogynaecology Journal, 13, 125-132.

Sapsford, R. (2004). Rehabilitation of pelvic oor muscles utilizing trunk stabilization. Manual Therapy, 9, 3-12.

Sapsford, R., & Hodges, P. (2001). Contraction of the pelvic oor muscles during abdominal maneuvers. Archives of Physical Medicineand Rehabilitation, 82, 1081-1089.

Sapsford, R., Hodges, P., Richardson, C., et al. (2001). Co-activation of the abdominal and pelvic oor muscles during voluntary exercises.Neurourology and Urodynamics, 20, 31-42.


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Sapsford, R., Richardson, CA., Maher, CF., et al. (2008). Pelvic oor muscle activity in different sitting postures in continent and incontinentwomen. Archives of Physical Medicine and Rehabilitation, 89, 1741-1747.

Sapsford, R., Richardson, C., & Stanton, W. (2006). Sitting posture affects pelvic oor muscle activity in parous women: An observationalstudy. Australian Journal of Physiotherapy, 52, 219-222.

Pelvic Floor Disorders: Background

Ashton-Miller JA. & DeLancey, JO. (2007). Functional anatomy of the female pelvic oor. Annals of the New York Academy of Science1101, 266-296.

DeLancey, J., & Ashton-Miller, J. (2004). Pathophysiology of adult urinary incontinence. Gastroenterology, 126, S23-S32.

DeLancey, JO., Kane Low, L., Miller, JM., et al. (2008). Graphic integration of causal factors of pelvic oor disorders: An integrated life spanmodel. American Journal of Obstetrics and Gynecology 199(6), 610. e1-5.

Dietz, H. (2006). Pelvic oor trauma following vaginal delivery. Current Opinion in Obstetrics and Gynecology, 18 (5), 528-537.

Dillon, L., & Fonda, D. (2000). Medical evaluation of causes of lower urinary tract symptoms and urinary incontinence in older people.Topics in Geriatric Rehabilitation, 15 (4), 1-15.

Lee, D. & Lee, L. (2004). Stress urinary incontinence: A consequence of failed load transfer through the pelvis? Paper presented at the 5th

Interdisciplinary World Congress on Low Back and Pelvic Pain.


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Pelvic Floor Function in Back and Pelvic Pain

Avery, A., O’Sullivan, P., & MacCallum, M. (2000). Evidence of pelvic oor muscle dysfunction in subjects with chronic sacro-iliac joint painsyndrome. Proceedings of the 7th scientic conference of the international federation of manual therapists.: International Federation ofManual Therapists.

Eliasson, K., Elfving, B., Nordgren, B., et al. (2007). Urinary incontinence in women with low back pain. Manual Therapy, 13(3), 206-212.

O’Sullivan, P., Beales, D., Beetham, et al. (2002). Altered motor control strategies in subjects with sacroiliac joint pain during the activestraight-leg-raise test. Spine, 27 (1), 1-8.

Stuge, B., Morkved, S., Haug Dahl, H., et al. (2006). Abdominal and pelvic oor muscle function in women with and without long lastingpelvic girdle pain. Manual Therapy, 11(4), 287-296.

Pelvic Floor Function in Sexual Dysfunction

Rosenbaum, T. (2007). Pelvic oor involvement in male and female sexual dysfunction and the role of pelvic oor rehabilitation in treatment: A literature review. Journal of Sexual Medicine, 4, 4 -13.

Pelvic Floor Muscles and Erectile Dysfunction

Dorey, G. (2000). Conservative treatment of erectile dysfunction 1: anatomy/physiology. British Journal of Nursing, 9(11), 691-694.

Dorey, G. (2000). Conservative treatment of erectile dysfunction 2: clinical trials. British Journal of Nursing, 9(12), 755-762.

Dorey, G. (2000). Conservative treatment of erectile dysfunction 3: literature review. British Journal of Nursing, 9(13), 859-863.


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Dorey, G. (2003). Pelvic oor muscle exercises for men. Nursing Times, 99(19), 46-48.

Dorey, G. (2004). Pelvic oor exercises as a treatment for men with erectile dysfunction. Nursing Times Supplement, 100 (12), 65-67.

Dorey, G., Speakman, M., Feneley, R., et al. (2004). Pelvic oor exercises for treating post-micturition dribble in men with erectile dysfunction.Urological Nursing 24(6): 490-497.

Hunter KF, Moore KN, Glazener CMA. Conservative management for postprostatectomy urinary incontinence. Cochrane Database ofSystematic Reviews 2007, Issue 2. Art. No.: CD001843. DOI: 10.1002/14651858.CD001843.pub3

Pelvic Floor Muscle Dysfunction in Incontinence and Prolapse (including Levator Avulsion)

Abdool, Z., Shek, K.L., & Dietz, H.P. (2009). The effect of levator avulsion on hiatal dimension and function. American Journal of Obstetrics

and Gynecology May 7 [Epub ahead of print].

Devreese, A., Staes, F., Janssens, L., et al. (2004). Incontinent women have altered pelvic oor muscle contraction patterns. The Journalof Urology, 178 , 558-562.

Devreese, A., Staes, F., Janssens, L., et al. (2007). Clinical evaluation of pelvic oor muscle function in continent and incontinent women.Neurourology and Urodynamics 23, 190-197.

Dietz, H.P., Kirby, A., Shek, K.L., et al. (2009). Does avulsion of the puborectalis muscle affect bladder function? International Urogynecology

Journal and Pelvic Floor Dysfunction Apr 28 [Epub ahead of print]

Smith, M., Coppieters, M., & Hodges, P. (2006). Postural activity of the pelvic oor muscles is delayed during rapid arm movements inwomen with stress urinary incontinence. International Urogynaecology Journal, 18, 901-911.

Smith, M., Coppieters, M., & Hodges, P. (2007). Postural response of the pelvic oor and abdominal muscles in women with and withoutincontinence. Neurourology and Urodynamics, 26, 377-385.


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Thompson, J., & O’Sullivan, P. (2003). Levator plate movement during voluntary pelvic oor muscle contraction in subjects with incontinenceand prolapse: A cross-sectional study and review. International Urogynaecology Journal, 14, 84-88.

Thompson, J., O’Sullivan, P., Briffa, K., et al. (2004). Assessment of pelvic oor muscle exercises in women with incontinence and normalcontrols. Paper presented at the Proceedings of the Joint ICS/IUGA meeting. To access this paper, go to www.icsofce.org, click on ‘meetingsand courses’, ‘ICS Annual Meetings’ then ‘ICS/IUGA 2004 (Paris)’ then ‘search’. Enter the surname of the rst author in the box next to

‘abstract search’ and select the desired article.

Thompson, J., O’Sullivan, P., Briffa, K., et al. (2004). Motor control strategies involved in pelvic oor elevation and depression: Posterpresented at Proceedings of the Joint ICS/IUGA meeting. To access this paper, go to www.icsofce.org, click on ‘meetings and courses’,‘ICS Annual Meetings’ then ‘ICS/IUGA 2004 (Paris)’ then ‘search’. Enter the surname of the rst author in the box next to ‘abstract search’and select the desired article.

Thompson, J., O’Sullivan, P., Briffa, K., et al. (2005). Altered muscle activation patterns in symptomatic women during pelvic oor musclecontraction and valsalva manoeuvre. Neurourology and Urodynamics, 24(5/6), 517-518.

Thompson, J., O’Sullivan, P., Briffa, N., et al. (2006). Assessment of voluntary pelvic oor muscle contraction in continent and incontinentwomen using transperineal ultrasound, manual muscle testing and vaginal squeeze pressure measurements. International UrogynaecologyJournal, 17, 624-630.


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Pelvic Floor Muscles in Association with Other Muscle Contraction and Functional Activities

Bø, K., & Stein, R. (1994). Needle EMG registration of striated urethral wall and pelvic oor muscle activity patterns during cough, valsalva,abdominal, hip adductor, and gluteal muscle contractions in nulliparous healthy females. Neurourology and Urodynamics, 13, 35-41.

Ree, ML., Nygaard I., & Bo K. (2007). Muscular fatigue in the pelvic oor muscles after strenuous physical activity. Acta Obstetricia etGynecologica Scandinavica, 86 (7), 870-876.

The Normal Pelvic Floor: MRI Studies

Bø, K., Lilleas, F., Talseth, T., et al. (2001). Dynamic MRI of the pelvic oor muscles in an upright sitting position. Neurourology andUrodynamics, 20, 167-174.

Christensen, L., Djurhuus, J., & Constantinou, C. (1995). Imaging of pelvic oor contractions using MRI. Neurourology and Urodynamics,14, 209-216.

Mikuma, N., Tamagawa, M., Morita, K., et al. (1998). Magnetic resonance imaging of the male pelvic oor: The anatomical congurationand dynamic movement in healthy men. Neurourology and Urodynamics, 17, 591-597.


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Pelvic floor exercises Booklet

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