Correct activation of the pelvic floor muscle:

• “Close and lift” (closing the rose bud and opening the rose bud)
• 70% of the muscle fibres are for endurance and 30% are for strength

1. Knees higher than hips
2. Feet resting on a step, no heel raising
3. Elbows resting on knees
4. Back straight, belly button relaxed
5. Belly button breathing (diaphragmatic)
6. Pelvic tilt forward
7. The pelvic floor muscle (Puborectalis) needs to relax to urinate and evacuate

Breathing is done by contracting the diaphragm, a muscle located horizontally between the thoracic cavity and abdominal cavity. Air enters the lungs and the chest rises and the belly expands during this type of breathing.

1. Inhale through the nose into the belly button. The belly button expands during inhalation
2. Exhale through the mouth, dropping the belly button
3. Visualise an umbrella: Inhale, opening the umbrella in all direction. Exhale, closing the umbrella.

Trans Cutaneous Electrical Stimulation is a neuromodulation therapy where a low voltage electrical current is used to stimulate the nerves in the pelvic floor or lower back via a vaginal or an anal electrode to strengthen the pelvic floor muscle or to inhibit the detrusor overactivity.

1. Biofeedback shows you when your bladder and urethral muscles contract, to help you gain awareness and control of your urinary tract muscles.
2. This means that weak muscles can be better activated on demand, muscles that are too tense can be relaxed, and overall muscle activity can be coordinated.
3. Sensors can be placed on the abdomen, perineum, anus or vaginally or rectally.
4. The monitor will show you which muscles are contracting, and which are at rest.
5. Biofeedback can take different forms.

• The physiotherapist's hand: Squeezing a finger with your pelvic muscles
• Manometry: Small balloons are inserted into your vagina or anus and filled with air or water. You contract your pelvic floor muscles and the pressure inside the balloons measures the strength of the muscles in your pelvic floor.
• Electromyography (EMG): electrical sensors are placed on the skin inside the vagina to measure the electrical activity of your muscles at rest and when they contact. The reading is shown either on a graph or screen.

Vaginal weights are plastic cones (variable sizes and weight) inserted into the vagina for progressive length of time during daily activities to strengthen the pelvic floor muscles.

1. Preventing recurrent urinary tract infection
2. Prevent post void residuals
3. Avoid bladder irritants
4. Control the urge of urination due to overactivity of the Detrusor muscle.
5. Correct amount of fluid and fibre intake during a day
6. Bladder chart evaluation and advice

1. Stress incontinence

• Estrogen- topical cream
• Ephedrine- alpha stimulant (helps the contractibility in the urethral sphincter)

1. Overactive bladder/Urge

• Tri-cyclic anti-depressant - to inhibit the bladder muscle contractibility
• Anticholinergics - to decrease force of contractibility of the bladder muscle
• Ca channel blockers - to decrease bladder contraction
• Capsaicin (chilies)

1. Stress incontinence

• Urethral sling
• Collagen Injections

1. Overactive bladder

• Botox
• Sacral nerve stimulation