Assessment and treatment of Pelvic Floor Dysfunction Part 1:Objective Testing of Pelvic Floor Function in Women Pelvic Floor

Muscle function needs to be assessed for a number of different conditions including Pelvic Organ Prolapse, Persistent Pelvic Pain, Stress Urinary Incontinence, Faecal Incontinence, Urgency and Urge Incontinence. Physiotherapists with a special interest in Continence and Womens Health can provide an individualised assessment of Pelvic Floor function depending on the presenting symptoms. These are all ways in which a Womens Health Physiotherapist may assess Pelvic Floor function: Perineal Observation What is it? Observation of the Perineum at rest and during movements e.g. contracting pelvic floor muscles, coughing, bearing down. What can it tell us? The resting position of the perineum and how much it moves gives an indication of the extensibility of the connective tissue of the Pelvic Floor. Digital Vaginal Examination What is it? Palpation of the pelvic floor muscles from inside the vagina. What can it tell us? Pelvic Floor muscle strength (Modified Oxford Scale 1-5), Signs of overactivity of the Pelvic Floor Muscles e.g. trigger points, pain on palpation. Signs of levator ani avulsion (indication only not reliable as stand alone assessment) Perineometry What is it? The therapist measures the pressure (cmH2O) produced by the pelvic floor contraction using a manometry machine specifically designed to measure the quality of a Pelvic Floor contraction. The Peritron is the most accurate Perinometer currently available which gives the ability to accurately measure and reliably track improvements in Pelvic Floor function. What can it tell us? Pelvic Floor resting pressure . Pelvic Floor Muscle contraction Strength Pelvic Floor Muscle endurance. Hiatus Assessment What is it? Measurement of the Genital Hiatus (GH) length and the Perineal Body (PB) Length when bearing down. What can it tell us? Research has shown that GH + PB correlates to the levator hiatus size and therefore gives us an indication of risk of Pelvic Organ Prolapse. Real Time Ultrasound What is it? An Ultrasound scan of the pelvic organs and pelvic floor What can it tell us? Bladder neck / urethral mobility Can visualise the lifting action of the pelvic floor muscles Part 2 next month will outline the physiotherapy treatment options available for common pelvic floor problems. Written by: Alice Taylor, Bsc(Hons) Physiotherapy

Principal Physiotherapist/Partner, Active Physiotherapy Mackay

Continence and Womens Health Group Member, APA IUGA Member