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Overactive bladder is a common form of urinary incontinence that is widely treated with pelvic floor muscle (PFM) training, also known as Kegel exercises. It is a common condition which can sometimes lead to embarrassing accidents. A new laboratory study lends insights into how PFM training works by reducing contractions of the detrusor muscle of the bladder. This is published in the American Journal of Physical Medicine & Rehabilitation, the official journal of the Association of Academic Physiatrists.
For the purpose of the study, researchers performed urodynamic studies in two groups of women. Eighteen patients had overactive bladder symptoms related to multiple sclerosis (MS), a chronic central nervous system disease. About 80 per cent of patients with MS experience "neurogenic" (nerve damage-related) bladder symptoms sometime during the course of their disease. Another 17 patients had "idiopathic" overactive bladder. This means that there seemed to be no specific cause of their urinary symptoms. Symptoms were similar between the groups, based on a standard OAB questionnaire.
In the experimental procedure, the women were instructed to perform a 15-second PFM contraction during a period of detrusor muscle overactivity. The study focused on overactivity of the detrusor muscle. This is the muscle in the bladder wall that contracts to help push urine out of the bladder. The results confirmed that contracting the pelvic floor muscles led to reduction in the pressure produced by detrusor overactivity. Although the decrease in detrusor muscle pressure with PFM contraction was significant in both groups, the effect was larger in patients with idiopathic OAB. For this group, the median decrease in detrusor overactivity was 69 per cent, compared to 34 per cent in the patients with MS.
Pelvic floor muscle contraction completely eliminated detrusor overactivity in eight of the 17 women with idiopathic OAB, compared to three of 18 women with MS. The difference likely reflects the more severe disability and greater detrusor overactivity in MS patients with OAB symptoms. Although PFM contractions were still effective in MS patients with neurogenic bladder symptoms, the link may be weaker due to neurological damage throughout the brain and spinal cord.
Pelvic floor muscle contractions can reduce the severity of contractions of the detrusor muscle of the bladder in patients with overactive bladder, including those with and without multiple sclerosis. PFM contractions may reinforce a key "voluntary reflex" controlling urination. Pelvic floor muscle contractions activate the frontal cortex of the brain, which is responsible for the "voluntary urinary inhibition reflex" thus improving conscious control of bladder function.
If you are new to this, then the right thing to do will be to identify your pelvic floor muscles. To do this, just stop your urination in midstream. Notice the muscles you use to do this. Once you've identified your pelvic floor muscles you can start practicing. Sit or lie down in a comfortable position. Tighten your pelvic muscles and hold for a few seconds. You can count to 10 while holding and then relax for. Put the pressure only on your pelvic muscles and not on the muscles in your abdomen, thighs or buttocks. Breathe normally. Do at least three sets of 10 to 15 repetitions every day.
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