Pelvic floor exercises in the elderly:

what are the benefits?

Irmina Nahon (M. Physiotherapy)
Pelvic Floor Physiotherapist
ACT Health Continence Promotion
Centre

Pelvic Floor Exercise & the Elderly

Where is the pelvic floor

What does it do
Aging: the bladder & the pelvic floor
Why do pelvic floor exercises
Muscles and ageing
Pelvic floor exercises for all ages

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Where Is the Pelvic Floor? - female

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The male pelvic floor

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What Does It Do?

Bladder & bowel control
Support pelvic organs
Bladder
Bowel
Uterus

Sexual function

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Weakness of Pelvic Floor Can Cause

Urinary Incontinence
Anal Incontinence
Prolapse

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Types of Urinary Incontinence

Stress incontinence
Urge incontinence
Over Active Bladder
Functional incontinence
Overflow
Other bladder problems

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Stress Incontinence

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Anal Incontinence
Flatus
Liquids
Solids

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Prolapse

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Weakness is caused by: For women

Pregnancy
Childbirth
Hormonal variations
Menopause
Gynaecological surgery

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Weakness is caused by: For everyone

Fluid input
too much,
too little,
bladder irritants (alcohol, caffeine)

Constipation
diet / fibre

Poor defaecation posture

Chronic coughing / sneezing
respiratory conditions,
smoking
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Weakness is caused by: For everyone

Being generally unfit or overweight
Heavy lifting & poor lifting techniques
Some medication: (blood pressure, diuretics,
codeine, arthritis)
Nerve damage (childbirth, stroke, MS,
Parkinson's, diabetes)
Spinal problems or injuries
Ageing
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Age Related Changes to the Bladder

Normal age related changes means that for some,
bladder function will be borderline.
These include:
reduced sensory awareness of bladder filling
reduced ability to effectively empty the bladder

Age specific changes prostatomegaly (),

reduced oestrogen levels ()
Change in level of anti diuretic hormone can
cause day and night urine production at the same
levels, altered pattern of voiding, fluid retention.
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Age Related Changes (1)

Nervous system
Bladder
Urethra
Oestrogen
Prostate
Co-morbidities

Parkinson's Disease
Dementia
COAD
Diabetes
Constipation/FI
SOURCE: Hunt (1993)

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Age Related Changes (2)

Attitudes
Loss of mobility &
dexterity
Loss of independence
Neuropsychological
disturbance
Drugs and drug
interactions
incidence of UTIs
Previous genitourinary
surgery
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Bladder/Urethra Changes
Structural

Functional

bladder collagen
Benign prostatic
hypertrophy
oestrogen

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bladder capacity
bladder sensation
post-void residual
volume
urine flow rate
urethral pressure
risk of urinary infection
concentration of urine
overnight

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Management of Incontinence in
Older Adults

Primary prevention

Childbirth trauma
PFM weakness
Detrusor overactivity
Impaired mobility or cognition

Secondary prevention
Reverse predisposing conditions OR
Prevent from progressing to incontinence

Tertiary prevention
Management strategies to reduce the impact of
incontinence
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Management of Incontinence in
Older Adults

Good bladder habits

Pelvic floor exercises
Toilet environment
Toilet alternatives
Prompted toileting
Timed toileting
Diet and Dentition

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Condom drainage
Catheters
Skin care
Protective clothing
Pads and Pants
Bed-pads and chairpads

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Management of Incontinence in
Older Adults
Where to get help
GP
Medical specialists
Continence nurse advisors
Continence physiotherapists
Community health centre/service
ACAS/DNS
Interpreter services
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10 Things to Remember
1. Screening is essential
2. Incontinence is not
inevitable consequence
of ageing
3. Mx options for older
adults essentially the
same as for younger
adults
4. Special considerations
for Ax & Mx of older
adults
5. Baseline assessment

6. Significant
improvement in elderly
when focus away from
bladder
7. Ix & Mx options
8. Nocturia & Nocturnal
enuresis
9. Incontinence in frail
elderly not necessarily
caused by dementia
10. Every person should be
given the opportunity
to achieve continence
(Independent/ dependent/ social)

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Incontinence is not an inevitable

consequence of ageing.

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Aging muscles
50% of total muscle mass loss between 20-90
Muscle weakening (atrophy) is worse with a
sedentary lifestyle
Changes in how muscles respond occur with
aging
But
Age related changes are often reversible

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Aging Pelvic Floor Muscles

Same as for other muscle groups
Weakness and loss of functional control
Can be reversed by exercising

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Pelvic Floor Exercises

Pelvic floor muscles are the layer of muscles
that support the pelvic organs.
Pelvic floor muscles exercise helps to reduce
or stop the leakage of urine and faeces.
Regularly attending PFEs will only make them
stronger.
These should become a life long habit

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Exercising the Pelvic Floor

Exercising Those Muscles
Squeeze, close, lift

CANT FIND
THEM?
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How to find them?

Self Evaluation

Self Examination
Stopping the flow
Coughing with confidence
Get a Grip or Pull Them In

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How to do Pelvic Floor exercises

How often do I exercise?
2-3 times per day

Getting into a routine

Cues

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Types of Exercises

Exercising Those Muscles

Change positions
Functionally & sub-maximally
Quick vs. slow

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When to Exercise?
Tighten Those Muscles with:

Sneezing
Coughing
Laughing
Whenever you leak
Functional activities

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How Old is Too Old?

No upper age limit
Doesnt work if cause of incontinence is not
weak muscles
Incorporate exercises in life

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Summary
Muscle weakness occurs with inactivity and
aging
Pelvic floor is a muscle as any other
Weakness causes incontinence
Exercising will make muscles stronger
Pelvic floor exercises reduce incontinence
Never too late to start exercising

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Any questions?

THANK YOU

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