Pelvic Floor Rehabilitation - Aged Care Guide

The Pelvic Floor: From Teaching to Rehabilitation Issue 1 2011
What’s Inside?
4 Pelvic Floor Muscle
Training with Kari Bø
5 Pelvic Floor Rehabilitation
Insights with Dr
Pauline Chiarelli
6 Men, Women & the Pelvic Floor
8 Pelvic Floor Exercise
and the Elderly
9 Q&A with Dr Margaret
Sherburn
10 A Case Study from
Jenni Porch
12 World Continence Week
and the Pelvic Floor
First Campaign
Pelvic Floor
Rehabilitation
Success depends on guidance,
understanding and compliance
In 1948 obstetrician/gynaecologist Dr Arthur
Kegel developed a program of contractions of the
pelvic floor muscles, specifically the levator ani
muscle, for women suffering from stress urinary
incontinence (SUI) 1 . Today, pelvic floor muscle
exercises (PFME) are most commonly recommended
as a first line treatment for both men and women
experiencing SUI and mixed incontinence and are
often prescribed with other conservative adjuncts
for SUI such as diary keeping, bladder training,
biofeedback, functional electrical stimulation,
lifestyle modifications and continence aids.
While there are many studies and reviews demonstrating positive
short term effects of PFME, positive long term effects of these
exercises have also been demonstrated. For instance, a 1996
study that evaluated the effect of PFME on genuine SUI five years
after the conclusion of an organised training program found
upon follow up that ‘75% of participants showed no leakage
during stress test, 70% were still performing PFME at least once
a week and pelvic floor muscle strength was maintained’ 2 .
Prior to the commencement of any PFME program, a thorough
assessment of the pelvic floor muscles is required to diagnose
and treat continence problems in the most appropriate fashion 3 .
And because continence nurses/physiotherapists can often treat
patients without a full diagnosis, it is necessary (where possible)
that they communicate with other medical practitioners to
uncover any underlying conditions that may be the cause of a
patient’s complaint 4 or influence the outcome of treatment.
Where it is appropriate for PFME to commence,
it has been recommended that the practitioner
devise a program focusing on patient-centred
goals with the patient (if practical), ‘deciding
Article continued on next page >>

Practical Steps of
Learning a Correct
Muscle Contraction
Understand – The patient
needs to understand where
the pelvic floor muscles are
located and how they work.
Search – The patient needs time to
put this understanding into her or
his body. Where is my pelvic floor?
Find – The patient must find where
the pelvic floor muscles are, but
often needs reassurance from the
physical therapist of the location.
Learn – After having found the
pelvic floor muscles, the patient
needs to learn how to perform a
correct contraction. Feedback from
the physical therapist is necessary.
Control – Most subjects still strive
for a while to perform controlled
and coordinated contractions
recruiting as many motor units as
possible during each contraction;
most people are unable to hold
the contraction, perform repetitive
contractions or conduct contractions
of high velocity or strength.
Taken from K Bø & S Morkved (2007) 13
the final goal of treatment’ 5 . This will help
guide the PFME program and the intensity
at which the patient needs to practise.
Attainment of patient centred goals is
associated with ’improved quality of life
and health status, decreased depression,
and greater patient satisfaction’ 6 .
Developing patient centred goals may
also help boost motivation and increase
the likelihood of program adherence
where ongoing training is required.
It is also important to remember that
despite the high prevalence of pelvic floor
dysfunction (urinary or faecal incontinence
or obstruction, constipation, vaginal or
uterine prolapse, vaginal or rectal pain,
sexual dysfunction or pelvic pain) 7 many
women and men have little knowledge
about the pelvic floor and how to exercise
the muscles correctly. As the very success
of a PFME program depends on the
“Developing patient centred
goals may also help boost
motivation and increase
the likelihood of program
adherence where ongoing
training is required.”
exercises being ‘performed correctly
and consistently’ 8 , it is vital to ensure that
your patient understands how to contract
the pelvic floor muscles properly and
at the right intensity. Performing PFME
incorrectly or at a low intensity will have
little to no effect and may make the
problem worse, compounding frustration
and compromising motivation and
compliance to the prescribed program.
Although there is a large amount of very
good patient literature available outlining
PFME, it is difficult for patients to first
identify then contract the muscle correctly
“...the guidance and
supervision provided by a
health professional offers
the greatest opportunity
for a patient to learn
about the pelvic floor...”
and to full effect without the guidance
of a suitably trained health professional 9 .
Undeniably, the guidance and supervision
provided by a health professional offers
the greatest opportunity for a patient to
learn about the pelvic floor while dispelling
any misconceptions and scepticism.
Interestingly, a study published in 2007
aimed to describe the types of PFME
instruction 921 women encountered
in the pre and post natal period, their
PFME behaviour, reasons they did
not perform PFME, and variables
associated with post partum PFME
performance. It found that ‘less
than one half of the women (41%) were taught PFME by a doctor, nurse/
midwife who were involved in their care. Instead more (59%) learnt
about PFME from other sources’ (books, videotapes, classes, friends
and family), with only 10% reporting learning by demonstration 10 .
This study highlights the need for health practitioners to routinely discuss their
patient’s knowledge and understanding of PFME and provide referral to a
Continence Physiotherapist and/or Continence Nurse Advisor for training and
advice if necessary. Routinely discussing the pelvic floor with patients may also
prevent a pelvic floor condition from remaining undiagnosed due to patient
embarrassment or acceptance of urinary incontinence as a ‘normal’ and/or
expected consequence of their condition. Books, leaflets and videos should
be used as an adjunct to guided training, rather than a replacement for it.
The amount of pelvic floor muscle training and supervision required by an
individual is dependent on the level of incontinence experienced, the degree
of damage sustained by the pelvic floor and the capability of the patient to
master PFME.
In those who are experiencing significant stress incontinence or who are
having trouble identifying and/or contracting the pelvic floor muscles, referral
to a specialist continence service or physiotherapist 11 is strongly advisable.
For those who are unable to generate a correct or strong enough contraction,
PFME training tools such as biofeedback and pelvic floor electrical stimulation
employed by specialist continence services have been used to success
in men and women when combined with a PFME program. Indeed, any
adjunct that facilitates learning enhances patient effort and increases
motivation and adherence to a PFME program should be considered 12 .
1 Newman, K, D., 2009, Pelvic floor muscle rehabilitation, accessed at Seek wellness website http://www.seekwellness.com/incontinence/
pelvic_floor_muscle_rehab.htm 25/01/2011 2 Bø, K., Talseth, T., 1996, Long Term Effect of Pelvic Floor Muscle Exercise 5 Years after cessation of
organised training, Obstetrics and Gynecology Vol 87, No 2, p261 3 Sandhu, J, S., 2010, Treatment options for male stress urinary incontinence,
Nature Reviews Urology, Vol 7, p 223 4 Bø, K., 2007, Overview of physical therapy for pelvic floor dysfunction, Bø, K., Berghmans, B., Morkved, S.,
Kampen M, V, Evidence Based Physical Therapy for the Pelvic Floor Bridging Science and Clinical Practice, p 5, Churchill Livingstone Elselvier. 5
Bø, K., 2007, Overview of physical therapy for pelvic floor dysfunction, Bø, K., Berghmans, B., Morkved, S., Kampen M, V, Evidence Based Physical
Therapy for the Pelvic Floor Bridging Science and Clinical Practice, p 5, Churchill Livingstone Elselvier. 6 Bovbjerg VE, Trowbridge ER, Barber MD,
et al., 2009, Patient - centred treatment goals for pelvic floor disorders: association with quality of life and patient satisfaction, American Journal
of Obstetrics Gynecology ;200:568.e1-568.e6. 7 Mary O’Dwyer 2010, Hold It Sister The confident girl’s guide to a leak-free life 2nd Edition,
Buderim, QLD, RedSok Publishing p13 8 Liu C. H, 2009, Effectiveness of Pelvic Floor Exercises, digital vaginal palpitation and interpersonal
support on stress urinary incontinence, accessed medical news today http://www.medicalnewstoday.com/articles/159676.php 27/01/2011 9
Korda, A., 2010, How To Treat Urinary Incontinence in Women, Australian Doctor, Feb 2010, p27, accessed at Australian Doctor website, http://
www.australiandoctor.com.au/HTT/PDF/ad_023_030_feb12_10.pdf 27/01/2011 10 Fine, P., et al., 2007, Teaching and practice of pelvic floor muscle
exercises in primi parous women during pregnancy and the post partum period, American Journal of Obstetrics & Gynecology, Vol 197, Issue 1
,p 107. 11 Pomfret I., Holden., C., 2007, Implementing Guidance on pelvic floor exercises, Nursing Times Vol 103, Issue 19, pp 40-41, accessed
at http://www.nursingtimes.net/nursing-practice-clinical-research/focus-implementing-guidance-on-pelvic-floor-exercises/199198.article
15/02/2011 12 Bø, K., 2007, Pelvic Floor muscle training for stress urinary incontinence, Bø, K., Berghmans, B., Morkved, S., Kampen M, V, Evidence
Based Physical Therapy for the Pelvic Floor Bridging Science and Clinical Practice, p 184, Churchill Livingstone Elselvier p 179 13 Bø, K., Morkved,
S., 2007, Pelvic floor and exercise science Bø, K., Berghmans, B., Morkved, S., Kampen M, V, Evidence Based Physical Therapy for the Pelvic Floor
Bridging Science and Clinical Practice, p 115, Churchill Livingstone Elselvier
Welcome to the June
2011 Issue of The
Continence Advisor
In recognition of the Australian and New Zealand
theme for World Continence Week 2011 (June 20
– 26), this edition focuses on the pelvic floor and
covers a wide range of topics. These include pelvic
floor muscle training (PFMT) for women and men,
factors necessary to obtain success from a PFMT
program and the pelvic floor and the elderly.
We are privileged to include contributions from
leading pelvic floor experts, and would like to
thank these people for enriching the content of
this issue: Professor Kari Bø, exercise scientist
and physiotherapist at the Norwegian School
of Sports Sciences Oslo and a leading expert in
pelvic floor muscle training who shares practical,
helpful information about patient education. Dr
Pauline Chiarelli, Associate Professor and Program
Convener for the Discipline of Physiotherapy at
Newcastle University Australia and Australia’s
first Physiotherapist Continence Advisor who
provides comment on physiotherapist training and
PFMT for men. Dr Margaret Sherburn, PhD FACP,
Women’s Health Programs Physiotherapy, The
University of Melbourne, who provides interesting
insights into the pelvic floor and ageing.
We would also like to thank Jenni Porch, Continence
Physiotherapist at the Southern Continence
Service Melbourne, who contributes an inspiring
case study demonstrating the successful outcome
of a PFMT program in a patient initially sceptical
about the benefits of pelvic floor exercises.
In TENA News, we discuss TENA’s collaboration
with Kari Bø to develop the extremely popular
Pelvicore Technique DVD, with additional
support materials, and demonstrate the
benefits of light bladder weakness aids to
support continence throughout PFMT.
Thank you for your continued subscription
to The Continence Advisor. Please continue
providing us with your valuable feedback.
Happy reading!
The TENA Healthcare team
Share Your Stories
with Professionals
in Your Field!
The Continence Advisor invites you to contribute
your case study or innovative management
strategies on any topic related to continence.
If you are interested in sharing your story
with the professionals in your field please
email Healthcare.Marketing@sca.com

Pelvic Floor
Muscle Training
with Kari Bø
Professor Kari Bø is an exercise scientist and
physiotherapist at the Norwegian School of Sports
Sciences Oslo and a leading expert in pelvic floor
muscle training. Here she shares her teaching
methods for effective pelvic floor muscle training
with The Continence Advisor.
Pelvic floor muscle training (PFMT) is very
effective in the treatment of stress urinary
incontinence. In fact, there are more
than 60 randomised control trials and
several independent systematic reviews
confirming this. The cure rates vary between
36 – 80% and we know that supervised
training is the most effective method.
We have demonstrated that PFMT changes
the morphology of the pelvic floor, acting
directly on possible causes of incontinence,
and in my experience, it is rare that women
do not experience any improvement in
symptoms at all following a PFMT program.
I believe the most important factor influencing
the success of pelvic floor exercises is a patient’s
ability to contract the muscles, increase muscle
force and adhere to their prescribed program.
Ability to Contract the Muscles
and Increase Muscle Force
It is vital that patients understand how to
perform correct pelvic floor exercises, so I use a
model of the pelvis complete with the muscles,
which I place on their lap. This means the
patient is basically looking down into her pelvic
floor, allowing me to explain how the muscles
can contract (lift and squeeze). I also make
the patient hold her hands as a cup in front
of her, and then I press down with my hand,
asking her to hold tight against my pressure
downwards. Another effective method involves
the patient sitting on an armrest, while trying
to lift the perineum away from the armrest.
After instruction and some rehearsal, I observe
movement of the perineum, do a one finger
vaginal palpation and then measure pelvic
floor muscle strength with my manometer.
It is important for the patient to practice
and work at achieving strong contractions,
as many women do very weak contractions
and do not progress in their attempts. A
tool that is reliable to assess the strength
of the contraction (such as a manometer)
can be very useful here. The undertaking of
inappropriate exercises can result in a ‘non
effect’, mainly because the patient has not
been able to do a correct contraction or the
“...the most important
factor influencing the
success of pelvic floor
exercises is a patient’s
ability to contract the
muscles, increase muscle
force and adhere to their
prescribed program.”
contraction has been far too weak. The worst
cases are those who are straining (pressing
down), and we can also see that many of
these women have pelvic organ prolapse. It is
extremely important that women are examined
properly so they continue to train correctly.
Physiotherapists have the basic education
to teach and assess muscle function, and a
women’s health physiotherapist is obviously
specially trained for this. However, it is important
that all healthcare professionals talk about PFMT
and know how to teach a correct contraction.
I think many physiotherapists have consulted
with patients referred by a gynaecologists
stating that the patient is able to contract, but
in fact the patient is actually pressing instead of
lifting and squeezing the pelvic floor muscles.
Adherence to the Prescribed Program
Adherence to the prescribed program
depends on patients understanding why
they need to perform PFMT and how
to correctly perform the exercises.
I never tell them when to exercise, but ask
them to tell me when THEY think they can
manage to do it. I also find it important to
use a training diary. However, some (only a
few) are not possible to motivate (as it can
be for general exercise), and it comes to
a point when this is really up to them.
In the initial phase where patients are required
to strengthen the muscles, they really need to
concentrate. During this phase it is important
that patients set aside some time and are
not conducting PFMT at the same time as
other activities. I recommend 15 minutes,
which is not too long and allows for 3 x 10
sets of contractions. When it comes to the
maintenance phase, we know that intensity of
the contraction is the most important thing,
so 2-3 strong contractions twice a week may
be enough. At this stage I think that doing
PFMT while in the car waiting for a green light
or while brushing teeth may work. Although
we have very little knowledge about this!
“...it is rare that [there is no]
improvement... following
a PFMT program.”
Where long term muscle training is required,
each woman must find her own way of coping.
Some women report doing exercises every
morning before getting out of bed, others do
them after a while without exercising, when
they feel “loose”, and then exercise hard
for some weeks until they feel fine again.
My idea has always been that PFMT
should be incorporated into general
fitness programs for women, but I realise
that this would only meet the need of
those already motivated for exercise.
The good thing about my Core Wellness DVD is
that women can do their training at home, and it
may make finding the time to exercise easier.
Pelvic Floor
Rehabilitation
Insights
Dr Pauline Chiarelli is an Associate Professor and
Program Convener for the Discipline of Physiotherapy
at Newcastle University (Australia) and Australia’s first
Physiotherapist Continence Advisor.
Pelvic Floor Physiotherapy
When I began my career in pelvic floor
rehabilitation almost 40 years ago, none of
my practice was evidence based. These days,
there is good evidence to show clinicians
the most effective way of assessing pelvic
floor muscle dysfunction and managing it.
There is also a very exciting and interesting
emergence of new knowledge in the anatomy
of continence and pelvic organ prolapse. All
health practitioners can benefit from and
be kept up to date with this information.
Teaching the Future Experts
When lecturing on the pelvic floor, my first
message to physiotherapy students is that it
is mandatory to explore the continence status
of any patient presenting with conditions such
as lower back pain, respiratory conditions and
osteoporosis etcetera, as there is evidence
to support significant associations between
these conditions and continence status. Of
equal importance is advising the students
that they are quite capable of interpreting
a well prescribed frequency volume chart.
Undergraduate level is not the place to teach
vaginal assessment and pelvic floor exercises;
however, if as graduates they are capable of
providing clients with a valid bladder diary
and are able to effectively and accurately
evaluate it before referring a patient on to an
experienced physiotherapist, they can save
the physiotherapist and the patient valuable
time and probably one or two visits.
Pauline’s Approach to
Pelvic Floor Exercises
Government authorities around the world
suggest that conservative measures shall
always be tried before other available
measures. It is always important to prescribe
the right management protocol for the right
person regardless of what the intervention
might be. Clinical reasoning is a basic skill
that underpins every physiotherapist’s
assessment and prescription.
In the case of stress incontinence, as long as it is
mild and the patient is motivated to comply with
the exercise program, then PFE can play a major
role. The trick is to tailor pelvic floor exercises to
the candidate and their type of incontinence.
When commencing a pelvic floor exercise
program, it’s really important to explore
the patient’s ideas of what they think this
constitutes. This way you’re able to correct
any wrong ideas they have before prescribing
an exercise program. Most importantly
patients must be aware that they need to
strengthen the pelvic floor muscles first,
and then keep on exercising them!
Any treatment protocol, whether it is drugs
or an exercise program needs to follow the
KISS (Keep It Simple Sweetie) principal. We
need to prescribe the minimal effective
amount of exercise dosage in order to try and
maximise patient motivation and compliance
with their tailored exercise program. We
also need to keep the exercise program
simple. A combination of correct education
of PFE and KISS will help to avoid and/or
rectify disappointment/disillusionment with
a PFE program where women are convinced
that PFE don’t work because they’ve been
doing them the wrong way for years.
Where necessary, long-term PFE protocols can
be maintained by incorporating the exercises
into functional activities. An easy habit for your
client to get into is to practise their pelvic floor
squeezes using activities that incorporate ‘the
knack’, which provides a resistive force in a very
functional way. For example, each time they
cough, sneeze or blow their nose they should
brace their pelvic floor muscles by squeezing
up hard and holding them. Men are asked to
empty their urethra at the end of every void
(“milking the bull”) to prevent post micturition
dribble - this also acts as a pelvic floor squeeze.
Incorporating the knack into daily life ensures
the patient is continuously engaging their
pelvic floor muscles, thus maintaining the
functional gains they achieved during the
prescribed program. This strategy is also
ideal for people who lead very busy and
active lifestyles. PFE are first line treatments
and should be instigated along with lifestyle
interventions. Lifestyle interventions are often
extremely difficult to achieve change, but a
well prescribed PFE program can actually help
to motivate these changes. For example, an
overweight woman who is asked to strengthen
her pelvic floor muscles while she is attempting
to reduce her body mass index, might in fact
be motivated by the impact of the exercises
on continence status, and thus continue
attempts to reduce her body mass index.
A Word on Men
Having been a long time educator and
advocate for continence achievement in
women, Pauline has turned her focus to pelvic
floor education for men, culminating in the
recent development of a pelvic floor exercise
DVD for men. Pauline is currently evaluating
the effectiveness of the DVD by visiting
prostate cancer support groups across New
South Wales and South East Queensland.
A ‘one size fits all’ approach is not appropriate
when educating men and women about
their pelvic floor muscles. To start with, we
should not make the assumption that men
can contract their pelvic floor muscles on
command. Secondly, the problem faced by
men is not that of damaged muscle tissue
or connective tissue. If men have an intact
nerve supply (which is often NOT the case
postoperatively) it is a matter of working
with muscles that are intact but not perhaps
previously used to increase urethral closure
pressure. So in a nutshell, pelvic floor instruction
for men is about educating the muscles.
In terms of attitude, men tend to be more
motivated than women to carry out an
exercise program, sometimes to the extent
that they can ‘overdo’ it! To prevent this, be
very specific and thorough when prescribing
the exercise program for men to follow. In
the case that extra motivation/awareness
of PFE for men is needed, good evidence
exists stating strong pelvic floor muscles can
strengthen an erection and prevent erectile
dysfunction (not related to nerve damage
associated with prostate cancer surgery).
Pauline’s DVD can be ordered by emailing
georgeparry@iprimus.com.au
CA Issue One / 2011 > 5

Men, Women and
the Pelvic Floor
Overview & treatment approaches
Traditionally considered the domain
of women, pelvic floor muscle
exercises (PFME) are now frequently
and successfully prescribed for
both the common (ageing and
chronic increases in intra abdominal
pressure) and gender specific
(vaginal delivery, prostatectomy)
causes of a weak and damaged
pelvic floor in women and men.
A wealth of evidence exists demonstrating
the alleviation and treatment of urinary
incontinence (UI) in those who have
undertaken PFME and those who have
participated in a pelvic floor muscle
training program (PFMT). In order to
achieve maximum benefits from the
exercises however, men and women require
unique education and tailored advice.
Women
The major cause of a damaged and weakened
pelvic floor in women is vaginal childbirth
(denervation injury and injury to pelvic
floor muscles 1 ), with an estimated one third
of women experiencing UI 3 – 6 months
after birth 2 . Stress incontinence is the most
common type experienced, where a small
amount of urine is involuntarily lost when
performing activities that put pressure
on the bladder. Activities like coughing
and sneezing are usually supported by
the pelvic muscles, and childbirth may
have weakened these leading to leakage.
Pelvic floor dysfunction may also become
evident or worsen during pregnancy, after
abdominal or pelvic surgery, during the
menopausal years and with ageing 3 .
Numerous examples exist that demonstrate
the positive outcomes of PFME programs
for women. As well as helping to alleviate
stress incontinence, strengthened pelvic
floor muscles may also help women with
mixed incontinence (the combination of
both stress and urge incontinence) and
assist some in controlling the urge to void.
A strong pelvic floor in prenatal women
assists with vaginal delivery, with one 2004
study finding that women in a structured
PFMT program between 20 – 36 weeks of
pregnancy had a lower rate of prolonged
second stage labour than women in the
control group. PFME also decrease the risk
of injury during childbirth 4 . And in the post
natal period, PFMT can prevent and treat UI,
with the effect having been shown to remain
‘for 1 year after cessation of supervised
training’ 5 . As for women who practice PFMT
post partum, a study published in 2007 found
that those who practised regularly (at six
months post partum) ‘had more children, had
attained a higher level of education and were
more likely to participate in general fitness
activities three or more times a week’ 6 .
Morphological changes to the pelvic floor
muscles have also been demonstrated in
those undertaking PFMT. The results of a trial
devised to investigate the effects of a PFMT
program in women with pelvic organ prolapse,
found that ‘women in the PFMT group
increased muscle thickness, decreased hiatal
area, shortened muscle length and elevated
the position of the bladder and rectum’ 7
compared to women in the control group.
Men
Men often experience the symptoms of
a weak pelvic floor caused by damage to
the sphincter following prostatectomy and
treatment for benign prostatic hyperplasia,
and while most men are able to regain
continence within the year following
surgery, numerous studies and evidence
exists demonstrating that PFME hastens
continence recovery. One such review
using evidence from randomised trials
concludes that PFMT ‘with or without the
use of biofeedback, hastens the return of
continence more than no PFMT in men
with UI after radical prostatectomy 8 .
To learn the technique correctly and gain
full benefit of the exercises, men should
commence the program in the months prior to
surgery. Post operatively, the program should
recommence once the catheter is removed.
And in men who were suffering UI more than
a year after prostatectomy, a behavioural
training program that included PFMT, bladder
control strategies and monitoring fluid intake
over eight weeks, was shown to decrease
weekly incontinence episodes by 55%
compared to men in a comparison group 9 .
Not only have PFME been successful in
alleviating stress incontinence caused by
prostatectomy 10 , contracting the pelvic floor
muscles strongly after voiding may help
to eliminate urine from ‘the bulbar portion
of the urethra to ease post micturition
dribble’. In addition, strengthening the
pelvic floor muscle can help men regain
their ability to control urge to void 11 .
Exercising the pelvic floor correctly
Women and men require unique
advice when it comes to achieving
the correct muscle contraction a
successful PFME program demands.
Women
Women should be advised to squeeze and
draw in the perivaginal and anal sphincter
muscles at the same time, lifting them
up inside. When done correctly a distinct
squeeze and lift sensation should be
felt 12 . In order for women to understand a
correct contraction Kari Bø outlines some
practical learning strategies on page 4 of
this issue. A helpful visualisation to enable
female patients to understand the required
contraction is a passenger lift that starts
with the closure of the doors (squeeze) and
then the elevator moving upwards (lift) 13 .
Men
To perform a pelvic floor muscle contraction,
men should be advised to squeeze muscles
around the rectal sphincter as if holding
back wind 14 . In order for men to understand
the action of a contraction, the Continence
Foundation of Australia recommends that
the patient stand sideways in front of a mirror
naked and tighten the pelvic floor muscles.
If done correctly, he should see the base of
the penis draw in and the scrotum lift, with
an obvious sensation of ‘letting go’ when the
pelvic floor muscle is relaxed 15 . Men should
be sure the pelvis is not moving, and that
they aren’t actively contracting the gluteal
or adductor muscles 16 . Recommended
positions for men to practice PFME for stress
incontinence are in ‘the crook lying position
with knees bent apart, standing with knees
apart and sitting with knees apart’ 17 .
Common mistakes
Common mistakes to beware of in
both women and men include bearing
down instead of squeezing and lifting
and tensing buttocks and thighs 18 .
Stopping the flow of urine midway
through emptying the bladder (to identify
contraction of the correct muscle) 19 is only
recommended once a week at the very
most 20 to prevent issues with voiding 21 .
In terms of an exercise guide, the Continence
Foundation of Australia recommends both
women and men squeeze and lift and hold to
a count of 8 before relaxing for 8 seconds in
between each lift of the muscles. Three sets
of 8 – 12 squeezes (while breathing normally)
throughout the day should experience some
improvement in symptoms within 6 - 12
weeks. It is important patients are reminded
that quality of contraction is more important
than quantity and it may take them a while to
build up the required maximum strength.
Assessing a contraction
Prior to the commencement of supervised
PFMT for the treatment of UI, the National
Institute for Health and Clinical Excellence
(NICE) recommends that women undergo
a routine digital vaginal assessment of
pelvic floor muscle contraction 22 . Likewise,
a rectal examination is recommended
to assess the strength and endurance
of the pelvic floor muscles in men 23 ,
however in all cases, the reasons for the
examination 24 must be explained.
For patient comfort, a same sex continence
specialist may be preferred to conduct the
examination, and a perineal examination
should be offered to men who do not
want a digital rectal examination 25 .
Allow the patient to practice the contraction
a few times before this assessment is
conducted and be mindful that most
patients can learn to contract correctly ‘if
given some time at home to practice’ 26 .
Once the patient can perform PFME to the
desired strength and repetition, ‘the knack’
is often recommended to patients as a
useful everyday manoeuvre to prevent the
occurrence of Stress UI upon an increase
of intra abdominal pressure (coughing,
sneezing, lifting and getting out of a chair).
In fact, a 2007 study testing ‘the immediate
effect of timing a pelvic floor muscle
contraction with the moment of expected
leakage’ (to pre-empt cough related stress
incontinence), quantified with a paper towel
test found that the wetted area of women
in the non pregnant group decreased
from a median of 43.2cm 2 to 6.9cm 2 and in
pregnant women from 14.8cm 2 to 0 cm 2 27 .
1 Morkved, S., 2007, Evidence for Pelvic Floor physical therapy for urinary incontinence during pregnancy and after childbirth , Bø, K., Berghmans, B., Morkved, S., Kampen M, V, Evidence Based Physical Therapy for the Pelvic Floor
Bridging Science and Clinical Practice, p 319, Churchill Livingstone Elselvier 2 Hosli, I., 2010, Influence of pregnancy and delivery to the pelvic floor, Ther Umsch, Vol 67, Issue 1:11-8. 3 Mary O’Dwyer 2010, Hold It Sister The confident
girl’s guide to a leak-free life, 2nd Edition, Buderim, QLD, RedSok Publishing p13 4Salvesen, K. Å., Morkved S., 2004, Randomised controlled trial of pelvic floor muscle training during pregnancy, British Medical Journal, Volume 329,
pp 378-80 5 Bø, K., Owe, K., Nystand, W. 2007, Which Women do pelvic floor muscle exercises six months post partum? American Journal of Obstetrics & Gynecology; 197:49. e1 – 49. e5 6 Bø, K., Owe, K., Nystand, W. 2007, Which
Women do pelvic floor muscle exercises six months post partum? American Journal of Obstetrics & Gynecology; 197:49. e1 – 49. e5 7 Hoff, B, Ingeborg MSC, PT; Majida, M., et al; 2010, Morphological changes after pelvic floor muscle
training measured by 3 dimensional ultrasonography: a randomised controlled trial, American Journal of Obstetrics & Gynecology; Vol 115- Issue 2, Part 1 pp 317-324 8 MacDonald, R., Fink, H. A., Huckabay, C., Monga, M. and Wilt,
T. J. (2007), Pelvic floor muscle training to improve urinary incontinence after radical prostatectomy: a systematic review of effectiveness, British Journal Urology International, Vol 100 pp 76–81. doi: 10.1111/j.1464-410X.2007.06913.x
9 Goode P, S., Burgio, K L., et al., 2011, Behavioural Therapy with or without biofeedback and pelvic floor electrical stimulation for persistent post prostatectomy Incontinence A Randomised control trial, The Journal of the
American Medical Association,Vol 305, No 2 pg 151 10 Cornu, JN. 2011, Urinary incontinence in 2010: The evolution of SUI management, Nature reviews. Urology,Vol, 8 Nature p 68 11 Dorey, G. 2003, Pelvic Floor muscle exercise
for men, Nursing Times Vol 99, Issue 19 p46, accessed at nursingtimes.net, http://www.nursingtimes.net/nursing-practice-clincal-research/pelvic-floor-muscle-exercises/205516.article 02/02/2011 12 Australian Government
Department of Health and Ageing Bladder & Bowel website Pelvic Floor Muscle Training for Women - Strong Pelvic Floor Muscles Mean good bladder control, accessed at http://www.bladderbowel.gov.au/living/bladderp/women/
pelvicfloorwomen.htm, 12/01/2011 last updated 29/02/2008 13 Bø, K., Morkved, S., 2007, Pelvic Floor and exercise science, Motor Learning. Bø, K., Berghmans, B., Morkved, S., Kampen M, V, Evidence Based Physical Therapy for the
Pelvic Floor Bridging Science and Clinical Practice, p 115, Churchill Livingstone Elselvier 14 Australian Government Department of Health and Ageing Bladder & Bowel website Pelvic Floor Muscle Training for Men - Strong Pelvic
Floor Muscles Mean good bladder control, accessed at http://www.bladderbowel.gov.au/living/bladderp/men/pelvicfloormen.htm 12/01/2011 last updated 19/11/2006 15 Australian Government Department of Health and Ageing
Bladder & Bowel website Pelvic Floor Muscle Training for Women - Strong Pelvic Floor Muscles Mean good bladder control, accessed at http://www.bladderbowel.gov.au/living/bladderp/women/pelvicfloorwomen.htm, 12/01/2011
last updated 29/02/2008 16 Dr Katelaris P., Katz, T., 2004, Bladder Rehabilitation after prostate cancer treatments, Medical Observer, accessed at http://www.prostatecancer.xom.au/journal_a2.html 25/01/2011 17 Dorey, G. 2003,
Pelvic Floor muscle exercise for men, Nursing Times Vol 99, Issue 19 p46, accessed at nursingtimes.net, http://www.nursingtimes.net/nursing-practice-clincal-research/pelvic-floor-muscle-exercises/205516.article 02/02/2011 18
Pelvic Floor Muscle Exercise, TENA Website, accessed http://www.tena.com.au/professionals/incontinence-management-centre/types-and-causes-of-incontinence/pelvic-floor-exercise/ 18/01/2011. 19 Australian Government
Department of Health and Ageing Bladder & Bowel website Pelvic Floor Muscle Training for Men - Strong Pelvic Floor Muscles Mean good bladder control, accessed at http://www.bladderbowel.gov.au/living/bladderp/men/
pelvicfloormen.htm 12/01/2011 last updated 19/11/2006 20 Australian Government Department of Health and Ageing Bladder & Bowel website Pelvic Floor Muscle Training for Men - Strong Pelvic Floor Muscles Mean good bladder
control, accessed at http://www.bladderbowel.gov.au/living/bladderp/men/pelvicfloormen.htm 12/01/2011 last updated 19/11/2006 21 Bø, K., Morkved, S., 2007, Pelvic Floor and exercise science, Motor Learning. Bø, K., Berghmans,
B., Morkved, S., Kampen M, V, Evidence Based Physical Therapy for the Pelvic Floor Bridging Science and Clinical Practice, p 117, Churchill Livingstone Elselvie 22 National Institute for Clinical Excellence UK (NICE) Clinical Guideline
40 (2006) accessed at NICE website http://www.nice.org.uk/nicemedia/live/10996/30282/30282.pdf 10/01/2011 23 Dorey, G. 2003, Pelvic Floor muscle exercise for men, Nursing Times Vol 99, Issue 19 p46, accessed at nursingtimes.
net, http://www.nursingtimes.net/nursing-practice-clincal-research/pelvic-floor-muscle-exercises/205516.article 02/02/2011 24 ibid 25 ibid 26 Bø, K., 2007, Pelvic Floor muscle training for stress urinary incontinence, Bø, K.,
Berghmans, B., Morkved, S., Kampen M, V, Evidence Based Physical Therapy for the Pelvic Floor Bridging Science and Clinical Practice, p 184, Churchill Livingstone Elselvier 27 Miller, JM., Sampselle, C., Ashton – Miller J., et al;2008,
Clarification and confirmation of the Knack maneuver: the effect of volitional pelvic floor muscle contraction to pre-empt expected stress incontinence, International Urogynecology Journal Vol 19, No 6 773 - 782
CA Issue One / 2011 > 7

NICE Guideline
Recommendations
Women
NICE clinical guideline 40 (2006)
recommends a trial of supervised
pelvic floor muscle training of at least
three months duration to be offered
as a first line treatment to women with
stress or mixed urinary incontinence 1 .
Men
NICE clinical guideline 97 (2010)
recommends supervised pelvic
floor muscle training to men with
stress urinary incontinence caused
by prostatectomy, and advises
that men continue the exercises
for at least three months before
considering other options 2 .
1 National Institute for Clinical Excellence UK (NICE) Clinical Guideline 40 (2006) accessed at NICE website http://www.
nice.org.uk/nicemedia/live/10996/30282/30282.pdf 10/01/2011 2 National Institute for Clinical Excellence UK (NICE)
Clinical Guideline 97 (2010) Lower urinary tract symptoms: The management of lower urinary tract symptoms in men,
accessed at NICE website http://www.nice.org.uk/nicemedia/live/12984/48557/48557.pdf 10/01/2011
Pelvic Floor Exercise
and the Elderly
Programs demonstrate encouraging results
Up to 40% of people
over 75 years of age are
affected by incontinence 1 ;
a major contributor to falls,
depression, anxiety and
social isolation and one of the
main reasons the elderly are
placed in residential care.
To help manage urinary incontinence
(UI) and improve patient quality of life,
a thorough and holistic assessment
that explores the multifactorial nature
of UI in the elderly is required 2 .
Once this has taken place and acute
and/or reversible factors of UI (urinary
tract infections, atrophic vaginitis,
mobility and access issues) have
been identified and managed, and
where genuine stress incontinence
is identified, pelvic floor muscle
exercises (PFME) may substantially
reduce symptoms 3 and in some cases
may prevent the need for drugs and
invasive measures in the elderly.
In fact, a study published in 2009
found that 83 percent of women
(aged between 67 – 95) who
underwent a six week chair based
PFME program combined with
four pelvic floor education sessions
reported that their UI symptoms
had improved. This program
focused on identifying, isolating
and strengthening the transverse
abdominus, the multifidus and the
pelvic floor muscles. The control group
on the other hand, who received
one session of educational basics
and no supervised training in pelvic
floor exercises, did not record any
statistically significant improvements 4 .
Encouraging results for the long term
efficacy of pelvic floor rehabilitation
in older women have also been
demonstrated. Of 40 women (mean
age 70) who underwent pelvic floor
muscle physiotherapy for UI between
September 1999 and February 2004,
27.5% had improved and 57.5%
remained stable compared with
their post treatment continence
status at 5 years follow up (2009).
In terms of compliance and adherence
to PFME five years on, 29 patients
(72.5%) were continuing the exercises
and 42.5% were performing them daily.
‘All adherent patients had improved
or stable status after five years versus
45.5% of non adherent patients’ 5 .
Obviously, a pelvic floor rehabilitation
program is only possible for the elderly
if the pelvic floor is neurologically
intact, the patient does not have
cognitive impairments and motivation
to comply with the program exists 6;7 .
“PFME and education
about good bladder habits
should be provided in all
general exercise classes
for the elderly, whether in
community or residential
aged care facilities.”
It is also vitally important that the PFME
program be tailored to the outcomes
elderly patient wishes to achieve
to encourage compliance. Desired
outcomes are likely to be different to
those of younger patients. For instance,
the elderly patient may simply wish to
lift their grandchild without leaking 8 .
‘PFME and education about good
bladder habits should be provided
in all general exercise classes for the
elderly, whether in community or
residential aged care facilities’ 9 . Even
though some elderly people may
be resistant to change/interventions
and content to ‘make do’ 10 , the
opportunity to learn about the pelvic
floor should always be provided.
1 Australian Government Department of Health & Ageing National Continence Management Strategy Phase Three Action: 2006-2010, accessed at Australian Government Department of Health
& Ageing website http://www.health.gov.au.internet/main/publishing.nsf/content/ageing-continence-phasethreea.htm 11/02/10 2 Wilkinson, K., 2009, A guide to assessing bladder function and
urinary incontinence on older people, Nursing Times, Vol 105, p 40 accessed at nursingtimes.net, http://www.nursingtimes.net/nursing-practice-clinical-research/specialists/continence/a-guide-toassessing-bladder-function-and-urinary-incontinence-in-older-people/5007215.article
11/01/2010 3 Wishaw, M,., 2008, How to Treat Urinary Incontinence in the Frail Elderly, Australian Doctor, July
2008, p34, accessed at Australian Doctor website, http://www.australiandoctor.com.au//htt/pdf/AD_029_036_JUL25_08.pdf 4 Rush University Medical Center, October 1 2009, Pelvic floor muscles
can help manage urinary incontinence in older women, Press Release, Accessed from Medical News Today http://www.medical news today.com on 10/02/2011 5 Simard, C., Tu, LM., 2010, Long term
efficacy of pelvic floor muscle rehabilitation for older women with urinary incontinence Journal Obstetrics & Gynaecology Canada Volume 32 Issue 12 pp 1163 -1166 6 Newman, K, D., 2009, Pelvic
floor muscle rehabilitation, accessed at Seek wellness website http://www.seekwellness.com/incontinence/pelvic_floor_muscle_rehab.htm 25/01/2011 7 Sherburn, M., 2007, Evidence for pelvic
floor physiotherapy in the elderly, Bø, K., Berghmans, B., Morkved, S., Kampen M, V, Evidence Based Physical Therapy for the Pelvic Floor Bridging Science and Clinical Practice, p 358 Churchill
Livingstone Elselvier 8 Bø, K., 2007, Overview of physical therapy for pelvic floor dysfunction, Bø, K., Berghmans, B., Morkved, S., Kampen M, V, Evidence Based Physical Therapy for the Pelvic Floor
Bridging Science and Clinical Practice, p 5 Churchill Livingstone Elselvier 9 Sherburn, M., 2007, Evidence for pelvic floor physiotherapy in the elderly, Bø, K., Berghmans, B., Morkved, S., Kampen M,
V, Evidence Based Physical Therapy for the Pelvic Floor Bridging Science and Clinical Practice p 365 Churchill Livingstone Elselvier 10 O’Dell, K., Jacelon, C., 2008, Morse, A., ‘I’d rather just go on as I
am’ – Pelvic floor care preferences of frail, elderly women residential care, Urological Nursing, Vol 28, issue 1 p 36-47
Your Pelvic Floor
as You Age
Q & A with Dr Margaret Sherburn, PhD FACP,
Women’s Health Programs Physiotherapy,
Melbourne School of Health Sciences, The
University of Melbourne, Victoria, Australia.
Q. What are the most common excuses older patients
use to avoid exercising their pelvic floor muscles?
We’ve heard them all! The most common include:
I’m too busy
I’m needed by my family
I babysit my grandchildren
It’s boring
I thought I’d done enough
I‘m too old for pelvic
floor exercise to a
make a difference
Q. How do you overcome these excuses and encourage
older patients to exercise their pelvic floor muscles?
What’s great about pelvic floor muscle exercises is that they are the
‘go anywhere’ exercise program. I tell patients that they can do these
exercises at any time and anywhere, no one will ever know! When
patients truly mean to do them but just forget, I tell them to place
some simple reminders around the house (stickers on the fridge
door or their toothbrush) or when they do a regular activity (before
going to sleep, during the ad breaks on TV or while on the phone).
Q. How important is it for older people to maintain a
regular program of pelvic floor muscle exercises?
It is vitally important. Recent research has shown that an
intensive 20 week pelvic floor exercise program is effective in
older women who have stress incontinence, but when women
stop doing their the exercises, their symptoms return.
I tell my patients that pelvic floor muscle exercises need to be thought
of in the same way as cleaning your teeth. Our parents told us why it
was necessary to clean our teeth, why we had to keep cleaning them
and reminded us to clean them for years. After they stopped reminding
us, we kept cleaning our teeth and are still cleaning them to this day.
It’s the same for pelvic floor muscle exercises. We teach patients
why and how to exercise the pelvic floor muscles, devise a personal
program and give them strategies to remember to do them, and then
it’s up to the patient to continue with exercises throughout their life.
Q. Can the ageing process of the bladder be slowed?
There’s no escaping the fact that we are all ageing - every day. It’s
our personal journey through life and each one of us has a different
pathway through our mature years. The upside is that we have passed
the angst of our youth, but the downside is that parts of us don’t work
as well as they used to, and cause us to do things in new ways.
We can certainly slow the process by being physically as active as our
bodies will allow, and by doing specific exercise for the part of the body
that is not working as well, whether it is our knees, our back, our heart
or our bladder. All organs and systems within the body age slower if
we exercise, including the bladder. Regular exercise has been shown to
be the most important single factor for healthy ageing. I always remind
my patients that they are never too old to exercise
and the exercises really make a difference to the
health of their bladder. And they must remember,
we don’t stop exercising because we grow old,
we grow old because we stop exercising!
Q. If I am caring for a patient who is frail
and unable to perform pelvic floor muscle
exercises, is there anything that can be
done to improve their incontinence?
There comes a time in some people’s lives where
supported care is required and the need for bladder
care increases. A pelvic floor muscle exercise program
will not be effective for these people due to cognitive
frailty. However, maintaining or improving leg
strength, endurance and walking pace is a good way
to lessen leakage. The mechanism for these activities
being effective is more complex, but functional leg
exercise has been shown to improve bladder function
in even the frailest of older people. Keeping your older
patients walking independently, climbing steps, and
being able to get on and off the toilet independently
are all practical ways to keep them drier.
CA Issue One / 2011 > 9

Alleviating Stress
Urinary Incontinence
with Pelvic Floor
Exercises
Vivacious and with an active
lifestyle, 52 year old Mary was
experiencing stress urinary
incontinence (SUI) upon
coughing, sneezing, laughing,
and physical activity.
Mary’s SUI had been getting worse
over a period of a few years and she
was needing to use 2-3 TENA liners
a day. Mary had heard about pelvic
floor muscle exercises (PFME) but was
unconvinced that a program would
help control her incontinence. Mary’s
scepticism was not lessened by her
friends or GP who gave her the feeling
that SUI was a common problem that
one learnt to deal with. They told her
things like: “Yes I have that problem too”
and “It’s normal after having children”.
When Mary’s daughter became aware of
the problem she encouraged her mother
to ask her GP to refer to a Continence
Specialist. While Mary was extremely
sceptical she was finally convinced to
seek professional help. She was also
provided with Kari Bø’s Core Wellness
Pelvicore Technique exercise DVD (see
page 11 for further information) as a
starting point for pelvic floor exercises.
Motivated by the informative DVD and fed
up of dealing with daily episodes of stress
incontinence, Mary returned to her GP and
was referred to the Southern Continence
Service. On receiving the referral and
examining Mary’s SUI symptoms, the
team decided that as a Continence
Physiotherapist, I was the most appropriate
member of the team to see Mary.
Over a six month period of time I saw
Mary on five occasions. After conducting
A physiotherapy case study by Jenni
Porch, Continence Physiotherapist
at the Southern Continence Service
Melbourne, Victoria, Australia.
an initial assessment, Mary commenced a
PFME regime tailored to suit her muscles.
At each session her program was updated
and changed as needed. I emphasised that
not only did she need to improve muscle
strength and endurance, but that she also
needed to learn to use them effectively
and at the right times! Mary learnt how
to tighten and lift her pelvic floor muscles
correctly during coughing and sneezing as
well as how to “switch them on” when she
was walking and doing other activities.
“[Mary] did not believe
anything could change
her situation and is
amazed at how regular
PFME have helped.”
Progress was monitored using a diary
record of her leakages and improvement
was soon evidenced by the reducing
number of leakage episodes per week
and the decreasing amount of urine lost.
One adjunctive therapy that Mary also
found helpful was a Bladder Neck Support
Device, this helped her on more active
days when extra security was required.
As her pelvic floor muscles improved
she needed this device less and less.
Like many clients, Mary experienced
some difficulty keeping motivated to
perform her daily exercise regime but
has found that when she was diligent
she did improve! By keeping personal
diaries, exercising with her DVD and
attending physiotherapy sessions,
Mary has been able to keep motivated
enough to continue with her exercises.
At our last review Mary reported that she
is now using only one small TENA liner per
day if she is going out of the house “just
in case” and she can have up to five days a
week that are totally dry. I suspect that at
our next follow up review in three months
Mary will be ready to be discharged
from our service onto a maintenance
program of exercises and strategies.
Mary is now very pleased that she
was nagged into seeking help for her
incontinence! She did not believe anything
could change her situation and is amazed
at how regular PFME have helped. She is
now spreading the word to her friends, and
commending the effectiveness of PFME
and the help provided by professionals.
Like Mary, many patients are very sceptical
about the effect of pelvic floor muscle
exercises, so it is extremely important to
inform them of the success others like
themselves have had upon embarking on
a PFME program. Another issue to tackle
is one of technique. Many people believe
they are doing their PFME correctly,
but poor technique or the intensity at
which they are performing the exercise
is not sufficient to make a real difference,
lowering their confidence in PFME and
compromising program adherence.
These people often do progress well
under the care of a physiotherapist
who is specifically trained in continence
and pelvic floor rehabilitation.
We need to spread the word that while
urinary incontinence is a COMMON
problem, it is NEVER normal. In the
majority of cases the situation can be
improved or cured completely. The
other thing to remember is that these
problems rarely get better by themselves
and often worsen as time goes on.
It’s never too early to seek help!
TENA News
Core Wellness & Pelvicore Technique
Core Wellness is a free programme
for health professionals, proudly
supported by TENA, designed to
provide support resources for pelvic
floor strength development.
For the first programme, Core
Wellness has proudly teamed up with
Kari Bø, internationally renowned
physiotherapist and specialist in the
research and treatment of women’s
urinary incontinence, to develop the
Pelvicore Technique DVD. Studies
show pelvic floor exercises can
Motivational Chart
TENA & Core Wellness have
developed the Motivational Chart:
a simple planner to track progress
of your patient’s pelvic floor
exercises. You can distribute it
to your patients as a helpful tool
by downloading it from
cure stress urinary
incontinence in
2/3 of women*;
Kari’s engaging DVD
provides helpful information about
the pelvic floor and demonstrates
simple, enjoyable exercises that
are proven to strengthen the pelvic
floor and other ‘core’ muscles.
To order your free copy of Kari’s
Pelvicore Technique DVD simply visit
TENA.com.au/ContinenceAdvisor
*Bø K, Hagen R, Kvarstein B, Larsen: Scand J, Sports Sci,11, 3: 117-121, 1989.
TENA.com.au/ContinenceAdvisor
Additionally you can download
other resources here such as a
patient demonstration cards to
assist with locating the pelvic floor
and carrying out pelvic floor
muscle exercises correctly.
Support with TENA light continence aids
TENA liners and light pads are specially designed to provide everyday
confidence, discretion and protection for individuals experiencing
light bladder weakness. TENA’s world leading patented technologies
demonstrate clear benefits; offering your patients the perfect support
to compliment their pelvic floor muscle training program.
TENA Liners
Thin and absorbent TENA Liners
are ideal for slight urine loss that
generally results from laughing,
coughing or sneezing. The super
thin and discreet liners offer a
similar look and feel of a menstrual
liner but provide Super Absorbent
Polymer technology – for greater
absorbency and odour control.
TENA light pads
TENA light pads are ideal for light
absorbency needs, for everyday
confidence with comfortable
protection. Featuring greater
absorbency with odour control,
Ultra Thin Mini pads absorb up to
165mL while Mini Plus pads absorb
up to 230mL.
TENA Men
Recommend specialised discreet
and thin male protection for your
patients with TENA Men. Specifically
designed for the male anatomy
(and only 5mm thick), TENA Men
Level 1 is a cup shaped pad offering
protection for light amounts of
urine loss, absorbing up to 275mL.
For further information on the
full TENA range or free samples
for your clinic or patients please
contact TENA Customer service:
Call: 1800 623 347 (Australia) or
0800 443 068 (New Zealand)
Email: TENA.Australia@sca.com
CA Issue One / 2011 > 11

World Continence
Week and the Pelvic
Floor First Campaign
The theme for World
Continence Week
2011 in Australia and
New Zealand is ‘exercise
and the pelvic floor’.
This supports The Continence
Foundation of Australia’s Pelvic
Floor First campaign that has
been running in Australia since
December 2009, and is being
adopted by the New Zealand
Continence Association in 2011.
The Pelvic Floor First campaign
A joint collaboration between the
continence and fitness industry, the Pelvic
Floor First campaign aims to reduce
the number of men and women who
experience pelvic floor dysfunction as a
result of inappropriate exercise regimes.
The campaign targets women and
men at increased risk of pelvic floor
problems and who participate in
some form of physical activity.
It also targets fitness and health
professionals (including continence
professionals, midwives, practice nurses,
maternal and child health nurses and GPs).
These professionals are ideally placed
to raise awareness of this issue, refer
clients for help and support, and
promote pelvic floor safe exercise.
The Continence Foundation is
producing a series of resources as
part of the PelvicFloor First campaign
which will be used to promote
World Continence Week 2011.
HELP FOR POOR BLADDER AND BOWEL CONTROL
The National Continence Helpline – a free service providing
advice, referrals and leaflets on many aspects of incontinence
TENA Customer Service Australia 1800 623 347 | TENA.com.au
TENA Customer Service New Zealand 0800 443 068 | TENA.co.nz
Register now and receive
The Continence Advisor
We encourage you to introduce
The Continence Advisor to your
friends and colleagues.
To subscribe simply visit
TENA.com.au/ContinenceAdvisor
Cert no. SCS-COC-00790
or contact
TENA Customer Service
Freecall 1800 623 347 (AU)
Freecall 0800 443 068 (NZ)
These include a Pelvic Floor First
micro site (www.pelvicfloorfirst.com.au),
a consumer and a fitness professional
brochure, a speaker’s kit for continence
professionals and a professional
development accredited online
course for fitness professionals,
developed in partnership with the
Australian Fitness Network.
During World Continence Week, The
Continence Foundation of Australia will
also be working with its State Branches
to organise local events supporting the
theme of exercise and the pelvic floor.
For further information please contact the
Continence Foundation of Australia on
1800 33 00 66 & www.continence.org.au or
the New Zealand Continence Association
on 0800 650 659 & www.continence.org.nz
and www.pelvicfloorfirst.com.au
FREECALL
1800 33 00 66
N e w Z e a l a n d
This publication is funded by SCA Hygiene Australasia, 30-32 Westall Road, Springvale, VIC 3171. ABN 62 004 191 324. All rights reserved. No part of this publication may be reproduced in any form without prior written consent from the publisher and sponsor.
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