Breathing but Busting

1
Breathing but Busting

• Trish Goulter
• Respiratory Physiotherapist
• Christchurch Hospital

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Objectives

• What is the role of the pelvic floor?
• What happens during coughing
• How we can prevent and manage problems
• Breath or bust, does it have to be a choice

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Role of the Pelvic Floor

• Support
• Integral to ? in intra-abdominal pressure
• Reinforces urethra closure
• Inhibits bladder activity
• Rectal support
• Stabilises spine

4
Female Pelvic Floor
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Male Pelvic Floor
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What happens during a Cough?

• Abdominal muscles tighten
• Increase of intra-abdominal pressure
• Pelvic floor muscles tighten

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Definition of Stress Incontinence

• Symptom Stress Urinary Incontinence is the
  involuntary leakage on effort or exertion, or on
  sneezing or coughing
• Signs SUI is the observation of involuntary
  leakage from the urethra, synchronous with
  exertion/effort or sneezing or coughing
• ICS 2002

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Mechanism of Continence
Abdominal pressure

Detrusor pressure

Urine weight
gt
Urethral pressure
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The Defaecation Position

• Sit with feet on a stool if possible
• Lean forward with flat back
• Put elbows on your knees

• Make your waist go wide and gently bulge your
  tummy as you work with the urge to go
• Pull up with pelvic floor contraction when you
  have finished

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Pelvic Floor Exercises

• Use the defaecation position
• Squeeze lift your pelvic floor muscles (PFM) on
  a breath out
• Continue to breathe normally!
• Hold this squeeze lift for a few seconds
• How often?

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The Knack

• Tighten and lift the PFMs before coughing,
  huffing, sneezing
• Miller
  1996

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Breathlessness

• Breathless is one of the most frequently
  mentioned symptoms in Quality of Life
  Questionnaire
• Michielsen et al 2006

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Urgency

• Urgency is the sudden, compelling urge to pass
  urine, often when the bladder is not full. It is
  difficult to defer, and may be associated with a
  feeling of panic.
• ICS

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Urgency Strategies

• Stop
• Let go
• KEEP BREATHING
• Tighten
• 10

• Press
• Curl
• Think
• Wait
• Move

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References
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References