RESUMEN
This paper explores a practical approach to pelvic floor health called the Skilling technique. Unlike the commonly recommended "squeezing upwards" method which teaches a woman to voluntarily squeeze upwards (a learnt technique), the Skilling method is entirely reflex: the squatting-based exercises on which it is based, strengthen the three reflex pelvic muscle forces which pull against the suspensory ligaments pubourethral ligament (PUL) and uterosacral ligament (USL) to: close the urethra during effort (control of stress incontinence), open the urethra during micturition, and stretch the vagina in opposite directions to control inappropriate activation of the micturition reflex [overactive bladder (OAB)]. The strengthened ligaments better support the pelvic visceral plexuses (VPs), which unsupported, can fire off de novo impulses which the brain interprets as "chronic pelvic pain". This review investigates the impact of the Skilling technique on pain, bladder and bowel symptoms in women. In premenopausal women, results show a 50% symptom improvement in 68% to 82% of women who have chronic pelvic pain, urge, frequency, nocturia, abnormal emptying, and post-void residual urine. A modified Skilling technique was applied in children aged 6-11 years with day/night enuresis. Remarkably, an 86% cure rate was achieved over 4 months. It was hypothesized that this accelerated cure, which is achieved naturally with age, may be connected to the reinforcement of collagen which occurs with the increase in pubertal hormones. In summary, the Skilling technique is a promising and accessible method to enhance pelvic floor health for both women and children, offering a practical alternative to traditional approached like Kegel exercises.
RESUMEN
The normal pelvic floor functions as a balanced synergistic system composed of muscle, connective tissue (CT), and nerve components, with CT being the most vulnerable. The aim was to address a wide range of pelvic floor dysfunctions by strengthening all possible components of the system with minimal time loss, weaving every element of treatment seamlessly into a daily routine. The study group consisted of patients from a tertiary referral pelvic floor clinic who, after testing, opted for nonsurgical treatment of their problem. There were no exclusion criteria. The patients had presented with symptoms which included stress, urge, frequency, nocturia, abnormal emptying and pelvic pain, and the fate of these was tracked prospectively. The regime comprised four visits in 3 months. An anatomical classification guided diagnosis of anatomical defects in the anterior, middle and posterior compartments of the vagina. HRT was administered to all patients, electrotherapy 20 min per day for 4 weeks, squeezing 3 x 12 per day, reverse pushdowns 3 x 12 per day and squatting or equivalent up to 20 min per day. Of 147 patients (mean age 52.5 years), 53% completed the programme. Median QOL improvement reported was 66%, mean cough stress test urine loss reduced from 2.2 g (range 0-20.3 g) to 0.2 g (range 0-1.4 g), p =<0.005, and 24-h pad loss from a mean of 3.7 g (range 0-21.8 g) to a mean of 0.76 g (range 0-9.3 m), p =<0.005. Frequency, nocturia and pelvic pain were significantly improved ( p=<0.005). Residual urine reduced from mean 202 ml to mean 71 ml ( p=<0.005). This method extends indications for nonsurgical therapy beyond stress incontinence, and the results appear to encourage this approach. Confirmation by other investigators is required.
