Over a woman’s lifetime it is very common to experience issues with pelvic health. Physiotherapists are trained in many techniques that assist in addressing common pelvic health problems.
The Pelvic floor is comprised of muscles, ligaments, nerves and connective tissue that extend from the front of the pubic bone to the tail bone. The muscles of the pelvic floor play a key role in core stability, bladder and bowel continence, and sexual health. Pelvic floor muscles work alongside our key muscles to ensure proper support of the low back and pelvis.
Some of the conditions a pelvic floor physio can treat are:
Incontinence of bowel or bladder
Chronic pelvic pain
Pelvic organ prolapse (POP)
Diastasis Rectus Abdominus (DRA) separated abdominal muscles
Coccydynia – painful tail bone
Nocturia – having to urinate throughout the night
Prenatal and postpartum physiotherapy
Prenatal and postpartum physiotherapy consists of specialized movements, stretches, and exercises that target prenatal and postpartum hip, back, pelvis, and other joint and muscle pain resulting from pregnancy.
Mothers often suffer from back, hip, and pelvic pain during pregnancy as well as following delivery. The pain can be a result of hormonal changes, increased laxity of ligaments, changes in posture due to weight gain during pregnancy, and breastfeeding postpartum. Pelvic floor physiotherapy can also help by assessing your internal pelvic floor pre- and postpartum to determine its strength. After determining if your pelvic floor is tight or weak, the pelvic floor physiotherapist can teach the proper contraction (Kegals) or relaxation of the pelvic floor with breath control.
Bladder and Bowel Incontinence
Stress urinary incontinence is when you leak urine due to increased abdominal pressure (from sneezing/coughing/jumping/laughing/lifting).
In this case, the pelvic floor and urethra aren’t strong enough to counteract the pressure causing urine to leak out. Pelvic floor physiotherapy can help you strengthen the pelvic floor and retrain this reflex to stop the leaking.
Fecal incontinence can be due to pelvic floor dysfunction, childbirth trauma, constipation and poor bowel techniques. Pelvic floor physiotherapy can assess the cause of the issue and help you retrain your system for regular and controlled bowel movements again.
Overactive bladder is when the bladder squeezes while it’s not full (or at an inappropriate time), this often causes an unbearable urge to pee. Sometimes you can leak as well.Pelvic floor physiotherapy using manual techniques combined with education and bladder retraining can be very effective for calming these urges and gaining bladder strength.
Research has shown that 80% of incontinence can be improved with pelvic floor physiotherapy.
Painful intercourse, or dyspareunia, can be treated with manual therapy and exercise. Our pelvic floor physiotherapist will begin by describing the role of the pelvic floor musculature in the pain cycle.
Manual therapy performed by your therapist involves mobilizing muscle and soft tissue, normalizing overactive muscles, improving circulation, and desensitization. The goal of dyspareunia treatment exercises is relaxation throughout the pelvic floor.
Pelvic Organ Prolapse (POP)
Pelvic organ prolapse is when the muscles and tissues supporting the pelvic organs such as the uterus, bladder or rectum become weak or loose.
This allows one or more of the pelvic organs to drop or press into or out of the vagina. Bladder prolapse is called a cystocele. This is when the bladder loses its support and bulges into the front wall of the vagina. A rectocele, or posterior vaginal wall prolapse is when the rectum loses its support and bulges into the back wall of the vagina. A uterine prolapse is when the uterus loses support and bulges in the vagina. The symptoms of a prolapse can include:
A feeling of heaviness in the vaginal or rectum
Incomplete bladder or bowel emptying
Something bulging at the vagina
A Pelvic floor physiotherapist can help with the treatment of any kind of prolapse. Teaching the patient to correctly perform pelvic floor exercises such as Kegals and correcting faulty posture can really help with early stages of pelvic organ prolapse. Education on proper toileting, diet and lifting mechanics can also help prevent the prolapse from progressing.
Another important area to look for postpartum is the abdominals. Sometimes during pregnancy you can have a separation in your abdominals, also know as diastasis.
This can look like a bulge or doming in your abdominals, you might also feel like you can sink your fingers into the abdominals above or below your bellybutton. A small separation however may not cause problems, and sometimes can resolve itself. Diastasis can cause pain in the abdominals, it may also contribute to pain in your lower back and pelvis which can lead to further issues with your pelvic floor such as Pelvic Organ Prolapse (POP). Pelvic floor physiotherapy will give you the appropriate exercises to help with the healing of your diastasis and help you with proper postures for activities of daily living (including getting into and out of bed).
It is not always possible to ‘close the gap’, however, the bulging/hollowing can be improved. Once your abdominal muscles begin to work normally again it is safe to confidently and independently commence your own exercise routine.
To determine your specific needs, a pelvic health physiotherapist will sit down with you to discuss your full medical history and pelvic concern. With an informed consent, a pelvic floor assessment will be performed. The assessment typically includes an internal examination and complete evaluation of your posture and pelvic mechanics. An internal exam is carried out (either vaginal and/or rectal) to assess the pelvic floor muscles. It is important to find out the strength of your pelvic floor muscles and if you can relax them properly. Based on the assessment findings and your goals, treatment will be tailored to suit you. It can involve advice, exercises, posture correction, manual therapy to the pelvis and internal muscles.