WHAT IS PELVIC HEALTH PHYSIOTHERAPY?
Pelvic Health Physiotherapy is also often referred to as Pelvic Physiotherapy, Pelvic Floor Physiotherapy and Women’s Health Physical Therapy.
If you have been referred by your doctor or specialist to any of these above programs, you are in the right place. Pelvic floor physiotherapy is a specialized area of physiotherapy that focuses on the muscles and joints of the pelvis, hips and low back. A pelvic physiotherapist can help to retrain these muscles to improve their strength and function.
Pelvic physiotherapy can only be performed by a specially trained physiotherapist (a pelvic physiotherapist) who is registered and specifically rostered with the College of Physiotherapists of Ontario to provide this type of specialized service.
Pelvic floor dysfunction is diagnosed by these specially rostered physiotherapists using internal and external“hands-on” or manual techniques to evaluate the function of the pelvic floor muscles. All patients will benefit from an internal assessment, however assessment and treatment can still proceed if only an external approach is tolerated at first.
WHAT IS YOUR PELVIC FLOOR?
Your pelvic floor is a group of muscles, ligaments and tendons that serve many very important functions. Yet, many of us don’t know what our pelvic floor is, let alonehow to keep these muscles strong and functioning well.
The pelvic floor is a group of muscles that creates a sling running from the pubic bone to the tailbone. It acts as a support for our internal organs, low back, hips, and the weight of a baby during pregnancy. Keeping these muscles strong can help improve discomfort with and prevent conditions like a prolapsed bladder and a prolapsed uterus. You have probably heard of the term “core-muscles” as it relates to support of the back. The pelvic floor is actually an integral part of your core. These hidden muscles are a very important support system in our body.
They also play an important role in controlling the functionality of your bowel and bladder. If these muscles are dysfunctional, they can cause incontinence and/or pelvic pain.
WHAT ARE CAUSES OF PELVIC FLOOR DYSFUNCTION?
As previously mentioned, our pelvic floor muscles can be like any other problematic muscle in our body and can create impairments by being either too weak or too tight, too long or too short. Other factors that can also contribute to pelvic floor dysfunction include hormonal changes (menopause), chronic urinary tract infections (UTIs), pregnancy and birth, gynaecological surgeries, poor posture, chronic coughing or straining (such as in asthma, jobs with heavy lifting, constipation), obesity, and aging.
SYMPTOMS OF PELVIC FLOOR DYSFUNCTION
Conditions that are a result of a weak pelvic floor include: incontinence and prolapse. Incontinence can include urinary incontinence, fecal incontinence or urge and stress incontinence. Although incontinence is common it is NOT a normal part of ageing. Prolapse occurs when the pelvic floor isn’t strong enough to support the internal organs and they begin to drop lower in the pelvis causing pelvic pain. There are many different types of prolapse, such as uterine prolapse, bladder prolapse or rectal prolapse.
Conditions that are a result of a tight pelvic floor are generally painful conditions such as: pain in the back, hips or pelvis, constipation, urinary frequency, urgency/urge incontinence, urinary retention, urinary hesitation or painful urination and/or pain during or after intercourse or sexual stimulation.
PELVIC FLOOR DYSFUNCTION TREATMENT
The list of symptoms and conditions linked to pelvic floor dysfunction can be overwhelming. But just like any other muscle in our bodies, these muscles can be strengthened and lengthened to help them perform better and resolve these conditions. In fact, Pelvic Floor Physiotherapy is your first line of healthcare defence for pelvic floor dysfunction (according to the 2012 Canadian Urological Association Guidelines).
Treatment of the pelvic floor depends upon the specific impairments of each patient and therefore varies depending on the problems we identify during our assessment. All treatment is tailored to your specific goals, issues and symptoms.
- Education – Many clients successfully improve their condition simply by understanding how and what sorts of activities and habits can affect the pelvic floor.
- Bladder and Bowel Tracking – Your voiding patterns will help your therapist determine if you have developed any habits that could be affecting your pelvic health. Based on your patterns they can also provide you with specific strategies to help with things such as urge incontinence.
- Manual Therapy – “Hands-on” techniques to help release affected muscles and tissue.
- Exercise – A home exercise program will be prescribed, based on your specific impairments that may include: breathing techniques, stretching and strengthening. Other areas such as your back and hips may also be targeted as they can contribute to pelvic floor dysfunction.
- Electrical Stimulation – It may be suggested that you start with electrical stimulation to help retrain the strength and awareness of your internal pelvic muscles. This is done with a metallic probe placed internally. A mild electric current is applied to help you localize and strengthen the pelvic muscles. Your therapist will guide you through this process before sending you home with this unit.
WHY DOES A PELVIC PHYSIOTHERAPIST NEED TO PERFORM AN INTERNAL EXAM?
Assessing the pelvic floor without an internal component is like a doctor taking your temperature through your clothes. These muscles are hidden inside your pelvis and cannot be adequately assessed without an internal examination.
Most women have heard the term Kegels. Kegels is the term used to describe pelvic floor strengthening exercises. They were named after Dr. Kegel who developed the approach to teach women how to strengthen their pelvic floor. To teach them correctly he inserted a finger into the vagina to assess their strength and to provide direct feedback to the patient with respect to how well they were performing the exercises. To this day, Kegel exercises continue to be prescribed and recognized as an important way of keeping the pelvic floor strong. Unfortunately, most practitioners who teach women how to perform Kegels no longer perform an internal exam when doing so and thus these exercises are often prescribed inappropriately or are not being performed properly by the patient.
Not all pelvic floor dysfunctions are a result of a pelvic floor that is too weak. Often, the reverse is found to be true, as most pelvic pain conditions are actually a result of these muscles being too tight! Without an internal exam, a practitioner realistically cannot assess whether your symptoms are due to tight pelvic floor or weak one. Kegel exercises prescribed when muscles are tight rather than weak can actually worsen many pelvic floor problems. Scientific research has clearly supported the higher success rates of pelvic floor rehabilitation when physiotherapists utilize an internal exam as a part of their treatment.
Pelvic physiotherapists who carry out this work are sensitive and highly trained professionals who will thoroughly discuss these issues before carrying out any treatment. Internal palpation is an integral part of treating the pelvic floor with medical evidence clearly showing higher rates of treatment success when it is included.
WHAT CONDITIONS CAN PELVIC FLOOR PHYSIOTHERAPISTS TREAT?
- Incontinence (Fecal or Urinary, Stress incontinence, urge incontinence or mixed)
- Urinary urgency, frequency, retention, hesitation
- Pain with urination or bowel movements
- Overactive bladder
- Pelvic organ prolapse
- Levator Ani syndrome
- Dyspareunia (painful intercourse)
- Vestibulodynia, Vulvodynia or Clitorodynia (pain in areas of the vagina)
- Persistent genital arousal disorder
- Interstitial cystitis
- Painful Bladder Syndrome
- Tailbone pain/Coccydynia
- Pudendal Neuralgia
- Low back pain
- Hip pain
- Sacroiliac (SI) joint pain
- Pelvic pain
- Pre-Natal care (prevent and/or treat low back, sacro-iliac, pubic symphysis, tailbone, and hip pain, education regarding forms of regular exercise you can continue while pregnant and during what stages of pregnancy, learning how to relax pelvic floor muscles as well as labour/delivery positions in preparation for vaginal delivery, how to minimize and/or prevent tearing during delivery)
- Postpartum care (treatment of Diastasis Recti, bladder leakage, overactive bladder, urinary urgency/frequency, prolapse, painful scar tissue, learning how and when to perform a correct Kegel and how to re-training the “core” and returning to safe exercise)
DID YOU KNOW?
- 30% of all women experience urinary incontinence
- Over 1/3 of women who perform Kegel exercises do so incorrectly
- ⅓ to ½ of women who have given birth vaginally have minor pelvic organ prolapse
- In France, all women are encouraged to see a pelvic floor physiotherapist for postpartum recovery
- In Great Britain, any patient with prolapse or incontinence must undergo several weeks of internal pelvic floor physiotherapy prior to becoming a surgical candidate