What is Pelvic Health Physiotherapy?
Pelvic Health Physiotherapists are trained in assessing and treating dysfunctions of the pelvic floor, such as incontinence, pelvic pain and prolapse. Assessments and treatments involve internal and external techniques which focus on the muscles, nerves, connective tissue, joints, ligaments, and tendons of the pelvic girdle, low back and hips. Pelvic floor Physiotherapists have received advanced training in pelvic floor dysfunction, and are registered with the College of Physiotherapists of Ontario, in order to perform internal assessments. Treatment techniques often include manual therapy techniques, exercises, connective tissue release, massage, modalities and education.
Common Myths about Incontinence:
- Incontinence is a natural part of aging
- Incontinence after childbirth is normal
- Nothing can be done to change incontinence
All of these common misperceptions are false! Incontinence is not a natural part of aging, it is not normal to have incontinence after childbirth and Pelvic Health Physiotherapy can help reduce and prevent incontinence of the bladder and bowel!
A Cochrane Review in 2010 found high quality evidence to support pelvic floor muscle training as the first line treatment for stress and mixed urinary incontinence in women.
What is the pelvic floor?
The pelvic floor consists of three layers of muscle, nerves and connective tissue. The pelvic floor muscles start at the front of the pelvis, the pubic bone, and connect all the way to the tailbone. The strength and tone of the pelvic floor muscles play a vital role in pelvic floor dysfunction. There are 5 main functions of the pelvic floor:
1. Supportive – the pelvic floor muscles are like a sling or hammock of muscles that support the bladder, uterus and rectum
2. Sphincteric – adequate strength of the pelvic floor helps to maintain continence of the bladder and bowel
3. Stability – strength of the muscles is important for preventing pain by maintaining stability and coordination of the pelvic girdle, low back and hips
4. Sexual – proper pelvic floor muscle strength aid in achieving orgasm and erection
5. Sump pump – blood and lymphatic flow back to the heart
Who would benefit from pelvic floor physiotherapy?
We treat women of all ages, who may be suffering from the following conditions:
- Urinary Incontinence: an involuntary loss of urine
- Stress incontinence: loss of urine associated with an increase in intraabdominal pressure, such as coughing, sneezing, laughing, lifting and/or jumping,
- Urge Incontinence: a sudden loss of urine due to an uncontrollable urge to void
- Mixed Incontinence: both stress and urge incontinence
- Increase in urinary frequency and/or urgency
- Persistent pelvic pain and/or pain with sexual intercourse
- Prepartum women – if experiencing pelvic, low back or hip pain and/or incontinence, but also to help prevent prolapse and/or incontinence after pregnancy.
- Postpartum women – if experiencing pelvic, low back or hip pain, incontinence or prolapse. But can also benefit from pelvic floor physiotherapy to prevent incontinence and prolapse from occurring in the future.
- Painful bladder syndrome, interstitial cystitis
- Chronic low back pain, SIJ pain and hip pain that hasn’t resolved with other conservative therapies
- Vulvar pain
- Fecal incontinence
Common Causes of Pelvic Floor Dysfunction
Hypertonicity (tightness of the pelvic floor muscles) can contribute to:
- Urinary incontinence (urge and mixed incontinence)
- Fecal incontinence
- Urinary and fecal urgency
- Painful urinating, incomplete emptying of the bladder, stopping and starting of the urine stream
- Dyspareunia (pain with sexual intercourse)
- Interstitial cystitis (painful bladder syndrome)
- Pain with bowel movements, constipation, straining
- Chronic pelvic pain
- Vulvodynia (pain in the vulvar area)
- Pudendal neuralgia (compression of the pudendal nerve)
Many patients with pelvic floor dysfunction experience pain due to pelvic floor muscles that are too tight. Women can experience pain during sexual intercourse due to sensitivity and trigger points in the pelvic floor muscles. In addition, tight muscles can cause an increase in frequency, urgency and incontinence of the bowel and bladder. It is important for the pelvic floor muscles to stay relaxed to prevent pain, and to allow for urination and bowel movements.
Hypotonicity (Weak pelvic floor muscles) can contribute to:
- Stress incontinence
- Urge incontinence
- Pelvic organ prolapse
The pelvic floor muscles must be strong in order to close off the urethra when an increase in intraabdominal pressure occurs, such as coughing and sneezing, to prevent incontinence. The pelvic floor muscles also require adequate strength to help support the bladder, uterus and rectum.
How to treat the Pelvic Floor:
Treatment techniques often include manual therapy, exercises, connective tissue release, massage, modalities and education. By performing an internal examination in the initial assessment, and in subsequent treatment sessions, the therapists are able to provide feedback to ensure proper performance of the pelvic floor exercises for relaxation and strengthening.
For a hypertonic pelvic floor, treatment will focus on:
- Relaxation exercises for the pelvic floor muscles
- Stretching exercises for the tight pelvic floor muscles, as well as muscles surrounding the low back, pelvis, abdomen and hips
- Manual therapy techniques such as normalization of tone of a hypertonic pelvic floor, mobilization of low back, hips and pelvis to increase mobility if affected, connective tissue release for tight muscles/fascia, and internal/external release of trigger points.
For a hypotonic pelvic floor, treatment will focus on:
- Strengthening exercises for the pelvic floor muscles
- Core strengthening exercises
- Manual therapy techniques such as normalization of tone of a hypotonic pelvic floor, mobilization of low back, hips and pelvis to increase mobility if affected, connective tissue release for tight muscles/fascia, and internal/external release of trigger points.
Some patients may have a combination of tight and weak pelvic floor muscles. When this occurs, it is important to work on relaxation techniques to reduce the tension in the muscles, prior to strengthening. Once the pelvic floor muscles have reached a normal resting tone, strengthening exercises may begin, if appropriate.
To schedule an initial consultation with our Pelvic Floor Physiotherapist, please call Embody Health Centre at 519-208-0333.