How can pelvic floor physiotherapy help?
Ask yourself the following questions:
1. Do you have pelvic pain (vagina, labia, lower abdomen, urethra, perineum)?
2. Do you have pain during or after intercourse?
3. Do you have decreased sensation with intercourse?
4. Are you unable to insert a tampon or have pain with a pelvic exam?
5. Do you leak urine, gas, or stool when you cough, sneeze, exercise or at any other time?
6. Do you have to run to the toilet urgently or unusually often?
7. Do you have pain with your bladder filling or emptying?
8. Do you feel a heaviness, bulging, or discomfort in your pelvic floor (vagina, bladder, or rectum)?
9. Do you have a burning sensation in the pelvic floor or a feeling of a foreign body in the area?
10. Do you have abdominal pain associated with abdominal surgery or scars?
If you answered yes to any of the questions, please note that this should not be accepted as normal and pelvic floor physiotherapy can help [1].
What is the pelvic floor?
The pelvic floor is a group of muscles at the base of your pelvis that form a sling/support structure for your pelvic organs. They run from the pubic bone in the front to the tail bone at the back. The pelvic floor muscles are important for:
1. Proper bowel and bladder function
2. Supporting the internal pelvic organs (bladder, uterus, bowel)
3. Sexual response during intercourse
4. Working with the muscles of the back and abdominal wall to support the low back
The pelvic floor is like any other muscle in the body, we can relax, strengthen, and exercise it. When the pelvic floor muscles have normal strength and tone, the pelvic organs are supported with limited tension on the ligaments and fascia of the pelvis. These muscles, however, can be weakened due to aging, stretched during childbirth, or become hypertonic due to stress, all of which can lead to pelvic floor dysfunction [2,3,4].
What do pelvic floor physiotherapists treat?
· Urinary incontinence
· Fecal incontinence
· Pelvic organ prolapse
· Chronic pelvic pain (vaginal, perineal, or rectal)
· Constipation
· Vulval pain syndrome/Vulvodynia
· Genito-pelvic pain – Vaginismus and Dyspareunia (painful intercourse)
· Painful bladder syndrome/Interstitial cystitis
· Pudendal neuralgia
· Pregnancy related pelvic girdle pain
· Diastasis recti abdominus (abdominal muscle separation)
· Chronic low back, sacroiliac joint and or hip pain
· Coccydynia (tail bone pain)
· Painful scars after childbirth or surgery
· Musculoskeletal injuries
What should you expect during an initial pelvic floor physiotherapy visit?
Our appointments are one-hour in length and one-to-one. We take a detailed history to help better understand your medical history, history related to your current condition, preferred activities and lifestyle, and your desired goals. We complete an external exam where the physiotherapist will look at your posture and muscles of the back, core, pelvis, and hip. Next, the physiotherapist will complete an internal exam to assess the pelvic floor. The internal exam can give information on pelvic floor muscle tone, strength, power, endurance, and pain. Following examination, the physiotherapist will provide education regarding the assessment findings and discuss a treatment plan that integrates your goals.
What if you don’t feel comfortable with an internal pelvic floor assessment?
If you do not feel comfortable with a pelvic floor examination, still consider working with a pelvic floor physiotherapist. An internal assessment does not always need to be performed to address pelvic floor issues. Remember that you are in control of the physical exam and consent is required throughout all aspects of the assessment. Working with someone who knows how to guide you through exercises and cue you to increase awareness of this area is still incredibly valuable.
What if you are unable to come see us in person?
Due to the current COVID-19 pandemic, we understand people may prefer to use our services from their homes. We offer virtual services, and we are here to help, whether it is in-person or online.
References
1. Wallace SL, Miller LD, Mishra K. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Curr Opin Obstet Gynecol. 2019, 31(6):485-493.
2. Delancy JO. Anatomy and biomechanics of genital prolapse. Clin Obstet Gynecol. 1993; 36:897-909.
3. Delancy JO. The hidden epidemic of pelvic floor dysfunction: achievable goals for improved prevention and treatment. Am J Obstet Gynecol. 2005. 192(5)1488-95.
4. Norton P. Pelvic floor disorders: the role of fascia and ligaments. Clin Obstet Gynecol. 1993; 36:926-938.
