Physiotherapy for the Pelvic Floor
Women’s Health Physiotherapy covers a wide range of conditions specifically concerned with the female body. The Pelvic Floor is one aspect that we specialize in.
The pelvic floor is like a braided hammock of muscles suspended beneath your pelvic bone. Because quarters are so close down there — your urethra, your vagina, and your bowel are all near neighbors — the pelvic-floor muscles, when they misbehave, can disrupt the normal functioning of all three.
As such we often see women with complaints of incontinence, frequency, pelvic pain, bowel disruption and pelvic organ prolapse. Each diagnosis comes with its own set of symptoms and treatment but to give a general idea of what Pelvic Floor physiotherapy involves here is an overview.
A detailed assessment is essential to unwind the often overlapping symptoms that a woman may be experiencing. Initially a detailed history is taken with specific questions around your symptoms and general health.
The physical examination will include an assessment of how the pelvic floor muscles are functioning; their strength, speed of response, endurance and ability to hold the pelvis and organs in place. Will an internal examination be required? In order to accurately assess if the muscles are working correctly an internal exam is encouraged. This allows the physiotherapist to assess if the muscles are weak because they are stretched (e.g. after childbirth) or if they are weak because they are tight (often associated with pain).
Sometimes a bladder chart is used to help identify what exactly is happening. This monitors how much you drink and how often (and how much) you are using the toilet.
After the assessment the physiotherapist will make a diagnosis of what the problem is. Some examples include:
Stress Incontinence: You are fine in normal situations, but let go of a few drops when doing strenuous activities for the pelvic floor such as running, jumping or heavy lifting
Urge Incontinence: Most of the time you are absolutely fine, including shopping or walking for a long time, but a soon as you arrive at a familiar place like your home, you have to rush to the toilet quickly to avoid an accident
Frequency: Unless you are pregnant, the average number of visits to the toilet should be between 4 to 6 times a day. If you have to go significantly more often, then there is something wrong
Pelvic Organ Prolapse: When you feel heaviness in your pelvis, or you feel something moving when you cough and sneeze
Pelvic Pain: When there is pain within the pelvis, this may relate to the bones, muscles or organs. This may be (but not always) related to pregnancy
Depending on the nature of the problem different treatment options exist.
If the pelvic floor muscles are found to be weak, stretched and underactive a strengthening program will be recommended. The physiotherapist will help you ‘find’ the muscles and guide you through different ways of improving their function. Sometimes using electrical muscle stimulation helps to ‘wake up’ muscles that are not contracting properly.
If the pelvic floor muscles are found to be over tight and painful the physiotherapist will guide you through relaxation techniques and assist in release of painful ‘trigger points’. This can result in relief of pain, improvement in continence and bowel function.
Advice will include positioning to assist in efficient emptying of bladder and bowel, how to retrain your bladder if it is overactive, how to recognize early signs of muscle tension to prevent pain and how to best keep yourself fit and active.