Pelvic Floor Physiotherapy
Pelvic Floor Physiotherapy for Women, Men, and Children
Physiotherapists with specialized training in evaluation and treatment of pelvic floor muscle dysfunction can address bladder ad bowel control issues, pelvic pain, painful intercourse, pelvic organ prolapse, post partum issues, erectile dysfunction, childhood bed wetting, and much much more.
What is Pelvic Floor Physiotherapy?
The pelvic floor is an important sling of muscles in the “saddle” area of the pelvis. It is attached at the front of the pelvis on the pubic bone, and at the back of the pelvis on the tailbone (coccyx); located inside your pelvis bowl. A strong pelvic floor will
- provide support to the internal organs of the body
- aid in bladder and bowel control and
- enhance sexual enjoyment.
Physiotherapists are experts in the assessment of muscle function—and this area is yet another set of muscles in the body. Specially trained pelvic floor physiotherapists can detect and re-train muscle dysfunction such as weakness, high resting tone (poor release of contractions), poor timing/motor control or issues with muscle strength, flexibility and endurance. Dysfunction of the pelvic floor muscles may occur at any age, from bed wetting in childhood, to post-pantun issues for women after the birth of a baby, to men at any age, to women’s peri-menopausal years. These problems can have significant impact on a person’s quality of life and sense of well being. These problems are not normal or age-related changes! Something can be done, in particular advise and a consultation with a Pelvic floor physiotherapist can set you on the path to recovery and resolution of your issues!
What Conditions Can Be Treated?
- Urinary Incontinence – both Stress Incontinence and Urge Incontinence (overactive bladder).
- Pelvic Organ Prolapse in women
- Pelvic Pain:
- In Women, conditions such as:
- Dyspareunia (painful intercourse)
- Vestibulodynia (previously known as Vulvar vestibulitis syndrome)
- Pelvic pain related to pregnancy and childbirth
- Pain related to post-partum scar tissue or adhesions
- Coccyx or “tailbone” pain
- In Men, conditions such as:
- Chronic prostatitis
- Testicular and/or penile pain syndromes
- Chronic constipation
- In Women, conditions such as:
- Bowel/Faecal Incontinence in men & women
- Post-prostatectomy incontinence
- Nocturia (frequent urination at night)
- Pudendal Nerve irritation/pinching
- Pre-natal pelvic and low back pain
- Weak core stabilization & muscle control (e.g. Diastasis Recti)
- In Children:
- Bed wetting (enuresis)
- Overactive bladder
- Underactive bladder
- Voiding postponement
Incontinence is commonly known as bladder leaking, and is defined as any amount of involuntary loss of urine from the bladder. Types of incontinence include:
- Stress Incontinence:
- Urine loss is due to an increase in the body’s intra-abdominal pressure such as during activities like sneezing, coughing, laughing, lifting or during physical exertion.
- Urge Incontinence:
- Urine loss is associated with a sudden uncontrollable urge to empty the bladder, and often associated with increased frequency of urination.
Bladder leaking is a real problem for many people. The Canadian Continence Foundation estimates that approximately 3.3 milllion Canadians experience some degree of incontinence, as high as 1 in 4 women. Because this subject remains taboo and can be embarrassing, it is thought to be significantly under-reported. Bladder leaking is prevalent, but not a normal part of life as we age. You are not alone. Many people have tried doing “kegel” exercises for their pelvic floor (named after the first doctor who first advocated doing these contractions regularly for health) but are unsure whether they are performing them correctly, or how many to do at a time. One study actually showed that 50% of the subjects could not perform a kegel contraction correctly with verbal instructions alone! Strengthening of the pelvic floor and core muscles can improve the closure of the urethra and support the bladder, and reduce the symptoms incontinence. A pelvic floor physiotherapist can tailor a treatment program to suit your specific needs.
Pelvic Organ Prolapse in Women
Sometimes known/felt as “heaviness in the vagina”. Weakening of the pelvic floor muscles can diminish support of the body’s internal organs such as the bladder, uterus and rectum. This may result in a dropping of the bladder backward into the vagina, known as a cystocoele, a dropping of the uterus down into the vagina, known as a uterocoele, or a dropping forward of the rectum into the vagina, known as a rectocoele. Weakening of the pelvic floor may occur after childbirth or may related to a decline in estrogen during peri- and post-menopausal years. Pelvic floor muscle training cannot reverse the prolapse itself but can significantly reduce the symptoms by improving muscle tone and supporting the organs like a shelf from below. Correcting poor patterns of abdominal use can also help.
It is estimated that as many as 15% of North American women suffer from pain in the pelvic floor area. Women may experience a burning/sharp pain during intercourse (dyspareunia), have difficulty during yearly medical examinations or with using tampons during menstruation. Men may experience pain in the pelvic region or lower abdomen, groin, sacrum, or tailbone, as well as pain during/after ejaculation. A terrible cycle of pain can develop where the experience of pain can lead to increased tension/guarding in the pelvic floor muscles which leads to increased pain, which leads to increased muscle tension/guarding which leads back to more pain.
Unfortunately much of the pelvic floor research has focused on women, and overshadowed the conditions and issues men face with their pelvic floor. We are just starting to ‘break’ the iceberg and being to investigate the greater concerns and treatment options for pelvic floor pain and dysfunction, for women, men, and children. Chronic prostatitis can affect 10% of men under the age of 50 years of age. Pelvic floor physiotherapy before or after prostatectomy can help with pain management, erectile function, and incontinence.
Pelvic floor physiotherapy can help to empower patients with pain to break the cycle of pain. The goal of treatment is to increase muscle and soft tissue flexibility, increase muscle awareness and control, which then decreases tension and improves relaxation in the pelvic floor muscles. Education about the structure of the pelvic floor and its relationship to the pain and how the body subsequently responds, is very important. Internal and external manual therapy techniques and home exercises may be used to release the high tension/tone.
Computer biofeedback can provide visual feedback on how to correctly contract and more importantly, release the muscles. Home exercises focus on “reverse” kegels, emphasizing the relaxation portion of muscle contraction.
Pediatric (Child) Pelvic Floor Care
Our pelvic floor physiotherapy approach with children differs from our adult clients. Depending on the child/parent’s concerns, a thorough history is taken. We DO NOT usually perform an internal pelvic exam as part of our assessment/treatment. Treatment usually includes:
- Education (child & parent)
- Strategies (tips & tricks to change behaviours; whether daytime / school / nighttime)
- Exercises (based on assessment findings & each child’s body; whole body approach, not just pelvic floor muscles)
What Should I Expect During My Visits?
Pelvic floor physiotherapy sessions are conducted in a quiet, private room, comfortable, and professional environment. On your first visit, your physiotherapist will conduct an assessment which includes a thorough health history and physical examination. The physical examination often includes an internal evaluation, via the vagina and/or rectum to assess the pelvic floor muscle function. (Remember the muscles are located inside the pelvis bowl!). A treatment plan will be developed based on your specific assessment findings. Individualized goals will be set and aimed at improving pelvic floor and core muscle function, and improving symptoms. Several possible treatment methods may be used during your sessions which typically last about 45 minutes.
- Therapeutic exercise programs directed at improving pelvic floor function -modified “kegels” to address muscle strength, speed, endurance and muscle awareness and co-ordination. Core stabilization exercises and breathing pattern co-ordination exercises also play an important role and may be prescribed.
- Manual therapy techniques aimed at improving the quality of muscle contraction and improving muscle awareness, by facilitating contraction or relaxation of the muscles. Certain techniques may also be aimed at improving muscle and soft tissue flexibility.
- Computer Biofeedback—a single-user internal probe may be used to monitor the pelvic floor muscle signal (by measuring electrical activity in the muscles). Information regarding muscle function is gained and visual feedback is provided to the patient. Saved results can later be reviewed to measure changes in the pelvic floor function.
- Electrical muscle stimulation—in cases where patients are having difficulty identifying and contracting their pelvic floor muscles, internal electrical muscle stimulation can help to induce a contraction.
- Education regarding factors which influence pelvic floor function such as behaviour and lifestyle habits, hormonal influences etc. will be provided. When required, a bladder retraining program may be taught to normalize voiding frequency and diminish urgency and it’s triggers. Specific education and advice will be provided for those patients experiencing pelvic pain.
Pilates and Pelvic Floor Program
Many patients who require further core strengthening will continue with the pilates program in conjuction with the pelvic floor program. The pelvic floor co-contracts with the deep abdominal stabilizers therefore pilates can be an excellent way to help strengthen the pelvic floor. Just as a pelvic floor physiotherapist will evaluate your WHOLE body, the ‘core’ (trunk) muscles and beyond play a key role in ensuring success with your recovery & pelvic floor health!