Pelvic Floor Physiotherapy Research Update

2010 was a good year for Physiotherapists specializing in pelvic health. Like a fine wine, we will look back on 2010 with good memories for how it shaped our practice.


In 2010, the Cochrane Collaboration published a review, Pelvic Floor MuscleTraining vs. No Treatment, or Inactive Control Treatments, for Urinary Incontinence in Women, which analyzed the effectiveness of pelvic floor strengthening in stress and urge incontinence. The Cochrane Collaboration is a “meta-analysis” which puts all of the relevant studies together to get an accurate “big picture” of the effectiveness of pelvic floor physiotherapy for the treatment of incontinence.


The Cochrane Collaboration concluded that there is Level I/ Grade A evidence (the strongest level of evidence available) for pelvic floor strengthening for urge and stress incontinence. The Cochrane Collaboration recommended that pelvic floor strengthening should be taught by a physiotherapist using internal assessment and treatment techniques, and that this treatment should be the first line of defense for urge and stress incontinence. This means that the research says pelvic floor physiotherapy should happen with all patients who leak before surgery is considered. Only those who cannot adequately train their pelvic floors should be considered for a TVT or other type of surgical sling repair. This is the gold standard now in Britain; this is what evidence-based practice says today, even though it is not standardly happening in Ontario, or most of Canada. Talk to your surgeon about pelvic floor physiotherapy before considering surgery.


Second, a Randomized Clinical Trial (strongest type of study) was presented at the International Pelvic Pain Society conference (Chicago 2010), and has just been published in the Journal of Urology (2012) by Fitzgerald et al. which demonstrated that internal pelvic floor myofascial treatment in chronic bladder pain patients was effective in 59% of patients compared to generalized massage therapy.


The NIDDK (a national research based organization in the United States) was very excited to report these results since it is the first trial that they have sponsored in ten years which has shown a positive result for painful bladder syndrome (interstitial cystitis), including medication, surgery and other therapeutic techniques.


We now have Level I evidence to support the use of internal pelvic floor physiotherapy for painful bladder conditions. Third, the American Urological Association (2010) has issued its first set of Interstitial Cystitis Treatment Guidelines recommending diet modification and physiotherapy as the first line of defence when a patient presents with painful bladder syndrome.


Pelvic floor physiotherapy is also an integral part of pre- and post-partum care. In France, it has long been the custom for every woman who goes through a vaginal delivery to see a physiotherapist as part of her post-partum recovery process. The muscles are massaged, lengthened, stretched and strengthened to prevent the weakness that can lead to incontinence, or the tightness which can result from a tear or episiotomy. These dysfunctions can contribute to so much pain, discomfort, and limitations in function.


Pelvic floor physiotherapy, which requires specialized training, is now available in more centres throughout Ontario compared to several years ago, where there were very few pelvic floor physiotherapists. Please refer to the Find a Pelvic Health Physiotherapist section of the website to find the closest physiotherapist to you that has met our training requirements in order to be part of this website.