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What is Pelvic Health Physiotherapy ?
Pelvic health physiotherapy is an evidence-based treatment for common conditions within the pelvis such as incontinence, pelvic organ prolapse, and pelvic pain. A comprehensive subjective and objective evaluation is conducted to identify all the factors that are contributing to your symptoms. A treatment plan will be formulated with personalized short and long-term goals.
The subjective assessment can include reviewing your past medical history and asking appropriate questions pertaining to pain, bladder and bowel, and sexual function with the use of validated and reliable outcome measures.
The objective assessment will look at global contributors such as breathing, posture and alignment, movement patterns, overall strength and conditioning, the lumbar and thoracic spine, and the pelvic floor muscle function.
The pelvic floor muscles are a group of muscles that attach to the front, back and sides of the pelvic bone and sacrum, which act like a hammock or sling. They also wrap around your urethra (where urine comes out), rectum, and vagina (in women). The pelvic floor muscles must be able to contract to maintain continence and relax to allow for urination, bowel movements, and in women, sexual penetration.
The Main Functions of the Pelvic Floor Muscles Are:
- Sphincter: To prevent urinary and fecal leakage.
- Support: For our internal organs (bladder, uterus, and rectum).
- Stability: For our back and pelvic girdle.
- Sexual: To increase satisfaction in sexual activity.
- Sump pump: Actions to assist the lymphatic system and veins in bringing blood back to the trunk.
Physiotherapists require advanced training to have the appropriate skills to assess your pelvic floor through internal palpation. This assessment is meant to be gentle and non-threatening. Your physiotherapist will be able to identify ‘the state’ of your pelvic floor and create a treatment plan if necessary.
Pelvic Floor Dysfunction Can be Caused By:
- Under-Activity/Hypotonicity of the Pelvic Floor Muscles (Weakness): Contributing to symptoms of incontinence and pelvic organ prolapse.
- Over-Activity/Hypertonicity of the Pelvic Floor Muscles (Tightness): Contributing to symptoms of chronic pelvic pain, dyspareunia (pain with intercourse), vaginismus, vulvodynia, pudendal neuralgia, interstitial cystitis/bladder pain syndrome, endometriosis, chronic prostatitis, urinary and fecal urgency, and urge incontinence.
To Kegel or Not to Kegel
That is the question! Kegels (pelvic floor strengthening) are not for everyone, and even when indicated, are often not done properly because people lack the awareness of where these muscles are.
Kegels are NOT always indicated and can sometimes aggravate your symptoms. The research concludes that Physiotherapists with advanced training in pelvic floor rehabilitation (using internal examination to palpate the pelvic floor) should be the first line of defence for stress, urge and mixed urinary incontinence in women. However, we don’t actually know ‘what the state’ of the pelvic floor muscles are until we do an internal evaluation.
Too Tight or Too Loose?
Many people with pelvic pain have pelvic floor dysfunction, but specifically over-active/hypertonic muscles, or muscles that are too tight. When these muscles have too much tension (over-activity/hypertonicity) they can contribute to pelvic pain or urgency and frequency of the bladder and bowels. When they are under-active/low-tone (hypotonic) they can contribute to incontinence and pelvic organ prolapse. You can also have a combination of muscles that are too tense and too relaxed.
When your pelvic floor muscles are tight and weak, the tension is treated before the weakness. Once the muscles have reached a normal resting tone, and are able to relax fully, their strength is reassessed and strengthening exercises may be prescribed.
Self-care is an important part of treatment for pelvic floor dysfunction. Avoiding to push or strain when urinating or having a bowel movement is very imperative. Ask your health care provider about how to treat constipation. Relaxing the muscles in the pelvic floor area is important and doing reverse Kegels may be one way to help lengthen and relax these muscles. Using methods such as deep breathing and warm baths can also be helpful.
Persistent pain education is an important part of treating pelvic floor dysfunction since the pelvic floor is an area that we often hold tension. Anxiety, stress and our thoughts, attitudes and beliefs can perpetuate the pain in our pelvis. Understanding how our pain system works has shown to be an effective way of reducing the threat of ongoing pelvic floor dysfunction.
Pelvic health physiotherapy has become more established in the literature as a first line of defense against incontinence, pelvic organ prolapse, and pelvic pain.