What is Pelvic Health Physiotherapy?
During a pelvic health physiotherapy session, clients and therapists work together to restore pelvic function. Functions restored could include:
pelvic mobility (needed for walking/bending/twisting)
bowel and bladder functions
sexual functions
Additionally, pelvic health physiotherapy restores pelvic dysfunctions that we have often been told are a normal part of aging or a consequence of pregnancy. Pelvic health physiotherapy also addresses pelvic pain.
Client Concerns:
So I pee when I laugh, doesn't that happen to everyone at a certain age?
My pelvis is achy, menstruation is painful and I have constipation of the bowels. Can anything be done so my belly is not hijacking my day?
For years I’ve been getting stiffer in the hips, my walking is slower. Can physiotherapy reverse this? It is getting harder and harder for me to complete my work shift!
What is the Pelvic Floor?
The pelvic floor includes the muscles between the pubic bone and tailbone (front to back) and the sitting bones (left to right). They function to:
support the bladder, rectum and uterus
open and close openings that allow urine and stool to come out
stabilize your low back and pelvis with attachments to your thigh bone and tailbone
The pelvic floor works in partnership with the diaphragm (breathing muscle under the ribs). Together they work to maintain or change abdominal pressure.
Client Concerns:
I am a runner. I came in with pain in the upper hamstrings and was surprised that the physiotherapist’s breathing exercises helped!!! What more can be done?
My doctor just diagnosed me with pelvic organ prolapse. What now?
I fell on my tailbone, it was 3 years ago! How come the pain isn’t settling down?
What is Treated? What Does a Physiotherapy Treatment Include?
The pelvic floor may become weak, tight and often both weak and tight. Connective tissue quality or muscle coordination may have changed. Pelvic strength, tone, tissues and coordination are assessed. The physiotherapist uses assessment findings to make an individualized treatment plan, working with the client to address pelvic floor changes. Therapies can include:
Activity modification: pain control activities, bladder and stool diaries
Exercises: pelvic stretches and strengthening
Education with models: locating structures at the root cause of pelvic symptoms
Manual therapy: physiotherapy hands on techniques, internally and/or externally with goals to NOT induce painful response, often clients can be taught to self-perform
Breath awareness: the pelvic floor works in concert with the diaphragm (breathing muscle)
Relaxation practices: often useful for those with tightness, chronic symptoms and pain
& More!
Client Concerns:
My partner and I are sexually intimate but there is pain with deeper penetration. Can this improve?
I have urine leakage. My Doctor prescribed Kegels. I did them diligently. No change. What else do you have to offer?
I have two years of worsening low back pain and hip pain. I have noticed I hold my breath when I move - especially when I get out of bed or bend! Would this sort of treatment help me?
Who Can Benefit from Pelvic Floor Physiotherapy?
The answer is …. so many people! Do you suffer from:
Ongoing low back pain or pelvic pain
Unexplained hip pain
Tailbone pain
Nerve pain in the pelvic floor (Pudendal neuralgia)
Constipation, (possible hemorrhoids)
Urinary urgency
Incontinence of urine (leakage)
Incontinence of stools (leakage)
Pelvic organ prolapse
Peri-menopausal symptoms
Post and prenatal care (excluding internal evaluation during the first trimester)
Painful intercourse (Dyspareunia)
Painful vaginal opening (Vulvodynia)
Vaginal contraction with attempted penetration (Vaginismus)
Chronic prostatitis
Prostate surgery
Client Concerns:
I have a prostate surgery booked. I have two friends who have had this surgery, but my friend Joe has urine leakage daily, Ivan has none. How can I change my odds for an outcome like Ivan?
I just had a baby, I’m past my 6 week postpartum checkup - no one told me that there would be so much vaginal tension and tenderness. Will pelvic physiotherapy help?
When I put my key in the door I have such an urge to pee - I sometimes don't make it to the toilet! Can we get to the bottom of this?
What Should I Expect at my First Visit?
Clients have asked: I have not done this before! I am unsure if an internal exam will be useful, what does it add that can’t be done externally?
Client comfort, consent and participation is paramount. The physiotherapist works with the client every step of the way to explain options and reasons for examinations and treatment. Each client’s comfort level is respected. Most care is external.
An internal examination is not required, however, it is considered the gold standard of pelvic health care. It improves therapy efficiency which can, in turn, result in decreased client frustration with progress.
During the initial assessment the following may occur:
History taking (questions surrounding your health, current symptoms, current bladder, bowel and genital functioning)
External exam (analysis of posture, strength, range of motion of the low back hips and pelvis)
Breathing patterns (The diaphragm, core and pelvic floor work closely together. Incorrect patterns of breathing and breath holding significantly impacts the function of the pelvic floor)
Internal exam (performed vaginally and/or rectally, to identify strength/weakness, tension, trigger points, and coordination of the pelvic floor musculature. Personal boundaries are respected and the goal is to not provide a painful response. )
What Should I Expect During an Internal Exam?
Clients have asked: What EXACTLY goes on ‘down there’ during one of these exams?
The physiotherapist will review the process with you for consent and clarity. The consent process involves explaining the risks, benefits, adverse reactions and alternatives. Questions and modifications are always welcome. Internal exams are gold standard care but not mandatory.
The table will be draped with disposable sheeting, a gown will be provided. You will be asked to undress from the waist down, don the gown and lay down on the table. Additional sheeting will be used for draping. The goal of assessment will be to evaluate muscle tone, coordination, strength and function. With a gloved hand and sterile lubricant the physiotherapist will insert one or two fingers into the vagina or one finger into the rectum. Ongoing consent, report of findings, instructions and ongoing verbal description of assessment will be part of the discussion between physiotherapist and client throughout the process.
Can you relate?
