Pelvic Floor Physiotherapists are trained in assessing and treating dysfunctions of the pelvic floor, such as fecal and urinary incontinence, pelvic pain, painful intercourse, pre and postpartum concerns, painful menstruation and prolapse.
Pelvic Floor Physiotherapy might be what you need if you notice urine leaking after:
- coughing, exercising, sneezing, or laughing
- struggle to empty your bladder when you urinate
- struggle to have a bowel movement
- feel pain after a bowel movement
- have pain during intercourse
- have pain while urinating
- cannot control your urge to urinate
- tear during vaginal childbirth
- experience pelvic pain
- have gone through a cesarean section
- have pain in the pelvic girdle
Changes happen to your body during your lifespan. Pregnancy, aging, lifestyle, menopause, chronic constipation or surgeries (like a hysterectomy or prostatectomy) can impact the health of your pelvic floor and its ability to provide you with proper bladder and bowel control.
Ideally, we should have direct control over our pelvic muscles because they are voluntary muscles. They allow us to control our bladder movements and bowel movements. They also allow us to have normal sexual functions and experience pleasure as well as support the lower back, the bowel, bladder, and uterus.
Common Forms of Pelvic Floor Dysfunction
The most common forms of Pelvic Floor Dysfunction include:
- Pelvic organ prolapse
- Bed wetting
- Urinary Incontinence
- Pain during Intercourse, or Dyspareunia
- Prostate Inflammation in men (Chronic nonbacterial Prostatitis)
Not all Pelvic complications have to do with a weak pelvic floor. With a hypotonic pelvic floor, the problem is poor muscle tone. When there is poor muscle tone, you might witness issues such as prolapse of the pelvic organ or incontinence.
With a hypertonic pelvic floor, the issue is overly tight muscles. You will notice constipation and/or painful intercourse.
All muscles – including the pelvic muscles – have to be able to relax and contract easily.
To Kegel or Not to Kegel?
Contrary to popular belief, kegel exercises may not necessarily cure all pelvic health complications. Kegel exercises are meant to strengthen the pelvic floor but not all Pelvic Floor Dysfunctions have to do with muscular weakness. In fact, if your pelvic floor muscles are too tight already, kegels are of no use.
Even when kegels are useful, they only help when they are properly done. Too often, there is a co-contraction of accessory muscles (ie. other muscles contract together with the kegel muscles). When this happens, you are actually doing a Valsalva maneuver and not a kegel.
Sometimes, a dysfunction in the pelvic area is not necessarily caused by a pelvic floor problem. The culprit may be a shift in the bones, joints, muscles, or connective tissues that are all connected to the pelvic floor. For example, urinary incontinence can result from excessive tension in the abdomen causing pressure on the pelvic floor.
It is easy to assess the strength of your pelvic floor muscles when they are in a normal resting condition. Our physiotherapist might prescribe exercises to strengthen weak muscles.
People who struggle to urinate are sometimes tempted to strain their muscles excessively when they are trying to urinate. This is not healthy. Physiotherapists will advise patients to relax and perform reverse Kegels instead, to lengthen and relax the muscles. A warm bath can help you relax your muscles, too.
Why You do Not Need Soap or Any Other Cleaning Agent
Even though many women use soap and other cleaning products to clean themselves ‘down there,’ the vagina and the vulva are self-cleaning organs. This means that soap is unnecessary and may, in fact, be counterproductive. If soap disrupts the pH balance, it can make you more vulnerable to Urinary Tract Infections, pain in the vulva, and yeast infections.
The best way to maintain health is to stay away from soaps in the vulva area, stick to warm water, and wipe from front to back when you visit the toilet. This keeps fecal matter from contaminating your vagina.
Wearing cotton underwear helps, too. Toilet paper should always be free of scents and colors. Vaginal wipes are absolutely not necessary since the organ is self-cleaning. Scented lotions are unhealthy. Personal lubricants need to be non-irritating and free from alcohol, preservatives, and parabens.
Some Popular Misconceptions
The pelvic floor is the abdomen’s muscular base, which is attached to your pelvis. The pelvic floor is also known as the pelvic diaphragm.
The pelvic floor has often been compared to a ‘sling’ or ‘hammock’ holding up things above it.
Women are told that urinary incontinence is normal as they age, or go through childbirth. This is one of the most insidious misconceptions. Any dysfunction of the pelvic floor should never be accepted as normal.
While urine incontinence may be fairly common, it is far from normal or inevitable. On the contrary, the condition is treatable. More than three million Canadian women go through urinary incontinence. Women who notice any issue with the pelvic floor should seek help from a Pelvic Floor Physiotherapist.
Women who go through vaginal delivery are often told that painful intercourse is ‘normal.’ This is yet another condition that, while common, should not be accepted as a normal consequence of childbirth.
Vaginal birth sometimes comes with complications like stretching of muscles, episiotomies and perineal tearing. All these lead to pain which can be reduced with pelvic floor physiotherapy.
Contrary to popular belief, giving birth via cesarean section does not necessarily prevent pelvic floor dysfunction.
During a cesarean section, doctors will cut through the muscles of the uterus and the Transversus Abdominis. Sometimes this operation can cause some dysfunction because the Transversus Abdominis forms part of the deep core and affects the pelvic floor. You cannot prevent pelvic floor dysfunction by undergoing either a cesarean section or a vaginal delivery. Each of these experiences is taxing on the body, but physiotherapy helps.
Even though Pelvic Floor Dysfunction is generally associated with women, they are not the only victims. Children and men can experience it, too. This is because the male and female anatomy are similar in many ways. For example, they both have a pelvic floor. Incontinence is not the only form of Pelvic Floor Dysfunction.
The Benefits of Pelvic Floor Physiotherapy
Patients who present with symptoms of prolapse or incontinence would benefit from the attention of a trained Physiotherapist. A Physiotherapist relies on evidence-based care techniques.
A Physiotherapist who has specialized training in pelvic floor rehabilitation will exhaust other options before recommending surgical intervention to treat incontinence.
Pelvic floor muscles are around the pelvic bone on all sides as well as the sacrum and the urethra, vagina, and rectum (women) and urethra and rectum (men). These muscles form something like a hammock or a sling supporting all the pelvic organs.
To work in an optimal way, the pelvic floor muscles have to be able to contract and hold (to prevent incontinence) and also to relax easily to enable bowel movements, sexual intercourse, and urination.
What the Pain Means
Pain is a sign that the pelvic floor muscles might be too tense. When connective tissues in your abdomen, lower back, groin, and thighs are too tight, it becomes difficult to perform an internal examination because it will be too painful. Connective tissue, which contains muscles, needs to be relaxed for any internal examination to be performed painlessly.
The relaxation of the pelvic floor muscles can be obtained by working with a surface EMG biofeedback, which eliminates the painful experience with a regular vaginal or rectal exam and allows for the introduction of awareness exercises. As the treatment progresses, it is reasonable to introduce internal work as tolerated and needed.
How Long Will it Take to Get Better?
We see most of our patients for an average of four to six visits, but sometimes up to 12 visits. Some patients require less and others more. We always want to see you enough that you are making appropriate progress but with the ultimate goal that you are becoming independent with the management of your own condition.
If you and your Physiotherapist decide you need more or less after your first appointment, you can adjust the appointments as needed and as schedules allow. Usually booking the initial assessment and a follow-up visit in two weeks will give an optimal starting point to determine what is required.
Generally speaking, after these initial visits, we will often decrease frequency depending on your condition and work on helping you get more independent with your home program to manage your condition.
Our Pelvic Floor Physiotherapist will observe how you move, examine your hips, pelvis, abdomen, spine, and muscles impacting your pelvic girdle. The vaginal and or rectal exam will be done if required to evaluate pelvic floor presentation.
A combination of various treatments such as therapeutic exercise, manual techniques, education on modifying behaviors, and/or biofeedback to address your limits and work towards your goals of improved function and return to activity will be used. Our Physiotherapists treat people of all genders and of all ages.
Book in now to learn more about why your pain persists, what you can do about it and how you can regain the confidence and quality of life you deserve!