Pelvic Floor Physiotherapy
WHAT IS PELVIC FLOOR PHYSIOTHERAPY? Pelvic floor physiotherapy is a specialized area of physiotherapy that deals with treating muscles of the pelvic floor. The pelvic floor muscles are a group of muscles that attach to the front, back and sides of the pelvic bone and sacrum. They are like a hammock or a sling, and they support the bladder, uterus, prostate and rectum. They also wrap around your urethra, rectum, and vagina (in women). 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.
Specialized Physiotherapy is becoming more established in the literature as a first-line of defence against Incontinence and Pelvic Pain. Pelvic Floor Dysfunction can be caused by:
- HYPOTONICITY (Weak pelvic floor muscles): contributing to stress incontinence, urge incontinence and pelvic organ prolapse. Incontinence is NOT a normal part of aging.
- HYPERTONICITY (Tight pelvic floor muscles): contributing to Urinary and Fecal Urgency, Urge Incontinence, Chronic Pelvic Pain, Dyspareunia, Vaginismus, Vulvodynia, Pudendal Neuralgia, Interstitial Cystitis and Chronic Prostatitis.
A specially trained pelvic floor physiotherapist can work with you to prepare the pelvic floor for labour and delivery and also to rehabilitate these muscles following birth. 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.
PRENATAL PELVIC FLOOR PHYSIOTHERAPY
Prenatal pelvic floor physiotherapy focuses on preparing the pelvic floor for delivery of the baby while preventing or limiting the damage!
Prior to delivery of the baby you can imagine that the weight placed on the pelvic floor continues to increase through the pregnancy. A physiotherapist can help you strengthen the pelvic floor to prevent common issues during pregnancy. These include urinary incontinence, low back pain, increased pelvic pressure and more. As the end of your pregnancy approaches, we begin to bring the focus to stretching of the pelvic floor muscles by working on perineal massage. We also provide education on optimal labour and delivery positions, hands on maneuvers to help alleviate discomfort during labour and also how to push when baby is ready to arrive.
POSTPARTUM PELVIC FLOOR PHYSIOTHERAPY
With the delivery of a baby comes trauma to the pelvic floor. The muscles of the pelvic floor are stretched, strained and often torn during the process. 6 weeks postpartum most women are given the “all clear” signal from their doctor to resume regular activities. Without proper rehabilitation of the muscles, new mamas can develop urinary incontinence, low back pain, pelvic organ prolapse, pain with intercourse and more.
Postpartum a pelvic floor physiotherapist will work with you to strengthen your pelvic floor and guide you back to regular activities and exercise. They will also look for a diastasis (separation of the abdominal muscles) and help restore the core. Finally, a very common issue postpartum is pain with intercourse. This often occurs as a result of scar tissue and hypersensitivity of the muscles following tearing and/or stretching. A pelvic floor physiotherapist will help soften the scar tissue and desensitize any hypersensitive areas to help resume pain-free intercourse.
PELVIC FLOOR PHYSIOTHERAPY FOR DYSFUNCTION
Some women may experience pelvic floor dysfunctions despite never having given birth. In addition, women that are well past their child bearing days may experience an onset of pelvic floor dysfunction later in life. A pelvic floor physiotherapist can work with this population to help restore the pelvic floor and treat the dysfunction. Common conditions treated by a pelvic floor physiotherapist include but are not limited to the following:
- Stress/Urge Urinary Incontinence
- Fecal Incontinence
- Pelvic Organ Prolapse
- Diastasis Recti
- Urinary Frequency
- Interstitial Cystitis
- Persistent Pelvic Pain