Pelvic Floor Physiotherapy

Pelvic Floor Physiotherapy is a specialized type of Physical Therapy or Physiotherapy. The Pelvic Floor is a group of muscles that run across the vagina like a hammock to support your bladder, vagina, uterus, rectum, and small bowel. The purpose of Pelvic Floor Physiotherapy is to to improve function of these muscles through exercise, breathwork, hands-on treatment, and lifestyle modifications. Like other muscles, the Pelvic Floor can become injured or weak causing dysfunction. Causes for dysfunction are extremely common as they include childbirth, weight gain, and constipation.

What to expect from a pelvic assessment

**Pelvic Assessment**
Your first visit to a pelvic floor physiotherapist will consist of a one-on-one private assessment that will last approximately one hour, depending on your specific needs. Assessments can consist of both internal and external examinations, though an internal assessment is not always necessary and will only be performed once you are comfortable with the process. The pelvic floor physiotherapist will begin by taking your medical history in order to learn of any past surgeries, medications, as well as sexual, obstetric, and gynecologic history. Patients are typically asked to stand, walk, and sit, in order to allow the physiotherapist to determine whether or not any existing posture or joint issues might be impacting the functioning of the pelvic floor muscles.

**Internal Assessment**
An internal pelvic assessment is often performed in order to determine an ideal treatment plan. Internal examination allows the therapist to assess any damage or issues with the muscles, organs, and connective tissue in the pelvic area, including an assessment of tone, strength, function, and prolapse. During the assessment, your physiotherapist will use a gloved technique in order to examine the pelvic floor externally, followed by an internal assessment with a one or two finger insertion. This is done in order to palpate the muscles and surrounding structures and assess tone, strength, coordination, and control.

Pelvic Physiotherapy Treatments and Follow-Up Appointments

Treatments

Treatment plans are tailored to your specific condition, and typically range from 30-45 minutes in duration. Treatments generally involve the strengthening of weak muscles, or reducing spasm in tight muscles. Plans may include exercises aimed at stretching/strengthening the pelvic muscles or relaxing shortened muscles; education in prevention and self-care; exercises aimed to improve coordination; biofeedback; and modalities such as ice or heat. Physical therapy may also be supplemented or replaced with other pain treatments such as medications or botox injections. Manual therapy is also sometimes used so that the therapist may apply hands-on massage and stretching in order to improve circulation and mobility.

The purpose of follow-up appointments

Every patient’s treatment plan will look different, as they are tailored to your specific needs and condition. Accordingly, the number of follow-up appointments that will be required can vary depending on your individualized treatment plan. Follow-up appointments are important for patient education, as your physiotherapist can offer advice on hygiene, lifestyle choices, and exercise techniques, among other things. You will also learn about management techniques in order to effectively deal with and improve your symptoms and condition. Hands on external and internal treatments may also be provided through follow-up appointments, in addition to individualized exercise prescription plans. Follow-up appointments can also be important for assessing the improvement of your symptoms and overall condition.

Symptoms and conditions Pelvic Physiotherapy can treat

**Pelvic Pain**
Tight muscle tone and a reduced capacity for stretching the pelvic floor may be indicative of a hypertonic pelvic floor. This occurs when the muscles are unable to relax and become too tense-- tension may also be present in surrounding hip and pelvic muscles. A tense pelvic floor can lead to general pain, constipation, pain during sex, urgency, and pelvic pain, in addition to restricted blood flow. A common contributing factor to pelvic pain is scarring, which can occur as a result of trauma to the area-- this includes C-sections, tears during childbirth, vasectomies, bowel surgeries, endometriosis surgeries, or other physical injuries. Often, scar tissue in the surrounding area results in a lack of oxygen and blood flow to the area, resulting in pain. In addition to pain and discomfort, tight pelvic floor muscles can lead to long-term damage. Pelvic physiotherapy can help decrease pain and prevent the occurrence or worsening of long-term damage.
**Pelvic Pressure and Prolapse**
When the muscles and tissues that support the pelvic organs (uterus, bladder, or rectum) become loose or weak, pelvic organic prolapse may occur. Given that the pelvic muscles and tissues act as a hammock for the pelvic organs, any weakening or damage to that hammock may result in a failure of the pelvic muscles and tissues to support the organs-- this is what is referred to as a prolapse. As a result, pelvic organs may press or drop into/out of the vagina. Symptoms of a pelvic prolapse include a sense that something is ‘coming out’ of the vagina; feelings of pressure, discomfort, or fullness; incontinence and leakage or bowel movement issues; and difficulty with tampon insertion. Pelvic floor physiotherapy can be an effective treatment for pelvic organ prolapse, as it can assist in the restrengthening of the weakened or damaged muscles.
**Urinary Incontinence and Bowel Leakage**
Pelvic floor physiotherapy can help with several types of bladder and anal leakage, including stress leakage (wherein urine leaks due to pressure on the bladder); urgency leakage (wherein urine leakage occurs following a sudden and intense urge to urinate); and mixed bladder leakage (a combination of the previous two types). Fecal incontinence (i.e. an inability to control your bowels, resulting in an urgent need to have a bowel movement) can also be treated with pelvic floor physiotherapy. Biofeedback is one technique that can help strengthen your muscles to help regain control over your bowel movements. Your physiotherapist can help instruct you on how and when to squeeze your muscles in order to effectively control your bowel and bladder. Other common techniques that will assist with leakage include pelvic floor exercises, manual therapy, electrical stimulation, vaginal dilators, and education regarding hygiene and habits that may impact symptoms.

Related conditions that Physiotherapy can support

Sexual Dysfunction

Women with pelvic floor dysfunctions have an increased prevalence of sexual dysfunction. Leading factors cited for the reduction in sexual experience include fear of soiling; concerns about the image of their vagina; coital incontinence, and dyspareunia (pain experienced before, during, or after sexual intercourse). A 2019 study found that pelvic floor muscle training can be an effective means for the improvement of sexual function in women with pelvic floor dysfunctions. Physiotherapy is an effective technique for the improvement of dyspareunia, as it can work to improve muscle relaxation and normalize resting muscle activity, among other benefits, according to another 2019 study.

Diastasis

Diastasis Recti refers to the thinning of the central seam of your abdomen, which occurs during pregnancy. Essentially, this refers to your stomach sticking out due to the widening of space between your left and right abdominal muscles. Diastasis recti is most commonly caused by either hormonally mediated factors of pregnancy and/or by the mechanical effects of pregnancy on the abdominal muscles. Symptoms of diastasis recti include abdominal pain and discomfort, as well as musculoskeletal issues such as lumbar back pain and pelvic instability. Other symptoms include urinary and fecal incontinence as well as pelvic organ prolapse, which can contribute to/exacerbate feelings of low body image and quality of life.