Pelvic health physiotherapy is a specialized area of physiotherapy that assesses and treats both women and men with problems in and around the pelvis. Part of this includes the pelvic floor, which is made up of joints, ligaments, nerves, and muscles. The muscles, tissues and nerves stretch like hammock from the pubic bone to tailbone and between your sitting bones.
What is so Special About These Muscles?
Well, they are unique because they do a lot- from supporting your internal organs, to controlling when to pee and poo, and playing a role in your sexual function.
5 Key Roles Include:
Bladder and Bowel control- these muscles assist with starting and stopping the flow of urine and passage of gas and stool.
Support- the pelvic floor muscles act as hammock and help hold up organs, such as the bladder, rectum and uterus.
Sexual Function- these muscles contribute to sexual satisfaction and orgasms
Stability- they are 1 of the 4 deep ‘core muscles’ that work together with the diaphragm, back, and abdominal muscles to provide spinal and pelvic stability.
Circulation- The pelvic floor acts like a pump for blood and lymph, moving fluid in and out of the abdomen and pelvis, which boosts circulation and decreases swelling and bloating.
Like any other muscle in your body, they too can become weak or tight leading to pain and dysfunction. Some examples include:
Weakness which can contribute to urinary incontinence, prolapse, or a weak core.
Tightness which can cause issues such as urge incontinence, constipation, pelvic pain, or pain with intercourse.
Some pelvic floor conditions that are treated by pelvic health physiotherapy are:
- Urinary leakage
- Urinary urgency, retention, frequency
- Constipation
- Pain with bowel movements
- Pelvic Organ Prolapse
- Painful intercourse (Dyspareunia, Vaginismus)
- Vaginal pain (Vestibulodynia, Vulvodynia)
- Painful periods (Dysmennorhea)
- Endometriosis
- Interstitial Cystitis / Bladder Pain Syndrome
- Pudendal Neuralgia
- Prenatal and Postpartum care (ex. pelvic pain, leakage, scarring)
- Diastasis Recti
Are Kegels the Solution?
Most of us have heard of Kegels, however, they are not the answer for everyone. Depending on your condition they can do more harm than good by worsening symptoms, and often they are performed incorrectly.
Pelvic health physiotherapists can determine if they are appropriate for you and if so, how to do them correctly and when.
What is Treatment Like?
Treatment varies from person to person depending on their needs and the condition. Some examples are:
- Connective tissue massage
- Gentle trigger point release to normalize tight & painful muscles
- Strengthening exercises
- Bladder and bowel re-training
- Manual therapy techniques to joints
- Scar tissue mobilization
- Alignment and posture awareness; breathing mechanics
- Nervous system re-training (examples: for muscle coordination, reducing pain, stress management)
- Home exercise programs
Did You Know…
Research has shown that the treatments carried out by a physiotherapist for pelvic floor problems are highly successful for both pelvic pain and incontinence.
The Cochrane Collaboration 2010 concluded, “physiotherapists with specialized training in pelvic floor rehabilitation should be the first line of defence, before surgical consultation, for stress, urge and mixed incontinence”
Did You Also Know…
In Europe, internal examination of the pelvic floor has been the gold standard by which treatment of the pelvic floor has been carried out for more than 30 years.
Women in France and other government funded European countries are given 10 free physiotherapy sessions after childbirth to help ‘re-educate’ their pelvic floor.
Here in Canada, pelvic issues still remain taboo and access to care is lacking. Fortunately, education and awareness is spreading so that you or someone you know doesn’t have to suffer in silence.
Beyond Health,
Lisa Napoli (MPT, PT, RYT)
Registered Orthopaedic and Pelvic Health Physiotherapist
Registered Yoga Teacher