Pelvic Health Physiotherapy

What is Pelvic Health Physiotherapy?

• Also known as pelvic floor physiotherapy
• A specialized branch of physiotherapy that focuses on the assessment and treatment of conditions related to the pelvic region
  
  • Pelvic Floor: Group of muscles, nerves, ligaments and tissue located at the bottom of the pelvis that support the organs of the pelvis which include the bladder, urethra, and rectum as well as the uterus and vagina for women

A Functioning Pelvic Floor assists in:

• Bladder and bowel control
• Pelvic organ support
• Pain-free sexual functions

Pelvic Floor Dysfunction can lead to:

• Bladder and bowel leakage
• Difficulties with emptying the bowel and bladder
• Pelvic Organ Prolapse (POP)
• Chronic pelvic pain
• Pregnancy-related pain
• Pain with intercourse

Treated Conditions:

• Bladder leakage: Stress Urinary Incontinence (SUI) and Urge Urinary Incontinence (UUI)
• Overactive Bladder
• Bowel leakage
• Voiding Dyssynergia: Inability to relax your pelvic floor in order to void/have a bowel movement
• Constipation
• Pelvic Pain
• Pelvic Organ Prolapse (Cystocele, Rectocele, Urethrocele, Uterine Prolapse, Vaginal Vault Prolapse, Entercocele)
• Interstitial Cystitis/Bladder Pain Syndrome (BPS)
• Dyspareunia (Painful intercourse)
• Vulvodynia/Vestibulodynia
• Vaginismus
• Pudendal Neuralgia
• Coccydynia (Tailbone pain)
• Pregnancy-related pelvic pain (Pre/Postpartum)
• Diastasis Recti (Abdominal separation)
• Lower back pain associated with chronic pelvic floor dysfunction
• Chronic hip pain
• Prostatitis
• Post-prostatectomy Incontinence
• Erectile Dysfunction
• Testicular/Penile pain

What To Expect From Your Pelvic Health Physiotherapist:

• Symptoms are discussed
• Physical assessment of the back, pelvis, sacroiliac joints, hip mobility and the function of the surrounding muscles
• Expect to be listened to and to learn
  
  • A psychosocial history is taken, including objective assessment of emotional distress and sensory-motor changes
  • Help you understand how the altered physiology in one system affects another and assist you in understanding what is happening in your body
• An internal vaginal/rectal exam may be performed to determine whether the pelvic floor muscles are hypotonic (weak)/hypertonic (overactive)
• Assessment of your ability to contract and relax these muscles
  *An internal exam is the most effective way to determine if the muscles are functioning correctly, but you can refrain if this is out of your comfort zone
• A treatment plan will be proposed based on the results of your assessment
  
  • Tailored to your needs
  • Strives to restore natural form and function
  • Learn why and how to prioritize your health utilizing various strategies to assist you in modifying your daily habits and behaviours
  • Help you create actionable steps that often include exercise prescription, nutrition advice and often a referral for more tailored advice from a naturopath
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Benefits of Pelvic Health Physiotherapy:

• Can help treat and prevent:
  
  • Hypertonic Pelvic Floor Dysfunction: Urinary frequency/urgency, pelvic pain, painful intercourse
  • Hypotonic Pelvic Floor Dysfunction: Stress/Urge/Mixed Urinary Incontinence, Bowel Incontinence, Pelvic Organ Prolapse
  • Prenatal/Postpartum: Pelvic Girdle Pain, birth preparation
  • Post-menopausal symptoms
  • Post abdominal/pelvic surgery issues

Treatment Goal:

• Restore control of the pelvic floor muscles (contraction and relaxation)
• Reintegrate the pelvic floor muscles into the surrounding muscular, neural and connective tissue network so they can properly support urinary, anorectal and sexual functioning

Treatment:

• Should always include an assessment of the central nervous system’s role in the pain picture including emotional distress, self-efficacy and sensory-motor changes
• Therapeutic exercise addressing the tissue components and central components of pain/weakness
• Bladder education and retraining
• Pelvic floor muscle re-education
• Use of modalities such as muscle stimulation, biofeedback and dilators
• Mobilization of the hips, low back and pelvic girdle
• Relaxation and breathing exercises
• Prenatal and Postpartum tools, exercise guidance and education
• Persistent pain education

*The Cochrane Collaboration 2010 concluded that physiotherapists with specialized training in pelvic floor rehabilitation (using internal examination to teach the exercises) should be the first line of defence before surgical consultation, for Stress/Urge/Mixed Incontinence in women

Physicians & Pelvic Physiotherapy

• Most doctors have little/no education about pelvic floor physiotherapy aside from a basic knowledge of Kegel exercises
• Kegels are usually indicated for a hypotonic (weak) pelvic floor, but often will worsen symptoms associated with a hypertonic (overactive) pelvic floor
• Many developed countries around the world are ahead of North America in this area and fund pelvic rehab for postpartum women