What is a pelvic floor physio?

• A Pelvic Floor Physiotherapist has taken post-graduate education to acquire specialized skills for working with the pelvic floor.
• Pelvic Floor Physiotherapists take a holistic approach, working with the muscles internally and externally to optimize the appropriate muscle balance of the pelvic floor and the muscles supporting it.
• Physiotherapy is a first line treatment to consider prior to surgery or other medical interventions for pelvic floor conditions.

What conditions do we work with?

• Persistent pelvic pain
• Dyspareunia (pain with intercourse)
• Urinary incontinence
• Fecal incontinence
• Constipation
• Pelvic organ prolapse
• Sacroiliac joint dysfunction
• Interstitial Cystitis
• Chronic Prostatitis
• Vaginismus
• Vulvodynia
• Rectus Diastasis

Stress Urinary Incontinence (SUI)

SUI is caused by weak pelvic floor muscles. However, this doesn’t mean the muscles have to be long and weak, they may also be short and weak. Often we see women with short/weak muscles who are doing kegels to strengthen their pelvic floor muscles but only end up tightening the muscles more and making their incontinence worse. For these peope we have to lengthen the muscles before we strengthen them. In order to lengthen the muscles we perform trigger point release on the tight muscles internally (either vaginally and/or rectally)

Urge Urinary Incontinence (UUI)

UUI is caused by a disruption in the neural conntection between the brain and the bladder. The brain is urging the individual that they have to go to the bathroom even when they don’t have a full bladder. This is caused by frequent ‘just in case’ pees (e.g., peeing before a 2 hour car ride even though you don’t have to). If you do the ‘just in case’ pees enough this confuses that neural communication between the brain and bladder. Pelvic floor PTs help patients change their behaviours around urgency and teach them strategies to allow their bladder to fill up before having to go urinate.

Pelvic Pain

Pelvic pain comes in many forms. Pelvic floor PTs works internally and externally (if the patient tolerates it) to desensitize the tissues that are hyperactive. Often these patients have very tight pelvic floors so we perform trigger point release on these muscles to release them internally and externally.

Radical Prostatectomy

Often after a prostatectomy, men experience some to copious amounts of urinary incontinence. Pelvic floor physios work rectally with patients to help them strengthen their pelvic floors in order to strengthen their external urinary sphincter to reduce or eliminate incontinence. Research shows that men have the best results when treated before surgery as well as after surgery. This allows them to strengthen their muscles to prepare for post-prostatectomy rehabilitation. [think about it, patients go for physio before a knee replacement to ensure a fast recovery after their surgery – same thing for the pelvic floor.

Pelvic Organ Prolapse

Pelvic floor PTs help patients with pelvic organ prolapse by aiding with pelvic floor strengthening. Research shows that pelvic floor muscle training can help patients with a grade 1 or grade 2 prolapse revert by 1 grade. For those with a grade 3 or 4 who are receiving other treatments such as a pessary or surgery, pelvic floor physio is an important adjuct to ensure that these strategies continue to assist the patient. If patients use these strategies and allow their pelvic floors to weaken more and more they will often run into more problems such as urinary incontinence or prolapse again.

Evidence:

1. Pelvic floor muscle training with a physiotherapist is recommended to prevent urinary incontinence during pregnancy and after deliver (Level 1 A).
2. Core stability training with a physiotherapist is recommended to prevent and treat back and pelvic pain during and following pregnancy (Level 1 B).
3. Pelvic floor muscle training with a physiotherapist is recommended for women with stress urinary incontinence (Level 1 A).