What is Pelvic Floor Physiotherapy?
Pelvic floor physiotherapy specializes in the treatment of pelvic floor muscles. These muscles extend from the pubic bone to the tailbone, and support the low back, hips, and pelvic organs (including the bladder, uterus, and rectum in women). They also work together to facilitate bowel, bladder, and sexual function. Just like any other muscles, however, the pelvic floor muscles can become weak, tight, or injured. These kind of muscular disturbances can arise for many reasons, including pregnancy, delivery, menopause, hormonal changes, surgery, trauma, falls, repeated infection, gastrointestinal problem, exercise, stress, trauma, or even prolonged sitting. The list of reasons can go on and on, but the result can be pain and dysfunction.
Many conditions of the pelvic floor go unrecognized or unaddressed because of their embarrassing nature, but can be successfully treated. Physiotherapists who are trained in Pelvic Health can help individuals who have incontinence, urgency, constipation, pelvic organ prolapse, sexual dysfunction, or pelvic pain disorders. Through familiar physiotherapy techniques, a Pelvic Floor Physiotherapist can help strengthen, train, and improve coordination of weak pelvic floor muscles, as well as relax or stretch tight ones. Patient education is also very important in the treatment of any pelvic condition.
What to Expect?
Your initial appointment usually takes about an hour and will include a private assessment with a trained pelvic health physiotherapist. The therapist will ask questions about what’s happening with your body and how it affects your life. You will also be asked to discuss your current and past health status, sexual activity, and birthing history (if applicable). There will be a short anatomy lesson to explain the roll and components of the pelvic floor, followed by a physical examination. Based on the exam findings, you will work together with your therapist to develop an appropriate treatment plan.
The physical examination will begin with an evaluation of posture, pelvic alignment, back and hip mobility and strength. If deemed appropriate by the therapist and patient, an internal examination will follow. For the internal exam, you will be asked to undress from the waist down, lie on your back, and you will be draped. There are no instruments used, only gloves and lubricant, and the therapist will gently use her finger to assess the tone, strength, endurance, and coordination of the pelvic floor muscles via the vaginal or rectal canal. She will also check for tender spots or trigger points. The initial internal examination usually takes 5-10 minutes or less, and sometimes a small amount of therapy can be done during this time if appropriate. This may include teaching someone how to properly squeeze or relax the muscles, or some internal muscle massage techniques to relieve tightness.
While an internal examination can offer a great deal of information to the therapist regarding your condition, it may not be appropriate for everyone. At any time, patients have the right to refuse or discontinue any part of the exam or follow-up treatments. Even without the internal exam, there are a variety of other treatment options a physiotherapist can offer for pelvic floor conditions.
Patients are welcome to bring a partner or friend with them if it increases their comfort level.
Once the physiotherapist has completed the initial assessment, she will use the findings to develop a comprehensive and personalized treatment plan for you. Education of your condition and on behavioural modification will be a large part of treatment. There is often a component of manual therapy involved as well, which is the use of the therapists hands to help with painful or tight tissues, or weak muscles. Sometimes modalities, such as EMG biofeedback or muscle stimulation, may be used. Patients are always given some kind of homework, including a home exercise program.