Pelvic health physiotherapy (also called pelvic floor physiotherapy or pelvic physiotherapy) is the assessment and treatment of various conditions that involve the pelvic floor or symptoms that manifest in this area. The pelvic floor includes muscles, ligaments, nerves and connective tissue. It plays an important role in the body by providing support for the bladder, genitals, uterus and anus.
If you suffer from any of the symptoms below, you may benefit from pelvic floor physiotherapy:
a strong, compelling urge to urinate or defecate that may be difficult to control.
waking at night repeatedly to urinate.
difficult passage of hard stools less than three times a week.
having to urinate so frequently that your normal routine is affected.
leakage of urine or feces that cannot be controlled.
Chronic pelvic pain:
pain within or around the pelvic region present for three months or more without any positive physical diagnosis or medical explanation.
Other common symptoms may include:
Before pelvic floor treatment begins, your pelvic health physiotherapist will take your full medical history and thoroughly discuss your current problems and symptoms.
With informed consent, your pelvic floor physiotherapist will perform a complete physical assessment of the joints and tissues affecting this area. This may include internal and external examinations to identify the affected tissues that may be contributing to your urinary, bowel or pelvic pain symptoms.
Common areas that may refer pain to the pelvic region include: the abdomen, lower back, hips, pubic symphysis (the firm, fixed joint between the two pubic bones) and sacro-iliac joint (the joint formed by the sacrum and ilium where they meet on either side of the lower back).
Based on your examination, your pelvic health physiotherapist will work with you to put together a plan of care that is specific to your particular goals, symptoms and dysfunction.
Since every person has a unique case, it is important that your treatment is customized to address your specific needs.
There are various modes of pelvic floor treatment that are well supported by the scientific literature and can be effective as part of your care. Some of these treatment options are:
1 Manual therapy
this is presently the ‘gold-standard’ when treating pelvic floor dysfunction. It involves various hands-on techniques such as: stretching, facilitation, soft tissue massage, mobilization as well as connective tissue, myofascial and trigger point release techniques to the affected muscles and tissue.
as with other musculo-skeletal joints in the body, an individualized exercise program including stretching, strengthening, proper posture and breathing techniques are essential for overall pelvic health. Areas within the pelvic floor and other muscles surrounding the pelvis, thorax and lower limbs may be targeted.
3 Hypopressive Exercise
this is a series of specific postures and breathing techniques that create a lower pressure system to the abdomino-pelvic area while reflexively recruiting the pelvic floor muscles. This can be helpful for improving or preventing urinary incontinence and prolapse conditions. It also helps with improving general posture and stimulates the sympathetic nervous system, which can result in higher energy levels and mood.
4 Electrical Muscle Stimulation (EMS)
this is also known as neuromuscular electrical stimulation (NMES). It involves the use of electrical impulses that help facilitate pelvic floor muscle contraction to improve strength. It can also be used to help with symptoms of pelvic pain and urgency.
this is another form of treatment that can help retrain weak or poorly functioning pelvic floor muscles. An electrical or mechanical device may be used to help provide auditory or visual feedback on how well or poorly you are using your muscles. This feedback helps you to recruit the muscles more effectively resulting in improved continence or pelvic pain symptoms.
6 Percutaneous Tibial Nerve Stimulation (PTNS)
this is another form of neuromodulation which stimulates the posterior tibial nerve at the ankle via a fine acupuncture needle connected to a hand held machine that emits electrical impulses. The stimulation of the nerve has been shown to be extremely effective in treating overactive bladder (OAB) in up to 80% of patients studied. It can also be helpful for those struggling with urinary or fecal incontinence.
7 Bladder and/or bowel routine tracking
it is important to review your voiding patterns with your therapist to ensure appropriate bladder and bowel hygiene. This is essential in helping to normalize your overall pelvic function.
education is power! You cannot under-estimate the importance of knowledge. Many clients have improved their symptoms by simply understanding how various aspects such as lifestyle, diet, urinary and bowel hygiene can affect the pelvic floor. Understanding the anatomy and physiology of the pelvic floor, posture education as well as knowing how to deal with chronic pain symptoms are vital to your recovery.
9 Other treatments to alleviate pain
this may include the use of heat, cold, trans-electrical nerve stimulation (TENS), interferential current (IFC), guided imagery, breathing and relaxation techniques. Your therapist will be happy to discuss these other options with you.
Did you know?
1 in 3 women experience urinary
Over 30% of women perform Kegel exercises
30-50% of women have a minor pelvic organ prolapse after a vaginal delivery
All women in France are given access to pelvic floor physiotherapy after having a baby