What is Pelvic Floor Physiotherapy?
Pelvic Floor Physiotherapy is a branch of orthopedic physiotherapy that focuses on the muscles, joints, tendons, ligaments, nerves, and fascia of the pelvic girdle. The pelvic floor muscles are a group of muscles that connect to the pelvis and sacrum acting like a sling to support your pelvic organs, providing stability for the lumbo-pelvic and hip joints, maintaining urinary and fecal continence, and aiding in sexual function. A registered pelvic health physiotherapist has received advanced training in pelvic dysfunction and will use internal and external techniques to assess and treat the pelvic floor and associated structures.
Who should see a pelvic floor physiotherapist?
Men and women who suffer from any of the following:
- Urinary urgency
- Stress, urge, and/or mixed incontinence associated with pregnancy, prostatectomies, menopause and hormonal changes
- Urinary frequency associated with pregnancy, prostatectomies, menopause and hormonal changes
- Pelvic organ prolapse
- Dyspareunia (painful intercourse)
- Interstitial Cystitis/Bladder Pain Syndrome
- Pain associated with endometriosis and/or dysmenorrhea
- Chronic Prostatitis (Class 3B)
- Hip, low back and sacroiliac joint pain that has not responded to traditional care
The Story of the “Kegal”
- Dr. Kegal created the “Kegal” exercise in the 1940’s with the intention to strengthen the pelvic floor post-partum to increase continence.
- This was done in isolation using palpation and biofeedback – we have come a long way since then.
- The pelvic floor is part of a core unit including transverse abdominis, multifidus, and the diaphragm – it is the dynamic interaction of these muscles which is important, therefore we must assess this relationship so we can properly train the dysfunction.
- Simple verbal or written instruction does not constitute adequate training for a Kegal exercise program (Bump et al 1991).
- Proper performance of Kegal exercises should be confirmed by digital vaginal examination (Society of Obstetricians and Gynecologists of Canada 2008). This is where the internal examination from a pelvic floor physiotherapist is important.
- “Kegals” are NOT for everyone – some individuals have tight, hypertonic pelvic floor muscles and over-activating these muscles may cause pain or make incontinence worse.
- Be sure to check with a pelvic floor physiotherapist before starting a pelvic floor strengthening program to ensure you are doing what is right for you.
Did you know?
- It is a misconception to think that it is normal to have urinary leakage after childbirth or as you age.
- It is a misconception to think that nothing can be done about urinary leakage.
- The pelvic floor muscles are 1 of 4 muscle groups responsible for core stability – if pelvic floor muscles are dysfunctional spinal support may be compromised (Hodges 2007).
- Pelvic floor muscle training is the first line treatment for stress and mixed urinary incontinence in women (Wilson 2005) (ICS Conference 2009) (Cochrane Collaboration 2014).
- Pelvic floor muscle training is effective and cost-effective in reducing prolapse symptoms and should be recommended as first line treatment for prolapse (Hagen 2011).
- In Britain, in order to be considered a surgical candidate for stress urinary incontinence, pelvic floor muscle training must be done with a trained physiotherapist (ICS Conference 2010).
- Many studies show an association between low back pain (LBP) and pelvic symptoms particularly urinary incontinence – UI was noted in 78% of 200 women with LBP (Eliasson 2008).
- Women with chronic pelvic pain had higher resting pelvic floor muscle tone, reduced strength, decreased relaxation capacity, and increased pelvic floor muscle tenderness (Loving et al 2014).
- Pelvic floor physiotherapy is recommended as second line of defense for treatment of Interstitial Cystitis/Bladder Pain Syndrome before cystoscopy or more aggressive testing – first line of defense is diet change and stress management (AUA 2010).