Think of the pelvis as the home of your bladder, uterus, rectum, and vagina (in women) or prostate (in men). In this analogy, the pelvic floor muscles serve as its foundation. These muscles provide a support structure that keeps the pelvic organs in their respective places by wrapping around the pelvic bone.
When the muscles, joints, connective tissue, or nerves in that area get too weak or stretched out, your pelvic floor starts dysfunctioning. This causes a range of problems such as incontinence, urination or bowel movement difficulties, chronic pain — even pain during sexual intercourse.
Pelvic floor physiotherapy is often recommended as a “first aid” to patients who experience these symptoms. Like any branch of physiotherapy, pelvic floor physio is safe, and involves improving the strength and function of the affected musculoskeletal structures. In this case, the treatment alleviates the pain, weakness, and dysfunction in your pelvic floor muscles.
Do I Have Pelvic Problems?
Your body normally tightens and relaxes its pelvic floor muscles when you take a pee or discharge your bowels. Pelvic floor dysfunction prevents your pelvic muscles from automatically contracting, and they just keep getting tighter and tighter. This relentless tension may cause:
- Incomplete bowel movement
- Urine or stool that leaks
- Urinary incontinence
- Painful urination
- Bladder and bowel movements
- Fecal incontinence
- Painful sex or pain in the genital area
- Menopause symptoms
- Pain in the pelvis, hip, abdomen, thigh, or low back
- Rectal pain
- Postpartum and pregnancy issues
- Interstitial cystitis (IC)
- Pregnancy-related pain
- Testicular pain
Will I Benefit From Pelvic Physiotherapy?
Your physician might refer you for physiotherapy if they suspect that the pain lies in a neuromuscular problem in your pelvic region. Pelvic floor dysfunction may be caused by:
- Traumatic injuries to the pelvic area
- Going to the bathroom too often or pushing too hard, which overuses the pelvic muscles and leads to poor muscle coordination
- Pelvic surgery
- Being overweight
When your pelvic muscles don’t work properly, the pain and accompanying symptoms prevent you from functioning normally. Pelvic floor physiotherapy focuses on reinstating the stability and proper function of your pelvic organs. This can help you regain control over your bladder and bowel movements, maintain good posture and breathing, and enjoy pain-free sexual arousal and orgasms.
Everybody Can Have Pelvic Woes
There is a taboo surrounding pelvic floor problems among Canadian women, especially over post-pregnancy symptoms and pain during intercourse. However, advocates are continuing their efforts to normalize seeing pelvic floor therapists for the treatment of endometriosis or vaginismus. Pelvic floor exercises are also widely recommended for women recovering from childbirth or those with a higher risk of vaginal prolapse.
While it is true that pelvic floor physio mainly benefits pregnant and menopausal women, men can also turn to this treatment to resolve weakness in their pelvic region. Pelvic physiotherapy can answer male pelvic problems such as premature or painful ejaculation, and rectal prolapse. The treatment also facilitates speedy recovery for men who underwent prostate surgery.
How Are Pelvic Floor Issues Diagnosed?
A pelvic floor specialist will evaluate and diagnose your symptoms. They will assess your medical history since this allows your therapist to determine the exact problem and the right course of action. They make ask if you:
- have a history of urinary tract infections
- have given birth
- feel pain when you have sex
- strain or feel pain when taking a pee or releasing your bowels
- have been diagnosed with interstitial cystitis (a long-term inflammation of the bladder wall) or irritable bowel syndrome (a disorder of the lower intestinal tract)
An internal exam is ideal, although your physiotherapist cannot insist if you find it too invasive. It is important to note, though, that a thorough physical exam accurately tests how well you can control your pelvic floor muscles. Your physiotherapist will use their hands to check for spasms, knots, and weaknesses in these muscles. If your problem is in the rectum or vagina, they might examine those regions, too.
Alternative Diagnostic Techniques
If you aren’t keen on having your physiotherapist touch you, there are alternate test options:
- Anorectal manometry is a pain-free test that measures the pressure, muscle strength, and coordination of your anal sphincter.
- A defecating proctogram, technically an invasive but pain-free procedure, involves you attempting to push thick liquid that’s inserted via an enema out of your rectum. A special video X-ray records the movement of your muscles, and helps show how well you can pass a bowel movement.
- A uroflow test measures if your urine flow is weak, or if you keep on stopping and starting as you empty your bladder. You can have this pain-free test pre-ordered if you inform your provider that you have bladder problems.
- Surface electrodes are self-adhesive pads placed on your skin to test your pelvic muscle control. Non-invasive and pain-free, this procedure only involves putting the pads on your perineum (the area between the vagina and rectum in women, and between the testicles and rectum in men), or on the sacrum (the triangular bone at the base of your spine).
Creating the Treatment Plan
Once the pelvic floor specialist diagnoses your symptoms, you are on to creating your personalized treatment plan. Pelvic physiotherapy includes exercises you can perform on your own or with your therapist, as well as massage therapy and other safe procedures. Your treatment plan may include a combination of these:
- Stretching or strengthening exercises of the legs, trunk or pelvic muscles
- Relaxation exercises for shortened pelvic muscles
- Education in self-management and prevention
- Coordination exercises
- Biofeedback for either relaxation or strengthening of pelvic muscles
- Modalities such as ice, heat or electrical stimulation
Everybody feels pelvic pain differently, and every treatment plan should cater to a patient’s specific needs. Your physiotherapist will consider not just your symptoms, but also your pain threshold for physical activities that you’ll need to perform during your treatment sessions.
What Happens During a Session?
During treatment, your physiotherapist accesses and manipulates your affected muscles through the rectum or vagina. This involves either stretching the muscles (if short and contracted), or applying resistance to improve strength (if weak and dysfunctional), which may use the following methods:
- Internal and external myofascial release – Most myofascial release treatments take place during a massage therapy session. Your physiotherapist gently feels the problem regions for stiff and tight muscles, and massages and stretches it with light manual pressure. This process is repeated multiple times until the therapist feels that the tension is fully released.
- Trigger point release – This is similar to myofascial release, but instead of massaging all throughout a pain region, your therapist focuses on applying direct pressure to specific muscular knots. The pressure level for this tends to be higher than myofascial release, so expect it to be more painful in the first few sessions.
Your physiotherapist will also help you perform physiotherapy exercises for your pelvic floor, such as breathing and relaxation exercises, heat/cold therapy, and bladder education and retraining (PDF file).
Will It Work?
Consistency and communication give pelvic physiotherapy a higher chance of success. It takes about 6 to 8 one-hour sessions for a few weeks before you achieve the desired results. You may also need to come back periodically to keep your pelvic problems in check.
We understand that pelvic physiotherapy can be a bit intimidating for first-timers. At Oriole Physiotherapy and Rehabilitation Centre, we make sure that we keep our therapy sessions comfortable and safe, especially for pregnant women. Our therapists specialize in treating a wide range of pelvic floor dysfunctions. Take advantage of physiotherapy techniques, call (416) 221-0772 to book an appointment with us!