Treatments
Pelvic health physiotherapy is an evidence-based treatment for common conditions within the pelvis such as incontinence, pelvic organ prolapse, and pelvic pain. A comprehensive subjective and objective evaluation is conducted to identify all the factors that are contributing to your symptoms. A treatment plan will be formulated with personalized short and long-term goals.
Where are the pelvic floor muscles located?
The pelvic floor muscles consist of three layers of muscle that form the base of the pelvis. Stretching like a hammock between the pubic bone and the coccyx, these muscles play a major role in holding in urine, gas and stool. They also support the pelvic organs like the uterus and bladder and play an essential part in the female orgasm. During a voluntary contraction, the pelvic floor muscles move forward and upward. This causes the organs (bladder, uterus and rectum) to move further inside the pelvis, which compresses the urethra, vagina and rectum forward, i.e., against the pubis.
A strong and toned pelvic floor that has endurance and coordination helps:
- Support the pelvic organs (bladder, uterus and rectum).
- Compress the urethra during physical effort and urgent needs to urinate, thereby preventing leaks of urine, gas and stool.
- To increase satisfaction in sexual activity.
What to expect at the assessment in pelvic health physiotherapy?
This assessment is appropriate for any woman experiencing pelvic floor symptoms or wanting to be proactive with their pelvic health.
The assessment is a one-hour individual pelvic health assessment with a registered women’s health physiotherapist. Depending on the reason of consultation, it may include a postural assessment, an abdominal assessment and a vaginal assessment.
It is safe and appropriate to seek for pelvic health physiotherapy at any point in your pregnancy. If you are experiencing pain or have any concerns, you can start treatment at any point. If you do not have any concerns but want to be proactive, it is recommended to see a pelvic floor physiotherapist for an assessment around 25 weeks of pregnancy.
Pelvic health physiotherapy during pregnancy can help:
- To prevent urinary incontinence
Pelvic floor muscle exercises during pregnancy decrease the risk to have urinary incontinence in late pregnancy of 62% and after delivery of 29% (Woodley et al. 2020).
- To prevent tear during delivery and postnatal perineal pain
Perineal massage during pregnancy reduce the risk of perineal tears during delivery, particularly the risk of more severe tears (third- and fourth-degree), as well as it showed a better wound healing and less perineal pain after the delivery (Abdelhakim et al. 2020). Pelvic floor muscles exercises during pregnancy are also related with less severe tears during delivery (Sobhgol, Smith, and Dahlen 2020).
- To push for a shorter time during delivery
Pelvic floor muscles exercises during pregnancy are related with shorter duration of the second stage of labour during delivery (Sobhgol, Smith, and Dahlen 2020).
- To prevent a diastasis recti abdominis (abdominal separation)
Diastasis recti abdominis is the partial or complete separation of the rectus abdominis, or “six-pack” muscles, which meet at the midline of your stomach. Some exercises should be avoid during pregnancy (ex: crunches) and others should be favoured (ex: core engagment) in order to limit the diastasis recti abdominis (Mota et al. 2018).
- To reduce low back, pelvis and pubic symphysis pain
Physiotherapy could help to reduce musculoskeletal pain intensity using different modalities as posture correction, muscle relaxation, specific exercises, muscle stretches and the use of a pelvic belt (Robinson and Balasundaram 2018).
What to expect at the assessment in pelvic health physiotherapy?
This assessment is appropriate for any pregnant woman, woman that has had her 6-week postnatal checkup, or any woman experiencing pelvic floor symptoms no matter how long ago you had your baby!
The assessment is a one-hour individual pelvic health assessment with a registered women’s health physiotherapist. Depending on the reason of consultation, it may include a postural assessment, an abdominal assessment and a vaginal assessment.
It is safe and appropriate to seek for pelvic health physiotherapy after a childbirth. An assessment can be done at six weeks postpartum. Depending on your assessment, your physiotherapist will be able to determine how often they would like to see you and develop a treatment plan to help you on your journey.
Pelvic health physiotherapy after birth can help:
- To practice your activities safely
Some activities, as running and jumping, require strong pelvic floor muscles. In order to avoid urinary incontinence and genital proplases, it is recommended to do pelvic floor muscles exercises before to return to your activities.
- To treat urinary incontinence and overactive bladder
Pelvic floor exercises improve symtoms of stress urinary incontinence (related to coughing, sneezing, jumping and heavy lifting) in 74% of women. Those exercises combined with a bladder training can also reduce symtpoms of urge urinary incontinence and overactive bladder (related to incontinence with urge feeling to urinate, frequent urination, reduce ability to hold urine) in 67% of women (Dumoulin, Cacciari, and Hay‐Smith 2018).
- To reduce symptoms related to genital prolapse
Genital prolapse occurs when a pelvic organ (i.e., the bladder, uterus or rectum) slips down into the vagina. The main causes of genital prolapses are pregnancy, vaginal delivery, constipation, obesity and chronic cough. All of these risk factors weaken the pelvic floor muscles and other tissues. The pelvic organs are only properly supported when the pelvic floor muscles, ligaments, and other tissues work properly. Pelvic floor muscle exercises help to reduce symptoms of genital prolapses, which are mainly a sensation of heaviness or pulling in the vagina, pain in the perineum and sensation of having an overly full rectum (Hagen and Stark 2011).
- To reduce a diastasis recti and improve your core
About 40% of women have a diastasis recti 6 month after their delivery (Mota et al. 2015). To reduce the distance between the rectus abdominis, first step is to improve the strenght of the transversus abdominis (the core muscles). Thereafter, specific abdominal muscle exercises can be perform according your strenght.
- To treat pain with intercourse
With vaginal tears, some perineal disconfort can persist. This discomfort is caused by scar tissue adhesions, areas where different tissues heal stuck together, which can lead to pain with daily activities, difficulty with urination and/or bowel movements, and painful intercourse. Scar tissue massage can be helpful to reduce those adhesions (Krapf and Tappy 2020). Pain with intercourse could also happen without scar tissue and be reduce with pelvic floor rehabilitation. Different modalities can be use to resolve this problem, as pelvic floor exercises improving their relaxation and their coordination, muscle relaxation and pelvic floor muscles streches.
- To take care of your Cesearian section scar
A Cesearian section can also have scar tissue adhesions, areas where different tissues heal stuck together. Those adhesions can be painful and weaken the abdominal muscles. Scar tissue massage can be helpful to gain flexibility in those tissues (Krapf and Tappy 2020).
What to expect at the assessment in pelvic health physiotherapy?
This assessment is appropriate for any pregnant woman, woman that has had her 6-week postnatal checkup, or any woman experiencing pelvic floor symptoms no matter how long ago you had your baby!
The assessment is a one-hour individual pelvic health assessment with a registered women’s health physiotherapist. Depending on the reason of consultation, it may include a postural assessment, an abdominal assessment and a vaginal assessment.
Pelvic health physiotherapy is an evidence-based treatment for common conditions within the pelvis such as incontinence, pelvic pain and other perineal issues. A comprehensive subjective and objective evaluation is conducted to identify all the factors that are contributing to your symptoms. A treatment plan will be formulated with personalized short and long-term goals.
Where are the pelvic floor muscles located?
The pelvic floor muscles consist of three layers of muscle that form the base of the pelvis. Stretching like a hammock between the pubic bone and the coccyx, these muscles play a major role in holding in urine, gas and stool. During a voluntary contraction, the pelvic floor muscles move forward and upward.
What to expect at the assessment in pelvic health physiotherapy?
This assessment is appropriate for any man experiencing pelvic floor symptoms or wanting to be proactive with their pelvic health.
The assessment is a one-hour individual pelvic health assessment with a registered pelvic health physiotherapist. Depending on the reason of consultation, it may include a postural assessment, an abdominal assessment and an anal assessment.