Pelvic Physiotherapy

What is Pelvic Physiotherapy?

Pelvic physiotherapy is a manual therapy for both men and women that focuses on the rehabilitation of the pelvic floor. Pelvic Physiotherapists are trained in assessing and treating dysfunctions of the pelvic floor, such as incontinence, pelvic pain and prolapse. They have received advanced training in pelvic floor dysfunction and are registered with the College of Physiotherapists of Ontario.

As part of the treatment of your pelvic floor, your physiotherapist may ask for your consent to perform internal assessments. By performing an internal examination during the initial assessment and in subsequent treatment sessions, therapists are able to provide feedback to ensure proper performance of the pelvic floor exercises for relaxation and strengthening. Internal assessments are not mandatory and external techniques can be applied with great success.

Pelvic Physiotherapy Treatment

Assessments and treatments involve internal and external techniques which focus on the muscles, nerves, connective tissue, joints, ligaments, and tendons of the pelvic girdle, low back and hips. Treatment techniques often include manual therapy techniques, exercises, connective tissue release, massage, modalities and education.

Pelvic Floor Dysfunction can be caused by:

Hypertonicity (tightness of the pelvic floor muscles)

Many patients with pelvic floor dysfunction experience pain due to pelvic floor muscles that are too tight. Women can experience pain during sexual intercourse due to sensitivity and trigger points in the pelvic floor muscles. In addition, tight muscles can cause an increase in frequency, urgency and incontinence of the bowel and bladder. It is important for the pelvic floor muscles to stay relaxed to prevent pain and to allow for urination and bowel movements.

Symptoms of hypertonicity include:

• Urinary incontinence (urge and mixed incontinence)

• Fecal incontinence

• Urinary and fecal urgency

• Painful urinating, incomplete emptying of the bladder, stopping and starting of the urine stream

• Dyspareunia (pain with sexual intercourse)

• Interstitial cystitis (painful bladder syndrome)

• Pain with bowel movements, constipation, straining

• Chronic pelvic pain

• Vaginismus

• Vulvodynia (pain in the vulvar area)

• Pudendal neuralgia (compression of the pudendal nerve)

Treatment for a hypertonic pelvic floor, will focus on:

• Relaxation exercises for the pelvic floor muscles

• Stretching exercises for the tight pelvic floor muscles, as well as muscles surrounding the low back, pelvis, abdomen and hips

• Manual therapy techniques such as normalization of tone of a hypertonic pelvic floor, mobilization of low back, hips and pelvis to increase mobility if affected, connective tissue release for tight muscles/fascia, and internal/external release of trigger points.

Hypotonicity (weak pelvic floor muscles)

The pelvic floor muscles must be strong in order to close off the urethra when an increase in intraabdominal pressure occurs, such as coughing and sneezing, to prevent incontinence. The pelvic floor muscles also require adequate strength to help support the bladder, uterus and rectum.

Symptoms of hypotonicity include:

• Stress incontinence

• Urge incontinence

• Pelvic organ prolapse

Treatment for a hypotonic pelvic floor, will focus on:

• Strengthening exercises for the pelvic floor muscles

• Core strengthening exercises

• Manual therapy techniques such as normalization of tone of a hypotonic pelvic floor, mobilization of low back, hips and pelvis to increase mobility if affected, connective tissue release for tight muscles/fascia, and internal/external release of trigger points.

Some patients may have a combination of tight and weak pelvic floor muscles. When this occurs, it is important to work on relaxation techniques to reduce the tension in the muscles, prior to strengthening. Once the pelvic floor muscles have reached a normal resting tone, strengthening exercises may begin, if appropriate.

Our Pelvic Health Physiotherapists

FAQs

What are some of the common myths about incontinence?

• Incontinence is a natural part of aging

• Incontinence after childbirth is normal

• Nothing can be done to change incontinence

All of these misconceptions are false. Incontinence is not a natural part of aging, it is not normal to have incontinence after childbirth and Pelvic Physiotherapy can help reduce and prevent incontinence of the bladder and bowel. A Cochrane Review in 2010 found high quality evidence to support pelvic floor muscle training as the first line treatment for stress and mixed urinary incontinence in women.

What is the pelvic floor?

The pelvic floor consists of three layers of muscle, nerves and connective tissue. The pelvic floor muscles start at the front of the pelvis, the pubic bone, and connect all the way to the tailbone. The strength and tone of the pelvic floor muscles play a vital role in pelvic floor dysfunction. There are 5 main functions of the pelvic floor:

1. Supportive: The pelvic floor muscles are like a sling or hammock of muscles that support the bladder, uterus and rectum

2. Sphincteric: Adequate strength of the pelvic floor helps to maintain continence of the bladder and bowel

3. Stability: Strength of the muscles is important for preventing pain by maintaining stability and coordination of the pelvic girdle, low back and hips

4. Sexual: Proper pelvic floor muscle strength aid in achieving orgasm and erection

5. Sump pump: Blood and lymphatic flow back to the heart

Who would benefit from pelvic floor physiotherapy?

We treat women and men of all ages, who may be suffering from the following conditions:

• Urinary Incontinence: an involuntary loss of urine

  • Stress incontinence: loss of urine associated with an increase in intraabdominal pressure, such as coughing, sneezing, laughing, lifting and/or jumping

  • Urge Incontinence: a sudden loss of urine due to an uncontrollable urge to void

  • Mixed Incontinence: both stress and urge incontinence

• Increase in urinary frequency and/or urgency

• Persistent pelvic pain and/or pain with sexual intercourse

• Prepartum women – if experiencing pelvic, low back or hip pain and/or incontinence, but also to help prevent prolapse and/or incontinence after pregnancy.

• Postpartum women – if experiencing pelvic, low back or hip pain, incontinence or prolapse. But can also benefit from pelvic floor physiotherapy to prevent incontinence and prolapse from occurring in the future.

• Painful bladder syndrome, interstitial cystitis

• Chronic low back pain, SIJ pain and hip pain that hasn’t resolved with other conservative therapies

• Vulvar pain

• Fecal incontinence