An Introduction to Pelvic Floor Physiotherapy
Hello! My name is Nicole Stieber-Sze, and I am a Registered Physiotherapist with a special interest in pelvic floor physiotherapy. I have been working as a physiotherapist for almost 10 years, and in the field of pelvic health for 4.5 years. I first became interested in pelvic floor therapy after struggling with my own pelvic floor after the birth of my eldest child, who is now 4 years old. Going for pelvic floor physiotherapy after her birth made a huge difference in my quality of life, and I knew that I wanted to be able to do that for other people! Today, I’ve put together some answers to a few questions that I hear commonly in my practice, as well as from people in the community. I hope that it gives you an idea of how pelvic floor physiotherapy might help you!
What is the Pelvic Floor?
The pelvic floor is a small, but very important group of muscles that are suspended inside the pelvis. They attach to the front, back and sides of the sacrum and pelvic bones and form a hammock or sling at the bottom of the pelvis. The pelvic floor muscles help close the urethra and anal canal to prevent incontinence (leaking of urine or stool). They also provide support for the organs of the pelvis (the bladder, uterus and rectum), form part of the core, and have a role in sexual function.
What is Pelvic Floor Physiotherapy?
Pelvic floor physiotherapy is a niche of physiotherapy which involves the assessment and treatment of the muscles of the pelvic floor. Physiotherapists who work in this field are Registered Physiotherapists that have taken post graduate courses that allow them to perform an internal examination.
What can pelvic floor Physiotherapy help with?
Stress Urinary Incontinence
Urge Urinary Incontinence
Pelvic Organ Prolapse
Urgency/Frequency of urination
Painful intercourse (dyspareunia)
Bladder Pain Syndrome and Interstitial Cystitis
Pelvic floor difficulties often fall into one of two categories:
Hypertonicity (the pelvic floor is short/tight)
Hypotonicity (the pelvic floor is weak)
It is also possible for the pelvic floor to be both tight AND weak!
In pain conditions, the nervous system also often becomes sensitized. Pain signals produced by the nervous systems act as the body’s alarm system. With chronic pain, the “alarm system” becomes extra sensitive, and it takes less to set it off than it would in someone without long standing pain. In addition to working directly with the tissues, in people struggling with pain, we often work to decrease the sensitivity of the nervous system (or alarm system) and look at other factors that might be causing the nervous system to be extra sensitive.
Pelvic Floor Myths
“It’s normal to leak after having kids!”
“ Incontinence is a normal part of aging”
“ There is nothing you can do about pelvic pain or incontinence”
“Surgery is the only way to fix incontinence/prolapse”
None of these things are true! Although pelvic floor dysfunction is very common after having children and after menopause, it is not something that needs to be permanent, or “the new normal”.
50% of community living women over the age of 45 experience urinary incontinence. 30-40% of women experience urinary incontinence during their first pregnancy, and up to 50% of women will experience pelvic floor dysfunction postpartum. BUT, there is excellent research to support pelvic floor muscle training as the first line treatment for stress urinary incontinence. It is thought to have an 80-85% success rate without surgery.
Is it more than just Kegels?
Yes! A pelvic floor physiotherapy assessment typically involves taking a detailed history of your problem, including your medical history, gynecological and pregnancy/birth history, and a history of any other treatments you have tried. Because the pelvic floor musculature can be affected by the joints and muscles of the pelvis, hips and low back (and vice versa), we will often do an orthopedic screen of the external muscles and joints. We often also look at things like your breathing pattern, and how you do certain movements, like going from sit to stand. We then often do an internal examination of the pelvic floor muscles. This is the best way to determine the length and strength of the pelvic floor, as well as assessing pelvic organ prolapse. From there, we can work on a treatment plan to work towards your goals. Kegels are not the answer for everyone! For a person struggling with a tight pelvic floor, initially we will work on lengthening and relaxing the pelvic floor muscles before considering any strengthening. Doing Kegels with a tight pelvic floor can worsen symptoms! This is also the reason why the internal portion of the examination is important, as it is difficult to accurately prescribe exercises without knowing how tight/strong the pelvic floor is. That said, we also recognize that an internal exam is not an option for everyone and there are also external techniques and technologies we can use for people who are not able to have an internal exam.
Is it just for women? What about women who haven’t had children?
No! Men, women and children can all be impacted by pelvic floor muscle dysfunction! In men, pelvic health physiotherapy commonly helps with post-prostatectomy incontinence, pelvic pain (including chronic prostatitis, and penile/testicular pain), erectile dysfunction, and frequent/urgent urination. Pediatric pelvic floor physiotherapy can help with things daytime incontinence, bedwetting, difficult toilet training, recurrent urinary tract infection, and chronic constipation/encopresis. Women can struggle with their pelvic health regardless of whether they have had children or not.
What if my children aren’t babies anymore?
It’s never too late! For some women, pelvic floor symptoms that are manageable in their 20’s and 30’s become much more significant with the hormonal changes that come with menopause. Pelvic floor physiotherapy can be helpful during all stages of life, including in seniors.
Can pelvic floor physio be helpful during pregnancy?
Yes! 35-40% of women experience urinary incontinence during their first pregnancy, and without treatment, they are more likely to remain incontinent during the postpartum period. Pelvic girdle pain, or pain in the pubic symphysis or sacroiliac joints, is also very common during pregnancy and can be improved through physiotherapy. Pelvic floor physiotherapy is typically considered to be safe in pregnancy provided you have not been told to abstain from intercourse, but it is always best to check in with your birth practitioner about your specific case!
Also read: Do you pee when you sneeze? I do!
Looking for a more comfortable pad to help with incontinence?
Nicole Stieber-Sze works at Guelph Women’s Health Associates, in Guelph, Ontario. She has a special interest in pelvic floor physiotherapy, and has furthered her education with Pelvic Health Solutions levels 1-3, as well as courses in pediatric pelvic floor dysfunction. She also enjoys working with breastfeeding families in the treatment of blocked ducts/mastitis, and in examining infant oral motor function. Nicole also has a strong orthopedic background, and has completed her intermediate manual therapy certification, as well as courses in acupuncture.
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