Women’s Health (Pelvic Floor) Physiotherapy

Over a woman’s lifetime it is very common to experience issues with pelvic health. Physiotherapists are trained in specialist techniques that assist in addressing common pelvic health problems.

The Pelvic floor is composed of muscles, ligaments, nerves and connective tissue that extend from the front of the pubic bone to the tailbone. The muscles of the pelvic floor play a key role in core stability, bladder and bowel continence, and sexual health. Pelvic floor muscles work alongside our key core stability muscles to ensure proper support of the low back and pelvis.

Some of the conditions a women’s health physiotherapist can treat are:

• Incontinence of bowel or bladder
• Chronic pelvic pain
• Urgency/frequency/overactive bladder
• Constipation
• Dyspareunia/painful intercourse
• Pelvic organ prolapse (POP)
• Diastasis Rectus Abdominus (DRA) separated abdominal muscles
• Coccydynia – painful tailbone
• Vulvodynia/Vaginismus
• Nocturia – having to urinate throughout the night
  
  

Conditions

Prenatal and postpartum physiotherapy

Prenatal and postpartum physiotherapy consists of specialized movements, stretches, and exercises that target prenatal and postpartum hip, back, pelvis, and other joint and muscle pain resulting from pregnancy. Women often suffer from back, hip, and pelvic pain during pregnancy as well as following delivery. The pain can be a result of hormonal changes, increased laxity of ligaments, changes in posture due to weight gain during pregnancy, and breastfeeding postpartum. Pelvic floor physiotherapy can also help by assessing your internal pelvic floor pre- and postpartum to determine its strength. After determining if your pelvic floor is tight or weak, the pelvic floor physiotherapist can teach the proper contraction or relaxation of the pelvic floor with breath control.

Bladder and Bowel Incontinence

Stress urinary incontinence is when you leak urine due to increased abdominal pressure (from sneezing/coughing/jumping/laughing/lifting). In this case, the pelvic floor and urethra aren’t strong enough to counteract the pressure causing urine to leak out. Pelvic floor physiotherapy can help you strengthen the pelvic floor and retrain this reflex to stop the leaking.

Faecal incontinence can be due to pelvic floor dysfunction, childbirth trauma, constipation, and poor bowel techniques. Pelvic floor physiotherapy can assess the cause of the issue and help you retrain your system for regular and controlled bowel movements again.

Overactive bladder is when the bladder squeezes while it’s not full (or at an inappropriate time), this often causes an unbearable urge to pee. Sometimes you can leak as well. Pelvic floor physiotherapy using manual techniques combined with education and bladder retraining can be very effective for calming these urges and gaining bladder strength.

Research has shown that 80% of incontinence can be improved with pelvic floor physiotherapy.

Dyspareunia

Painful intercourse, or dyspareunia, can be treated with manual therapy and exercise. Manual therapy performed by your physiotherapist involves mobilizing muscle and soft tissue, normalizing overactive muscles, improving circulation, and desensitization. The goal of dyspareunia treatment exercises is relaxation throughout the pelvic floor.

Pelvic Organ Prolapse (POP)

Pelvic organ prolapse is when the muscles and tissues supporting the pelvic organs such as the uterus, bladder or rectum become weak or loose. This allows one or more of the pelvic organs to drop or press into or out of the vagina. Bladder prolapse is called a cystocele. This is when the bladder loses its support and bulges into the front wall of the vagina. A rectocele, or posterior vaginal wall prolapse is when the rectum loses its support and bulges into the back wall of the vagina. A uterine prolapse is when the uterus loses support and bulges in the vagina. The symptoms of a prolapse can include:

• A feeling of heaviness in the vaginal or rectum
• Incomplete bladder or bowel emptying
• Something bulging at the vagina

Treatment of prolapse includes teaching the patient to correctly perform pelvic floor exercises such as Kegals and correcting faulty posture can really help with early stages of pelvic organ prolapse. Education on proper toileting, diet and lifting mechanics can also help prevent the prolapse from progressing.

Diastasis Recti

Another important area to look for postpartum is the abdominals. Sometimes during pregnancy you can have a separation in your abdominals, also known as diastasis. This can look like a bulge or doming in your abdominals, you might also feel like you can sink your fingers into the abdominals above or below your belly button. A small separation however may not cause problems, and sometimes can resolve itself. Diastasis can cause pain in the abdominals; it may also contribute to pain in your lower back and pelvis, which can lead to further issues with your pelvic floor such as Pelvic Organ Prolapse (POP). Pelvic floor physiotherapy will give you the appropriate exercises to help with the healing of your diastasis and help you with proper postures for activities of daily living (including getting into and out of bed).

It is not always possible to ‘close the gap’, however, the bulging/hollowing can be improved. Once your abdominal muscles begin to work normally again it is safe to confidently and independently commence your own exercise routine.

What will happen during a women’s health physiotherapy appointment?

On your first appointment, a detailed history will be taken about your problems and concerns in detail. Questions regarding your symptoms, medical and social history will be asked. Some of these questions may be personal yet they are asked to gain a full insight into the nature of your condition.

Depending on your concerns, a physical examination will be completed including assessing your posture, pelvic alignment, abdominal muscles, and how you perform functional activities.

You may be offered an internal (vaginal) pelvic floor examination based on your symptoms and concerns. This is not mandatory but provides valuable information in being able to diagnose and provide effective treatment. You will be provided with a detailed explanation of the internal examination. An internal examination assesses your pelvic floor function, and can be completed in your first appointment or subsequent appointments. You have the right to have a chaperon present during this assessment.

Once completed, we will discuss the examination results and treatment plan. You will usually be given some treatment/exercises at the end of your first appointment. To ensure the best outcome, it is important to be active in your rehabilitation and follow the advice of your women’s health physiotherapist.