Pelvic Floor Therapy
Pelvic floor muscle retraining may reduce the numbers of leakage episodes, the amount of leakage and the symptoms of urinary incontinence
Anatomy of your Pelvic Floor
Your pelvic floor provides essential support for your vital organs. This key region of the pelvis, extending from pubic bones to tailbone and sit bones across both sides, is composed of endopelvic fascia, a pelvic diaphragm and urogenital diaphragm. These muscles provide crucial structural strength in men or women - supporting not only bladder and bowel functions but also woman's uterus too! Furthermore, openings through this all-important band ensure that urine and feces exit as needed.
How can pelvic floor problems develop?
Your pelvic floor muscles can be weakened by childbirth, surgery, heavy lifting, being overweight, menopause or constipation.
Pelvic floor problems with pregnancy and after childbirth
During pregnancy the hormone relaxin helps to relax stabilizing ligaments around the pelvis in order to ease the passing of the baby through the birth canal. In some cases, the relaxed ligaments may not return to their normal properties and you may be left with public ligament laxity and instability. When your pelvic ligaments become weak, this can cause your pelvic floor muscles to contract continuously against an unstable base. This can cause muscles spasm and pain
Pelvic floor problems and its relevance to sports injury
Women involved in high performance, high impact sports should be educated in preventative pelvic floor dysfunction strategies. These strategies can help to prevent adverse reactions of prolonged high performance sports involvement on the muscles of the pelvic floor. Some of these adverse reactions later in life can include urinary incontinence, constipation, painful intercourse, vaginal laxity and pelvic organ prolapse.
Pelvic floor and obesity
According to the journal Best Practice and Research Clinical Obstetrics & Gynecology obesity is associated with higher prevalence of pelvic floor disorders. Urinary incontinence, fecal incontinence and sexual dysfunction are more prevalent in patients with obesity. While weight loss is a major factor in improvement of these symptoms, pelvic floor treatment can lead to increasing patients' quality of life.
Pelvic floor problems and menopause
With menopause pelvic floor muscles, just like other muscles in your body, can weaken. However, pelvic floor pain or symptoms of urinary frequency (constantly needing to go to the toilet) or urgency (needing to get to the toilet in a hurry) are not normal part of menopause or at any other time.
For other patients, the pelvic floor muscles may be overactive. Over activity in your pelvic floor muscles can cause difficulty with intercourse, emptying your bladder or bowel, and using a tampon. Patients with overactive pelvic floor muscles won’t benefit from strengthening the pelvic floor because they need to be taught how to relax the muscles.
In most cases the cause of dysfunction of the pelvic floor is unknown. However in some cases trauma to the pelvis or complications of child birth can lead to dysfunction of this region.
In most cases the cause of dysfunction of the pelvic floor is unknown. However in some cases trauma to the pelvis or complications of child birth can lead to dysfunction of this region.
Having to pee a lot is just one symptom. Other symptoms of pelvic floor muscle problems can include
Incontinence – Leakage of urine or feces.
Urgency – A strong urge to urinate or defecate.
Frequency – Having to urinate so often that it disrupts your usual daily routine.
Chronic Pelvic Pain – pain, burning or pressure in the pelvic region.
Constipation – difficulty passing stools
Painful Intercourse
Nocturia – waking often at night to urinate
The Evidence for Pelvic Floor Rehabilitation
There is good evidence to support the use of pelvic floor muscle retraining as a first line strategy for incontinence. Pelvic floor muscle retraining may reduce the numbers of leakage episodes, the amount of leakage and the symptoms of urinary incontinence. Additionally, literature reviews from the Cochrane Collaboration have shown that women who have undergone pelvic floor training for urinary incontinence were:
* Eight times more likely to have cure or improvement than those that did not
* More likely to report improvement in quality of life
* Authors were confident that pelvic floor muscle training can cure or improve symptoms of urinary incontinence and stress urinary incontinence
* More likely to report improvement in quality of life
* Authors were confident that pelvic floor muscle training can cure or improve symptoms of urinary incontinence and stress urinary incontinence
There is now some evidence available indicating a positive effect of pelvic floor muscle retraining for prolapse symptoms and severity(2).
Kegel Muscle Training
Kegel exercises are a powerful tool in the conservative treatment of pelvic floor dysfunction, however they may not be recommended for everyone. If your muscles are too weak or overly tight Kegels can worsen your symptoms. So it's important to work with your pelvic floor physiotherapist before engaging in any strengthening regimen.
What are the First Steps?
The initial goal in creating an effective treatment plan for you is to complete a comprehensive assessment. This will likely involve discussion of your symptom history and progression, as well as a physical evaluation - with an internal exam often being advised when it comes time to decide the correct intervention technique needed. Of course should pain or discomfort be present this portion may need putting off until later on down the line of care.
We can help you
At Family Physiotherapy all of the initial assessment is performed in a professional manner. Assessments and treatments take place in private rooms. We focus on evidence based practices to optimize your recovery. Our pelvic therapist has also completed advanced pelvic and back courses and can help you with your pelvic floor and any other related symptoms you may be having.
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