Anatomy of the pelvic floor
The pelvic floor is the region spanning the bottom of your pelvis from the front (pubic bones) to the back (tailbone) and from side to side (sit bones). The pelvic floor is comprised of the endopelvic fascia, the pelvic diaphragm and the urogenital diaphragm. Openings through the pelvic floor allow the flow of urine and feces to exit out of us. The pelvic floor muscles help to support the pelvic organs. In men and women these organs are the bladder and bowel. In women the pelvic floor muscles also support the uterus.
Symptoms of pelvic floor dysfunction
- 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
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.
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(1). 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
There is now some evidence available indicating a positive effect of pelvic floor muscle retraining for prolapse symptoms and severity(2).
Kegel Muscle training
Strengthening of the pelvic floor muscles is often associated with conservative treatment of the pelvic floor. This approach is useful when the muscles of the pelvic floor have inadequate functional strength. However, in some cases Kegel retraining is not recommended. If pelvic dysfunction is due to excessive tightness of the pelvic floor muscles, symptoms can be worsened by further strengthening. Additionally, in some instances the pelvic floor muscles are too weak to be properly trained by Kegel exercises.
What are the first steps
The first step in determining the right treatment plan for your symptoms is a detailed assessment. This will include a thorough history of your symptoms and their progression and a physical examination. It is recommended that an internal examination is performed to determine the appropriate intervention to resolve your symptoms. However in some cases pain and discomfort may prevent this portion of the examination early on in treatment.
At Family Physiotherapy all of the initial assessment is performed in a professional manner in private assessment and treatment rooms. We focus on evidence based practices to optimize your recovery.
- Dumoulin C, Cacciari LP, Hay‐Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews 2018, Issue 10.
- Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database of Systematic Reviews 2011, Issue 12
- Dumoulin C, Hay‐Smith J. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews 2010, Issue 1