Women’s Pelvic Health

Pelvic floor physiotherapy is ideal for women who are having issues related to incontinence, prolapse, or pelvic pain.

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Frequently asked questions about Pelvic Floor Physiotherapy for Women

What may cause you to have a problem with your pelvic floor?

  • Pregnancy; vaginal or c-section
  • Chronic straining with bowel movements
  • Chronic cough
  • Imbalance of abdominal pressures
  • Posture/Muscle Imbalances
  • Various pathologies

Common Signs and Symptoms you may experience

  • Urinary and / or Fecal Incontinence
  • Organ Prolapse
  • Pelvic Pain
  • Sexual Dysfunction

What happens during your first session?

Though each session may be slightly different, an assessment is always performed during the first appointment. An internal assessment of the pelvic floor is necessary which involves a vaginal and/or rectal exam, which gives me information about your pelvic floor such as:

  • Muscle strength/endurance
  • Muscle stiffness/flexibility
  • Motor control/ability of the muscles to contract and relax
  • Evidence or not of an organ prolapse
Common Pelvic Floor Problems in Women

Abdominal Separation – Diastasis Recti Abdominis (DRA)

This is when the muscles separate away from the abdominal midline (linea alba) greater than 2.7 cm or roughly 1 inch or about 1 finger width.

Risk Factors

  • Pregnancy
  • Obesity
  • Performing lots of ‘core’ exercises incorrectly

 

How It’s Treated

Your initial assessment will establish the existence of the diastasis and then teach you with the help of real time ultrasound (RTUS) to engage your deep core system (transverse abdominis muscle) properly. Education, home exercises, functional movements and exercise modification will be given to get you started on improving your core stabilizing system.

Common Pelvic Floor Problems in Women

Bladder/Bowel Control Issues

Stress Urinary Incontinence (SUI)

This is when there is an involuntary loss of urine experienced with laughing, coughing, lifting, exercising. This is often due to a weak pelvic floor.

Urge Incontinence/Overactive Bladder (OAB)

Urge incontinence is the sudden loss of urine due to a strong urge to go to the bathroom. People often have triggers; things that make them want to go even more, such as hearing water running, getting your key in the door, etc. You may experience bladder leakage because the urge is so strong and you are unable to hold it any longer. Though there may be weakness in the pelvic floor, there are often muscles that are too tight. Treatment will always involve bladder and brain behaviour changes.

Over Active Bladder is the strong urge to go with/without the loss of urine. This is treated the same as urge incontinence.

Fecal Incontinence

This is the involuntary loss of fecal material. The inability to hold back stool or gas may happen because the pelvic floor muscles are weak but there may also be dietary issues that need to be tended to.

Coccydynia/Tailbone Pain

Pain most commonly felt during sitting but can also be present when standing up from your chair, lying down on your back and rolling up and down. This can happen during childbirth or result from a fall on the tailbone. Sometimes treatment is needed from an internal approach due to the the pelvic floor muscle attachments to the coccyx and sacrum. Sometimes these muscles are tighter on one side and need to be released which will decrease the tension felt around the tailbone allowing you to sit comfortably once again.

Dyspaurenia/Painful Intercourse (Vestibulodynia, Vulvodynia)

Symptoms may be described as pain, burning, or ripping during intercourse. Pain may be felt at the external genitalia (Vulvodynia), at points on the introitus/entry to vagina (Vestibulodynia) or deeper inside the pelvis and may be experienced on entry or with deeper thrusting. Women often report feeling pain with one or more of the following:

  • Tampon insertion
  • During a pap test either with instrument insertion or once in, instrument widening
  • With penetration
  • Wearing tight pants
  • Sitting

This is a very real problem and needs to be treated with muscle relaxation, pain management strategies, biofeedback to learn motor control of the pelvic floor.

Endometriosis

The endometrium (the tissue lining the inside of the uterus), grows on other organs inside the pelvis. This can cause pain and inflammation not allowing free movement of the organs and fascia. Pain during menstruation and intercourse are commonly reported but low back pain, urinary urgency and infertility may also occur.

Levator Ani Syndrome

A constant dull ache/pain felt in the rectum that originates from pelvic floor muscles that are too tight and are unable to relax. This can lead to bloating, the need to urinate frequently, urinary incontinence and/or difficulty urinating. Treatment includes breathing and postures for relaxation and trigger point release techniques for the pelvic floor muscles.

Low back pain/pelvic girdle pain/SIJ pain

In order to have enough mobility and enough strength to perform the activities you want to throughout your day, you need to have good stability as well. This comes from the deep muscles that attach to our spine and pelvis. These muscles support us so our bigger muscles can move us. These muscles include:

  • Pelvic floor muscles
  • Transverse abdominis muscle
  • Deep multifidi (deep back muscles)
  • Diaphragm (our primary breathing muscle)

These muscles work together balancing the intra abdominal pressures our body experiences when we move and perform activities. When we breathe in, air travels from the atmosphere, a place of higher pressure to our lungs, a place of lower pressure. The air inside our lungs now has increased the pressure which makes us exhale, or blow the air back out into the atmosphere. When we inhale, our diaphragm lowers as does our pelvic floor and when we exhale our diaphragm and pelvic floor lift; our transverse abs and deep multifidi are also lengthening and shortening. This all happens in response to the change in pressures.

If someone is primarily a ‘chest breather’ their diaphragm and pelvic floor won’t be able to reach these full excursions and this throws the balance off. If our abdominal core system is not working efficiently, increased forces will be felt through the rest of the body, such as the low back, hip and pelvis.

Treatment will look at your internal system to ensure the pelvic floor is working optimally. This can be done either internally and/or by using real time ultrasound to look at how the pelvic floor muscles are acting on the bladder and to look at the transverse abdominis and oblique muscles to ensure they are working optimally.

Pelvic Organ Prolapse (POP)

  • Cystocele (bladder prolapse/anterior wall prolapse)
  • Urethrocele (uterus prolapse)
  • Rectocele (rectum or posterior wall bulging into the vagina)

This occurs when the bladder, urethra or rectum drops from its normal position to one that is lower. Though there are many risk factors for this, having a weak pelvic floor that is unable to support the organs is a common reason. Treatment will help you to learn how to access your pelvic floor muscles as well as balance the intra abdominal pressure so it doesn’t negatively influence the pelvic floor.

People can have POP with or without incontinence.

How do you know if you have a prolapse?

  • Pelvic heaviness
  • The feeling that something is rubbing inside your underwear or that something is going to drop out
  • Discomfort/difficulty during intercourse
  • The feeling that a tampon is in…when it isn’t

Treatment will include pelvic floor muscle strengthening, education and exercise modifications

Pre/Post Natal Assessment

This assessment will include both an internal pelvic floor assessment as well as using imaging ultrasound to look at your transverse abs to ensure they are working well to support you.

When is it time to have a pelvic floor assessment?

  • If you are planning a pregnancy as this will give you information about how strong/flexible your pelvic floor muscles are
  • During your pregnancy after the first trimester – this is appropriate in some cases; otherwise help can be given to ensure your transverse abs are working well to support you
  • 6 weeks postnatal – if from 6 weeks or so onwards, you are still experiencing incontinence, it’s time to have your pelvic floor checked
  • If you are experiencing pain with intercourse a few months after delivering your baby, it’s time to have a pelvic floor assessment. There may be pain from stretching, tearing or muscles that are too tight. Soft tissue massage and home exercise can help improve the healing of the tissues so you can resume your regular activities.

Symphysis Pubis Dysfunction (SPD)

This is a condition where there is excessive movement at the pubic symphysis joint. This may happen from a fall causing a pelvic misalignment or during pregnancy and/or childbirth. Pain is most commonly felt at the pubic bone but discomfort can be reported at the SIJ, hip, groin, lumbar spine and legs. Treatment helps to realign the pelvis and home exercises/modifications will be given to further this support. Imaging ultrasound will identify whether or not the deep abdominal muscles are working well.