Pelvic Health


What is the Pelvic Floor? 

Everyone wants to know what and where is the pelvic floor? Young, old, male and female, everyone has a pelvic floor. Optimal function of the pelvic floor is essential to happy, healthy human life. Through the pelvic floor we urinate, relieve our bowels and enjoy intimacy and sexual relations. That’s why a happy pelvic floor = happy you.

The pelvic floor is a group of muscles that sit at the very bottom of your pelvis in a hammock type fashion; spanning from the coccyx and sacrum in the back to the pelvic bones along the sides and the pubic bones in the front. The pelvic floor muscles have a big job to do: they hold up all the organs directly above (the bladder, uterus, rectum and prostate), and also surround the openings of the urethra, rectum and in women, the vagina.


What is Pelvic Floor Dysfunction?

Pelvic Floor dysfunction occurs for different reasons, however, in all cases the pelvic muscles are not operating as they should. For example, urinary incontinence (UI) is one type of pelvic floor dysfunction, and 1 in 3 women will experience UI. Although UI is a common condition, it is not “normal” to have incontinence. A variety of pathology may lead to pelvic floor dysfunction however, the two most common are:

1. Short, tight muscles; 
2. or Lengthened, weak muscles. 

Short and Tight Pelvic Floor Muscles: 

The muscles of the pelvic floor may shorten in response to something such as an abdominal or pelvic surgery, or painful menstruation. The tight and short muscles are usually associated with urgency, urge incontinence, dyspareunia (pain during sex), chronic pelvic pain, painful bladder syndrome (interstitial cystitis), pudendal neuralgia, vaginismus, vulvodynia, and chronic prostatis.

Long and Weak Pelvic Floor Muscles: 

For different reasons the muscles of the pelvic floor may be generally weak, or become ‘stretched out’. This muscle lengthening and weakness may develop, for example, after carrying and delivering a baby, or chronic coughing. This presentation is most commonly associated with incontinence (stress urinary incontinence, or urge urinary incontinence) and pelvic organ prolapse. 

A Certified Pelvic Health Physiotherapist can help with your Pelvic Floor Dysfunction.

  • urinary leakage or incontinence with laughing, jumping, coughing
  • urinary leakage or incontinence associated with urgency:
  • the key in the door syndrome
  • tailbone pain
  • trouble with Kegal exercises
  • pelvic floor weakness
  • heaviness, pressure or feeling of fullness in the pelvic area
  • pelvic organ prolapse (cystocele or rectocele)
  • protrusion of tissue outside the vaginal entrance
  • difficutly passing stool
  • pelvic pain and cramping during menstruation
  • pain during sex

 

In 74.4% of primiparous women (women having borne one child) who had low back, or pelvic area pain, a diastasis rectus abdominus was detected. (1)

50% of women who have had children have some degree of pelvic prolapse (for example fallen bladder). (2)

1. Parker MA, Miller, LA, Dugan SA. Diastasis rectus abdominus and lumbo-pelvic pain and dysfunction: are they related?. Journal Womens Health Phys. Ther. 2009; 33 15-22. 2 Hagen S & Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database of Systematic Reviews. 2001; Issue 12. Art. No.: CD003882. DOI:10.1002/14651851. CD003882.pub4.


What is Pelvic Health Physiotherapy?

Pelvic Health Physiotherapists have post-graduate education and specialized certification to qualify for their distinction, which is registered with the College of Physiotherapists.

Your Pelvic Health Physiotherapist will assess and treat conditions related to the muscles, fascia, ligaments and nerves in the pelvis. Pelvic Health Physiotherapy involves regaining optimal function of your pelvic floor and pelvic region, achieving healthy bladder and bowel control, ideal muscle strength and pelvic organ support, and pain free (sexual) function.

 Treatment may include:

  • myofascial mobilization
  • techniques to restore proper muscle length
  • muscle strengthening exercises with manual facilitation
  • trigger point release
  • regaining function of diastasis
  • mobilization of lumbar spine, coccyx, SI joint and hips
  • Home exercise program


Kegals

Pelvic floor muscle strength helps to control and prevent urinary incontinence and pelvic organ prolapse and many women start on ‘Kegal’ exercises (also called, ‘pelvic floor muscle strengthening’) to help manage their condition and become discouraged when they don’t see results, or upset when things progress and become worse. Kegals are not indicated for all incontinence and kegal exercises can also be carried out incorrectly.

A variety of different things can cause pelvic floor dysfunction which is why kegals are not always indicated; particularly for conditions of urgency, frequency and pelvic pain.Whether, and when, you start on a pelvic floor strengthening program depends on what type of pelvic floor condition you have; diagnosing this is the expertise of a Pelvic Floor Physiotherapist. Research shows that Kegals can sometimes do more harm than good is when a Kegal contraction is NOT done correctly:

  • 51% of women verbally trained to on how to contract their
    pelvic floor muscle contracted incorrectly
  • 25% of women “push out”, instead of “pulling in”, stretching the
    elvic floor muscle*.
    (1)

A certified Pelvic Health Physiotherapist can assess your condition and distinguish whether you are correctly contracting your pelvic floor and if your condition is appropriate for strengthening exercises.

 

Pelvic Floor Physiotherapy is Getting Great Reviews

Studies in scientific literature (The Cochrane Collaboration 2010), and guidelines for healthcare, the Clinical Practice Guidelines for Society of Obstetricians and Gynaecologists of Canada, (the CPG for SOGC), have recommended proper performance of Kegal exercises should be confirmed by digital vaginal examination”. That’s why pelvic floor physiotherapy (that includes internal examination to properly treat patients, and teach pelvic floor exercises) is being recommended as the first line treatment for pelvic dysfunction, even before surgical consultation for conditions of incontinence.

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Joint Clinical Practice Guidelines

The joint Clinical Practice Guidelines provided by the Canadian Physiotherapy Association for the SOGC and approved by the Board of Directors of the Canadian Society for Exercise Physiology state that:

  1. Pelvic Floor Muscle Training with a Physiotherapist is recommended to prevent UI, during pregnancy,
    and after delivery (Level 1, Grade A evidence)
  2. Core stability training with a Physiotherapist is recommended to prevent and treat back and pelvic pain
    following pregnancy (Level 1, Grade B
    evidence)

References:

1. Bump R.C., Hurt W.G., Fantl J.A. & Wyman J.F. Assessment of Kegal pelvic floor muscle exercise performance after brief verbal instruction. American Journal of Obstetrics and Gynecology. 1991. 165(2)322-329.