Pelvic Floor Physiotherapy
Pelvic floor physiotherapy (PFPT) is a specialized branch of physiotherapy involving the assessment and treatment of the pelvic floor muscles via internal and external examination. The pelvic floor muscles are those group of muscles that attach to the front, back, and sides of the pelvic (hip) bones and sacrum. They create a bowl/hammock of muscles to support the pelvic organs including the bladder, uterus and prostate; they also support the urethra, rectum, and vagina. A functional pelvic floor has muscles that contract and relax in a regular rhythm to allow for continence, urination, bowel movements, and pain-free sexual intercourse.
Dysfunction can occur when the muscles are either too weak (hypotonic) or too tight (hypertonic). During the assessment, the physiotherapist will do an external orthopaedic assessment of the lumbar spine, sacroiliac joints, and hip flexibility. Other joints may be tested depending on client complaints. Following that, an external, visual exam of the genitals will occur, with palpation to the perineum and external pelvic floor muscles. With continued consent, an internal exam involving the insertion of two clean, gloved, lubricated fingers into the vagina or one clean, gloved, lubricated finger into the rectum will follow. It is through the internal exam that the physiotherapist is able to determine if the muscles are too tight, too weak, or some combination of the two. Once the assessment has been completed, the physiotherapist will start working with the client on an individualized treatment program that can include but is not limited to, stretching, strengthening, and toileting retraining.
WEAK PELVIC FLOOR
Hypotonic pelvic floor dysfunction can contribute to stress incontinence, urge incontinence, mixed incontinence, and pelvic organ prolapse. Stress incontinence is the involuntary loss of urine or stool during or after activity, such as jumping, running, laughing, coughing, or sneezing. Urge incontinence is the involuntary loss of urine or stool following a strong urge to get to the toilet. Mixed incontinence occurs when someone has a combination of stress incontinence and urge incontinence. Pelvic organ prolapse is when one of the pelvic organs starts to “fall” out of place. It can contribute to feelings of heaviness or bulging at the vaginal or rectal opening. Hypotonicity is treated with a strengthening regime that can also involve education regarding toileting and positional techniques to lessen symptoms.
TIGHT PELVIC FLOOR
Hypertonic pelvic floor dysfunction can contribute to a host of problems for the client, including the following:
Urinary issues: frequency, urgency, hesitancy, painful urination, incomplete emptying, nocturia (frequent urination at night), and a stop and start of the urine stream.
Bowel issues: constipation, straining during bowel movements, pain before, during, or after bowel movements.
Sexual dysfunction: pain with penetration, inability to have vaginal penetration, pain/inability to orgasm, pain with sexual stimulation.
Hypertonicity of the pelvic floor can also contribute to unexplained lower back pain, hip pain, deep abdominal pain or pelvic pain, and pain in the genitals.
Hypertonicity is treated via relaxation and stretching of the muscles (internal and external); once the muscles have achieved a relaxed tone, strength and function are then assessed and the client is given additional exercises that could include strengthening of the muscles.
With neurological conditions, bowel and bladder dysfunction can occur, as well as sexual dysfunction. The physiotherapist can assess your pelvic floor and help build a treatment plan around your specific neurological deficits.
For example, men with Parkinson’s disease commonly experience erectile dysfunction. Depending on the progression of the disease, the physiotherapist can assess the strength and function of the pelvic floor and develop a strengthening program to improve erectile function.
Further examples can include assisting someone with multiple sclerosis who has a spastic/urgent bladder, helping someone with cauda equina who is experiencing pain and incontinence, and someone with a pelvic nerve injury who may be experiencing prolapse.
Common conditions men experience include:
- Urinary incontinence (including post-prostatectomy incontinence and nocturia)
- Fecal incontinence
- Constipation/bowel dysfunction (including irritable bowel syndrome)
- Erectile dysfunction
- Pain with sex (including pain with erection and ejaculation)
- Deep abdominal or pelvic pain
- Chronic prostatitis
- Pain with toileting
Common conditions women experience include:
- Urinary incontinence (mixed, urge, stress)
- Bladder retention/hesitation
- Fecal incontinence
- Pain with sex (including vaginismus, dyspareunia, vulvodynia, and dryness associated with menopause)
- Pain with pregnancy or post-partum (including SI joint dysfunction, pubic symphysis separation)
- Labour and delivery preparation (including strengthening and stretching the pelvic floor, discussing labour positions, and rectus diastasis closure)
- Pain with periods (Dysmenorrhea)
- Pelvic organ prolapse (including bowel, bladder, and uterine)
- Deep pelvic pain/pain associated with toileting
Constipation/bowel issues (including irritable bowel syndrome)
FOR CHILDREN AND YOUTH
Common conditions with children include:
- Bed wetting
- Retention (bowel and bladder)
- Painful periods