Pelvic Health Physiotherapy

What is pelvic health physiotherapy?
Pelvic health physiotherapy also called as pelvic floor physiotherapy is therapy to address the pain and function related to issues originating from or involving the pelvic area. Pelvic area is the lower part of the trunk of the human body between the abdomen and the legs. If you think of the pelvis as being the home to organs like the bladder, rectum, and uterus (or prostate in men), the pelvic floor muscles are the home’s foundation.

Pelvic floor dysfunction is diagnosed by specially trained doctors and physiotherapists by using internal and external “hands-on” or manual techniques to evaluate the function of the pelvic floor muscles. Your physiotherapist will assess your ability to contract and relax these muscles.

Dysfunction in the pelvic floor muscles can be broadly categorized in to weakness and tightness.

Weakness (Hypotonia):

 Weak pelvic floor muscles can contribute towards,

• Stress incontinence.
• Urge incontinence, and
• Pelvic organ prolapse.

Tightness (Hypertonia):

Tight pelvic floor muscles can contribute towards,

• Urinary and Fecal Urgency.
• Urge Incontinence.
• Chronic Pelvic Pain.
• Dyspareunia -Painful intercourse.
• Vaginismus -involuntary contraction of muscles around the opening of the vagina in women with no abnormalities in the genital organs.
• Vulvodynia -chronic pain or discomfort around the opening of your vagina (vulva).
• Pudendal Neuralgia – pain, discomfort, or numbness in your pelvis or genitals. and
• Interstitial Cystitis – chronic condition causing bladder pressure, bladder pain and sometimes pelvic pain.

The goal of pelvic floor physiotherapy is to improve pelvic floor function through exercises, lifestyle modifications, education, and hands-on treatment to decrease and eliminate your symptoms. This therapy involves assessing and treating the pelvic floor muscles that are involved with urinary, bowel, and sexual function.

What does it involve?
Just like any other musculoskeletal assessment, pelvic health assessment involves checking your movements and posture.

In addition to that, it may also involve approaching and assessing the pelvic muscles through an internal assessment. This may involve assessing the pelvic floor through the vaginal and rectal tissues using a gloved finger or an instrument.

Just the way it’s important to palpate the hip muscles when you have a hip pain, it is important for the physiotherapist to palpate the pelvic floor for pelvic health issues in order to assess the problem.

Your physiotherapist will then formulate a treatment plan based on the assessment findings. The treatment would involve educations, exercises and hands-on manual therapy.

I just had a baby; do I need to see a pelvic health PT?
Most childbirth involves some amount of changes in the pelvic floor even if it wasn’t a vaginal delivery. The pregnancy itself loads the pelvic floor and may cause some weakness. In some instances, the pressure of “getting back to shape”, may lead to improper selection and ambitious progression of exercises often times resulting in injury and associated dysfunction.

But I do my Kegels!
Kegels exercises are just a small part of pelvic health physiotherapy, there are circumstances where it may not be appropriate or adequate for you. Just like how a stationary bike is not an answer for all knee problems.

Do I need a doctor’s referral?
Physiotherapists are primary health care practitioners and do not require a doctor’s referral. However, if you have coverage for physiotherapy through an extended health benefit plan, the insurance company may require a doctor’s referral.

Having said that, if you would like we can keep your doctor informed on the issues related to your pelvic health and our treatment plans to address it.  

What are a few conditions that may benefit from Pelvic Health Physiotherapy?

• Urine leakage with coughing, sneezing, running, jumping or laughing.
• Urine leakage when you have an urgency to pee.
• Painful intercourse.
• Pelvic organ prolapses.
• Low back, hip and tailbone pain
• Voiding more than 8-10 times per day (when not related to any other medical condition)
• Prenatal and Postnatal mothers.
• Surgery that involves the lower abdomen.

are some of the conditions that are often referred to a pelvic health physiotherapist.

What to expect in your physiotherapy appointment for pelvic health?

1.Interview:
Your physiotherapist will do a detailed interview regarding your condition to understand the underlying symptoms and how it is affecting you. Your physio will explore the mechanisms of injury, surgery or other reasons that may have a role to play in your current problem.  She may ask other questions related to pelvic health as well such as your bowel and bladder routine and also your sexual health.

2. Physical assessment:
i). External:
The external assessment will involve checking you posture, range of motion, strength. This is similar to an assessment that you may have had in the past for any other condition in a physiotherapy clinic. Your physiotherapist will also assess the bones and muscles of your lower back, hips and sacro-iliac joints will need to be assessed as well since these joints can stress your pelvic floor muscles.

ii) Internal assessment:
Internal assessment is an important and unique part of pelvic health assessment. It involves your physiotherapist observing and palpating your external genetalia, palpating and assessing your internal vaginal and anal muscles by inserting a gloved and well lubricated finger in your vagina and/or anus. Your physio may then ask you to do deep breathing, pushing down or other maneuvers to see how your pelvic floor responses to these movements.  The physio will also do palpation to assess the restrictions in soft tissues.

3.Treatment:

Education:
Your physiotherapist will discuss with you to explain the underlying problem and how it is affecting you, the treatment methods that she would use and how it will help you in your recovery in order to get better and accomplish your goals.

Exercises:
There are specific pelvic floor related exercises that your physiotherapist will teach you. She will also  provide you with detailed home exercises program for you to follow. The exercises will be modulated and progressed based on how you respond.

Manual Therapy:
Manual therapy may involve mobilization of the tight/restricted soft tissues internally or externally. Your physiotherapist will explain the rationale and the process involved and get your consent before proceeding with any manual therapy treatments.

Based on the underlying problems, it may also involve other physiotherapeutic tools like electrotherapy, acupuncture, Kinesiotaping as well.

Please do not hesitate to ask any questions that you may have anytime before, during or after your appointment.

Frequently Asked Questions

Why do you need an internal assessment?
Your pelvic floor is a group of muscles supporting your pelvic organs. To assess their structure and function, internal assessment is the most efficient and clinically available method.

Why do I need to address my frequency and urgency issues when pain is my main complaint?
Low back/hip /pelvic pain is very closely related with urinary urgency and frequency.  Addressing pain without addressing urgency and frequency will be inadequate.

Is Kegels’ exercises enough:
Kegels’ exercises are one of the many treatment options for pelvic floor dysfunctions. It may not be adequate and in several instances, it may not be suitable either.

How many sessions will I need? 
It depends on the nature, extent and severity of your pelvic health issues. If addressed early, you may require only few sessions.

What preparations do I have to do before visiting the clinic – do I need to shave my external genitalia?
Other than regular hygiene (plain water wash), you do not need to do anything out of what you generally do. If hair removal is what you do routinely, you may. Its not a requirement.

What will the treatment involve?
Treatment commences after assessment and it would involve, education, exercises and hands-on manual therapy. It may also involve other physiotherapeutic tools like electrotherapy, acupuncture, Kinesiotaping as well.