What is Pelvic Health Physiotherapy?
The pelvic floor muscles are a group of muscles located inside the pelvis of both men and women. The muscles are attached to the front, back and sides of the pelvis, acting as a sling which support the bladder, uterus, rectum, and prostate, and wrap around the urethra, anus and vagina.
They work silently, below the level of our awareness, to assist with bowel, bladder and sexual function, as well as contribute to our core strength, ensuring low back and pelvic stability and function. The muscles must be able to contract, in order to maintain continence, and relax in order to allow for urination and bowel movements, and sexual intercourse (in women).
Pelvic floor muscle dysfunction is assessed by a specialized physiotherapist who performs an internal exam to assess the level of tone (high tone or low tone) of the pelvic floor muscles, and the ability of these muscles to contract and relax. The joints, muscles, bones and connective tissue of the external lumbo- pelvis (hips, low back and sacro-iliac joints) will also be assessed as the dysfunction in any of these areas can result in, or be the result of, pelvic floor muscle dysfunction.
Hypertonic Pelvic Floor Muscles (PFMs)
When the muscles of the pelvic floor have too much tension (hypertonic) they can contribute to pelvic pain, urgency or frequency of the bowels and bladder, stress and urge incontinence, dyspareunia, interstitial cystitis, vaginismus and vulvodynia. Muscles that are high in tone can also be weak. Muscle over-activity must be treated prior to weakness; once the muscles can fully relax at rest, the strength of the muscles is reassessed and strength training exercises and treatment will follow accordingly.
Hypertonic PFMs can cause the following symptoms:
– Urinary urgency, frequency, stress and/or urge incontinence, hesitancy, painful urination, incomplete emptying
– Constipation, straining and pain during and after bowel movements
– Unexplained or unresolved pain in the low back, hips, pelvis and genital area or rectum
– Pain during or after sexual intercourse, orgasm or stimulation
Hypotonic Pelvic Floor Muscles
When the muscles are have low-tone (hypotonic) they can cause stress incontinence and pelvic organ prolapse. Low tone muscles pelvic floor muscles need to be strengthened via a structured program aimed at increasing strength, endurance and control of specific muscles. Many people have difficulty isolating these muscles without at least one consultation with a pelvic health physiotherapist.
Other Conditions Treated by Pelvic Health Physiotherapy:
In addition to incontinence, urgency and frequency of the bowels and/or bladder, pelvic pain, and organ prolapse, additional conditions can be treated with pelvic health physiotherapy:
– Constipation
– Sacro-iliac dysfunction
– Pudendal nerve irritation
– Interstitial cystitis
– Chronic prostatitis
– Dyspareunia
– Vaginismus and vulvodynia
– Dysfunction in sexual function and pleasure