The pelvic floor muscles are an integral group of muscles that assist with bladder, bowel, and sexual function. They also play an important role in core stability, which allows the low back to function without difficulty.
When these muscles have too much tension they can cause pelvic pain or urgency and frequency of the bladder and bowels. When they have too little tension they can contribute to stress incontinence and organ prolapse. You can also have a combination of muscles that are too tense and too relaxed or even muscles that are just not coordinating properly to provide proper function.
Pelvic physiotherapists have specific training in the assessment and treatment of various pelvic conditions in both males and females including:
- Urinary incontinence (stress or urge)
- Pain during or after intercourse, pain with orgasm or stimulation, ejaculation problems
- Prolapse of pelvic organs (bladder, rectum, or uterus)
- Urinary urgency or frequency
- Bowel dysfunction - constipation, straining, pain, or fecal or flatus incontinence
- Pain in the low back, tailbone, genitals or rectum
- Painful menstruation
- Pelvic conditions such as endometriosis, prostatitis, and interstitial cystitis
- Pregnancy and postpartum issues including pain, leakage, pelvic pressure, diastasis rectus, scarring from tearing, episiotomy or c-sections
"Although many of these symptoms are common - more common than you might think - they are not normal!
These symptoms are a sign of pelvic floor dysfunction. It is not normal to leak when you cough/sneeze/exercise, to have pelvic pain or pressure, nor to have any pain with intercourse. Furthermore, Kegels are not always indicated for pelvic floor problems. In fact, sometimes they do more harm than good.
Pelvic Health Physiotherapy/Pelvic Floor Physiotherapy Assessments
Assessment and treatment of the pelvic floor are done through both external and internal exams. When the pelvic floor muscles are assessed this way, research has shown that the treatments done by a pelvic physiotherapist are very successful.
It is an exciting time in the world of research in this growing field of physiotherapy. There is Level 1 evidence (the strongest level of evidence in research) to support the practice of pelvic floor strengthening for urinary incontinence. The Cochrane Collaboration 2010 concluded that pelvic physiotherapists (using internal examination to teach the exercises) should be the first line of defence before surgical consultation for stress, urge and mixed incontinence in women.
Prenatal and postpartum care is another important role of pelvic therapy. In Europe, every woman is assessed and treated if necessary by a pelvic floor physiotherapist after giving birth. This is to prevent the weakness that can lead to incontinence or prolapse, or the tightness which can result from pregnancy or from a tear or episiotomy. These dysfunctions can contribute to pain and limitations in function.