What is a pelvic floor physio?
- A pelvic floor physiotherapist is someone who has taken post-graduate courses in order to specialize in skills required for working with the pelvic floor. This individual is rostered in the controlled act of internal pelvic exams which may include putting any instrument or finger beyond the labia major or beyond the anal verge.
- A pelvic physiotherapy assessment is not strictly of the pelvic floor muscles themselves, but rather combines both internal and external assessment.
What conditions do we work with?
- Stress, urge, and mixed urinary incontinence
- Stress — loss of urine secondary to an increase in intraabdominal pressure i.e., laughing, sneezing, jumping, running, lifting
- Urge — urine loss associated with a strong, uncontrollable need to void i.e., unable to delay voiding once the first urge to urinate is felt
- Mixed — a combination of stress and urge incontinence
- Overactive bladder — a sensation of urge without incontinence; likely voiding beyond the normal amount per day
- Fecal incontinence — inability to control, or weakness of, anal sphincters
- Constipation — bowel movements that are infrequent, hard to pass, or painful
- Pelvic organ prolapse (rectum, bladder, uterus/vault) — subjective disorder described as an annoying protrusion at or near the vaginal opening which may or may not be accompanied by feelings of pain or pressure; often aggravated by gravity or increases in intraabdominal pressure
- Diastasis rectus abdominus — impaired integrity of the linea alba connecting the two abdominal muscles, creating the appearance of separation at the midline of the abdomen
- Pre and post-natal populations
- Persistent pelvic pain
- Sacroiliac joint dysfunction
- Persistent low back pain
- Pre and post radical prostatectomy — With prostate removal, the internal urethral sphincter is removed as well, which contributes to major issues with urinary incontinence for men. Research demonstrates that pelvic floor muscle training with rectal palpation both before and after surgery, leads to the best outcomes and prevention/resolution of symptoms.
- Interstitial cystitis — feeling of pain or pressure in the bladder area with lower urinary tract symptoms not related to infection
- Chronic prostatitis — chronic prostate pain and swelling, not related to infection
- Vaginismus — a condition involving muscle spasm in the pelvic floor muscles that can make it difficult or impossible to have intercourse (dyspareunia), undergo a gynaecological exam, or insert a tampon
- Vulvodynia — chronic (> 3 months) pain or discomfort around the opening of the vagina with no identifiable cause
- 3 million Canadians have symptoms of urinary incontinence
- 1 in 3 women, and 1 in 9 men experience symptoms of urinary incontinence with this number increasing with age
- 1 in 2 women who have had children experience pelvic organ prolapse with this number increasing with age
- 78% of patients with low back pain also have symptoms of urinary incontinence
What does the research say?
- Pelvic floor physiotherapy should be the first line treatment for urinary incontinence and pelvic organ prolapse before considering any other medical intervention
- Pelvic floor physiotherapy should be instituted pre and post radical prostatectomy to prevent and remediate symptoms of urinary incontinence
- Core stability training with a physiotherapist is recommended to prevent and treat low back and pelvic pain during and following pregnancy
- Pelvic floor muscle training with a physiotherapist is recommend to prevent urinary incontinence during pregnancy and after delivery
- In a 2018 study examining the prevalence and type of pelvic floor dysfunction among women with lumbopelvic pain, 96% of participants were determined to have pelvic floor dysfunction and 84% of these participants had an overactive pelvic floor