A pelvic floor physiotherapist is someone who has taken post-graduate courses in order to specialize in the skills required for assessing and treating the pelvic floor. This individual is rostered with the College of Physiotherapists of Ontario in the controlled act of internal pelvic exams.
The pelvic floor refers to a group of small muscles with very important functions in everyday life. The pelvic floor muscles form a bowl at the bottom of the pelvis to support our organs, provide continence and sexual function and contribute to stability of the abdominal and pelvic cavities.
A pelvic physiotherapy assessment combines internal and external assessment of the pelvic floor and surrounding areas with respect to individual symptoms and functional limitations.
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
Statistics
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
Frequently asked questions:
What do I expect at my first pelvic physiotherapy appointment?
Your pelvic health physiotherapist will first begin by taking a detailed history of your symptoms, functional limitations and goals for treatment. This may include questions about bladder and bowel function, sexual function, menstrual cycle, low back, hip and tailbone symptoms. You may also be asked to fill out some questionnaires to provide a more global picture of your overall health and pelvic floor dysfunction.
This information will guide the physical assessment which may include examining posture, pressure management or breathing patterns, in addition to examining the low back, hips, pelvic, abdomen and pelvic floor muscles.
An internal pelvic exam involves inserting a finger or instrument beyond the labia majora and/or beyond the anal verge to assess pelvic floor muscle tone, control and coordination.
Is an internal examination required?
An internal exam will likely be recommended as it provides valuable information on pelvic floor muscle activation, coordination, tender points and muscle tone, however it is NOT required. As a patient, you have the right to refuse anything that you are not comfortable with. Many parts of the physical assessment can be done externally.
What should I wear to a pelvic floor physiotherapy appointment?
Be sure to wear comfortable clothes that you are able to move freely in without restricting movement. If you consent to an internal exam, you will be asked to undress from the waist down and will be given a drape sheet.
Can I come to my appointment if I’m on my period?
Yes! Your period does not affect the assessment or treatment, so as long as you are comfortable you can attend your scheduled visit. If some of your symptoms are worse during your period then it may provide useful information.
If you do not feel comfortable with any internal exam or treatment while on your period, many other assessment or treatment techniques can still be done externally.
If you or someone you know would benefit from a consultation or assessment, contact Megan at Westmount Physiotherapy and Rehabilitation today!
