PELVIC HEALTH PHYSIO

The pelvic floor is like a hammock stretching from your pubic bone to your tailbone and a collection of muscles, fascia, ligaments, tendons that supports your pelvic organs.

Pelvic floor is part of our core musculature.

The pelvic floor has many functions including:

• Sphincteric control for normal bladder and bowel emptying
• Pelvic organ support
• Sexual function
• Able to relax and open to allow physiological child birth
• Counteracting downward forces generated from activities that increase abdominal pressure (ex: lifting, coughing)
• Lumbo-pelvic stability

Just like any other muscle in the body, your pelvic floor muscles can tighten, have poor endurance and/or poor coordination, scar adhesions, lack strength, cause pain or function poorly.

Pregnancy

Chronic Constipation

Vaginal delivery with forceps/Vacuum

Episiotomies/Perineal tears

C section/scar adhesions

Unhealthy bladder and bowel habits

Menopause

Breast feeding

Hypermobile joints

Chronic coughing (e.g. Cystic fibrosis, Bronchiectasis)

Pelvic surgeries

Joint malalignment/habitual postures

Strenuous physical activity

Family history

Smoking

Obesity

Leaking urine when you cough, laugh, run, sneeze or exercise

Feeling heaviness, pressure or a dragging sensation in the pelvis or vagina

Having to rush to restroom and leaking before you can get there

Waking up to use the restroom often at night

Incomplete emptying of the bladder and bowel including constipation

Decreased sensation with sexual intercourse

Pain during sexual intercourse or difficulty with penetration

Pain in the lower abdomen, vagina, pelvic girdle, tail bone

We focus on assessing the pelvic floor muscles and associated areas, identify the causative factor and help strengthen the pelvic floor muscles and transition to your daily functional activities or athletic goals later. More often than not, the instructions given by your midwife, GP, obstetrician, gynaecologist are too vague or not specific enough to treat the actual problem. Moreover, some people with pelvic pain should not do pelvic floor exercises as it might make the pain worse.

Research shows physiotherapy in the form of pelvic floor muscle retraining can improve and resolve incontinence.

Seeing your pelvic floor physio who specializes in the pelvic area is very important to get right instructions. Exercises prescribed is individualized to the patient. A triathlete should and will have a different program compared to someone who has never really exercised.

Pregnancy, child birth via vaginal delivery or c section is physically demanding and also stressful and damages the pelvic floor, abdominal muscles and nerves. All postnatal mums recover differently. Some new mums can run quite soon and some only after one year.

Rehabilitation of a sprained ankle takes six months to recover. Childbirth is like a sporting injury to the body. Any injury, the stages of recovery and time frames must be considered to optimise full function and to avoid future problems.

If you are at risk of pelvic floor problems make sure you avoid exercises that put too much stress on it such as heavy lifting, running, jumping, deep lunges and high impact sports. Abdominal exercises such as planks, sit-ups, crunches and double leg lifts really push down on the pelvic floor.

There are many safe pelvic floor exercises which put less stress and downward pressure on the pelvic floor like low impact cardiovascular exercises such as walking, swimming, cycling, postnatal exercises, pilates and yoga. Sometimes you might have to modify the exercise, position, weights, intensity and frequency according to your progress.

If you are at risk of pelvic floor dysfunction don’t put up with it, seek help and advice from your pelvic floor physio. In addition, we can advise on safe exercises which will return you to your sports and discuss treatment options, if required. Address all the factors contributing to the patient’s dysfunction. Educate and provide home program for symptom management.

Pelvic floor muscle training

Education about healthy bladder and bowel function

Urge management strategies

Bladder training

Toileting techniques

Bracing techniques

Biofeedback training for pelvic floor

Realtime ultrasounds for pelvic floor training

Assessment and treatment of painful scar tissue, mastitis/blocked milk ducts and painful intercourse.

Pelvic floor exercises can also be very beneficial for treating current problems as well as prevention of future issues. When pelvic muscles are strong, we have more control over our bladder and bowel movements. Before you start doing your pelvic floor exercises, it is important that you are aware of their location. Research shows that many women have difficulty in identifying these muscles and in fact some women do them incorrectly which worsens the problem. A pelvic floor physio can help you identify these muscles and make sure you are performing the exercises correctly.

Yes, research has shown pelvic floor physiotherapy can be very effective in treating stress incontinence in up to 80% of cases. So, there is no need to suffer in silence.