Pelvic Floor Physiotherapy
What is a Pelvic Floor Physiotherapist?
Who should seek out pelvic floor physiotherapy?
There are several symptoms that are very common but are NOT normal and could lead you in the direction of a pelvic floor physiotherapist. These include:
- Bowel or bladder leakage or incontinence (involuntary loss of urine or stool)
- A feeling of incomplete emptying after urinating or having a bowel movement
- A feeling of heaviness in the vagina
- A sense of a bulge in the vagina, like something is “falling out”
- Strong urgency for bowel or bladder (having a hard time making it to the toilet in time!)
- High frequency of urinating (more then every couple hours) or waking at night to urinate
- Constipation or difficulty passing stool
- Genital or pelvic pain (vulva, clitoris, vagina, anus, tailbone, sacro-iliac joint, pubic bone)
- Pain with sexual intercourse at any stage of life
Some clients may be referred directly from their family doctor or their obstetrician, gynecologist or urologist but a referral is not always necessary unless your insurance requires it. Diagnoses that may be made by doctors or nurse practitioners for a referral to pelvic floor physiotherapy could be:
- Stress incontinence
- Urgency or urge incontinence
- Overactive Bladder Syndrome
- Interstitial Cystitis
- Chronic Constipation
- Pelvic pain
- Pelvic Organ Prolapse (POP), which could also be termed: rectocele, cystocele, uterine prolapse or urethrocele depending on which organ is involved
- Dyspareunia, vulvodynia, vestibulodynia or vaginismus
- Pregnancy related pelvic girdle pain
- Post-partum: Diastasis Recti, re-introduction to activity/exercise, scar management following vaginal or cesarean birth
- Coccydynia (or tailbone pain)
Pelvic floor physiotherapy can also be sought out for educational and preventative purposes. Education and coaching that can be provided could include but is not limited to:
- Learning about their own body parts and their function. For example, how the bladder should normally work or advice on optimizing bowel routine.
- How to stay mobile, active, strong and in-tune with their pelvic floor, core or whole body in general.
- Review how they are doing their Kegel and optimize it for efficient function and prevention of other issues later in life.
- Pre-natal women (or even pre-conception) for education on the normal changes of pregnancy, the recommended exercise guidelines, preparing for birth and labor and preventing aches and pains.
- Post-natal women (even if they are having or have had a C-section!) for re-introduction into activity and exercise, cesarean section or vaginal scar management, and diastasis recti assessment and recommendations.
- Women going through the changes of menopause, for example discomfort or pain with intercourse.
What to expect on the first visit:
A pelvic floor physiotherapy assessment would involve a detailed subjective examination asking various questions regarding past medical history, urinary, bowel and sexual function. An objective assessment would follow including observing posture, low back and pelvic movement, core and hip strength as well as an external and internal vaginal and/or anal-rectal examination.
The external examination involves observing the skin condition and mobility around the vulva including the clitoris and the labia, checking light touch sensation and reflexes to rule out neurological involvement, applying gentle pressures to the pelvic floor muscles, observing the client perform a Kegel as well as bear down to watch for any sign of prolapse. The internal vaginal or anal-rectal examination would involve inserting a lubricated, gloved finger into either the vagina or the anus. The decision would depend upon the subjective examination and reason for the assessment and discussed prior to beginning the examination. The physiotherapist would then assess the pelvic floor muscle tone, strength, endurance, coordination and ability to relax.
Once everything has been assessed, education will be provided on the examination findings and a treatment plan will be discussed. Treatment is dependent on the assessment but may involve pelvic floor strengthening exercises, relaxation exercises, manual therapy techniques for the muscles or joints, breathing techniques, low back and hip mobility and strengthening, behavioral modification techniques including filling out a bladder diary or optimizing bowel routine.
The initial assessment is 75 minutes long and follow up sessions are typically 45 minutes, although the physiotherapist may suggest one hour follow up sessions depending on the assessment and the treatment plan.
It is important to note that consent must be achieved before beginning the assessment and if at any point the client is feeling uncomfortable or has questions regarding part of the assessment or treatment it is vital that they share this with the physiotherapist and adjustments will be made accordingly.
