Pelvic Floor Physiotherapy

At Archway Health and Sports Services we have a number of special interests, including physiotherapy management of pelvic health disorders. This area of physiotherapy involves the management of conditions related to pelvic floor muscle dysfunction. These muscles lie at the base of your pelvis, between the pubic bone and tailbone and are responsible for bowel and bladder control, as well as sexual function.  Pelvic floor dysfunction can contribute to incontinence, difficulties emptying the bladder and bowel, pelvic organ prolapse, chronic pelvic pain, sexual pain, and pregnancy related pain.

Symptoms that may related to pelvic floor muscle dysfunction include:

• Leaking urine when you cough, laugh, sneeze or exercise
• Leaking urine due to inability to hold urine during strong urges
• Urinating more than 8 times per day
• Difficulty initiating urination
• Feeling that you have not emptied your bladder fully after urinating
• Feeling pressure or heaviness in the pelvic region
• Straining to have a bowel movement
• Experiencing pain during or after a bowel movement
• Pain with sexual intercourse or difficulty with penetration
• Pelvic pain (vaginal, clitoral, rectal, or perineal)
• Pelvic girdle, buttock or coccyx (tail bone) pain

A physiotherapist trained to evaluate the pelvic floor can provide assessment and treatment of the following conditions:

Stress or Urge Incontinence

Pelvic Organ Prolapse

Over Active Bladder

Pregnancy Related Pain (Pre and Post Partum)

Interstitial Cystitis

Dyspareunia

Vaginismus

Vulvodynia/Vestibulodynia

Pudendal Neuralgia or Entrapment

Coccygodynia

Physiotherapy can help!

Physiotherapy is internationally recognized as the first choice of treatment for incontinence and prolapse. Your therapist will use evidence-based techniques that are more cost-effective and less invasive than other options such as surgery. Research shows that physiotherapy is highly effective at improving and resolving these conditions.

In 2010, the Cochrane Collaboration published a review that analyzed the effectiveness of pelvic floor strengthening in stress and urge incontinence.  Based on the findings, it was recommended that pelvic floor strengthening be taught by a physiotherapist using internal assessment and treatment techniques and pelvic floor physiotherapy should be the first line of defense for urge and stress incontinence (before surgery is considered).

Unfortunately, when women initially talk to their doctor about urinary incontinence, they are often simply told to “do Kegels.” The problem with this prescription is that research shows that without instruction on how to perform pelvic floor muscle strengthening by a professional using internal techniques, many women will perform the exercise incorrectly, some in a manner that could actually promote incontinence. Furthermore, Kegels are not appropriate for everyone and may cause increased pelvic pain when prescribed to the wrong person.

Assesssment and Treatment

At your first appointment a physiotherapist will sit down with you to obtain your medical history. Following the history, the physiotherapist will perform an external and internal musculoskeletal examination. The internal assessment is done by the therapist gently inserting one finger into the vagina or anus and palpating each muscle group.

• Your initial assessment may include:
• Postural assessment
• Joint mobility and strength testing
• Skin inspection
• Neurodynamic testing
• Evaluation of connective tissue and musculature of the pelvic girdle
• Internal examination of the pelvic floor to assess muscle tone, connective tissue mobility, motor control and strength

After the assessment has been completed, the physiotherapist will discuss the assessment and treatment plan with you. You are always welcome to bring another person with you to any and all physiotherapy appointments and have that person present during assessment/treatment.

• Treatment sessions involve internal and external manual therapy and may include some or all of the following:
• Connective tissue mobilization
• Pelvic muscle exercises with manual cueing
• Neural mobilization
• Myofascial release
• Myofascial trigger point release
• Neuromuscular re-education
• Sacro-iliac joint/hip/lumbar spine mobilization
• Home exercise program development
• Pelvic floor muscle stretching
• Relaxation techniques
• Patient education

Communication is very important to us! We believe in a multi-disciplinary collaborative approach to evaluate and address all components of pelvic health so that you receive the best treatment possible. Prior to your first appointment and throughout the treatment process, please feel free to contact us to ask questions or discuss concerns.