What are pelvic floor muscles?

The pelvic floor muscles are a group of muscles that wraps around the underneath of bladder and rectum. These muscles attach to the front, back and sides of the pelvic bones and sacrum

They are like a hammock or a sling, supporting the bladder, uterus, prostate and rectum. They play an integral part to maintain body’s well being.

Sometimes these muscles can become too tight which will often cause pelvic pain or urgency and frequency of the bladder and bowels or too weak contributing to stress incontinence and organ prolapse. This increased or decreased tension in the muscles ultimately leads to pelvic floor dysfunction.

How pelvic physiotherapy can help?

Pelvic physiotherapists have specialized training to diagnose, assess and treat pelvic conditions in both males and females which includes the following:

· Urinary Incontinence (stress/urge)

· Urinary frequency, urgency, hesitancy, stopping and starting of the urine stream, painful urination, or incomplete emptying.

· Post -prostatectomy incontinence

· Constipation, straining, painful bowel movements, fecal incontinence

· Chronic pelvic pain (dysmenorrhea, endometriosis, prostatitis, testicular and penile pain, interstitial cystitis, uterine fibroids, endometrial polyps)

· Vaginismus and vulvodynia.

· Pelvic organ prolapse (uterus, bladder, rectum)

· Pain during or after intercourse, orgasm, sexual stimulation.

· Unexplained pain in your low back, pelvic region, hips, genital area, or rectum

· Pre/post pregnancy issues (pelvic pressure, leakage, diastasis rectus, episiotomy, C- section)

· Pelvic floor dysfunction in pregnancy and coccydynia, pregnancy related pelvic girdle pain.

What does the typical session entail?

The physiotherapist will take a detailed subjective history of symptoms related to the pelvic floor dysfunction. She will ask you to fill out further questionnaires if needed, which will give a better idea of what is contributing to the specific symptoms. After gathering all the relevant medical information, she will begin a physical assessment which will vary depending on your symptoms and may or may not be completed on the first visit.

The physical assessment involves internal exam assessing the pelvic floor muscles, tone and strength, looking for trigger points in the pelvic floor muscles, and other objective findings.

Once the examination is complete, the pelvic therapist will explain the findings, educate about the pelvic floor muscles, describe the proposed treatment plan and will give time to ask questions.

How often do I need treatment?

Follow up sessions will include the manual (hands on) techniques on the surface of the muscles in the pelvis, use of modalities to strengthen/retrain pelvic floor muscles, exercises or other homework specific to your problem, explain how often to return for treatment. 

The number of treatment sessions will vary for every individual. Some conditions may improve significantly, others that are more chronic may take a longer recovery time. The physiotherapist will communicate the prognosis and expected timelines with you.

The Cochrane Collaboration 2010 concluded that physiotherapists with specialized training in pelvic floor rehabilitation (using internal examination to teach the exercises) should be the first line of defense, before surgical consultation is considered for stress, urge and mixed incontinence in women