Pelvic Floor Physiotherapy:

Treatment Options for Women with Urinary Incontenience or Pelvic Pain

Most of us are aware of physiotherapy care for injuries such as an ankle sprain or bad back; but did you know there is specific physiotherapy treatment for Pelvic Floor problems called Pelvic Floor Physiotherapy or Rehabilitation (PFR)?

WHAT is PELVIC FLOOR REHABILITATION/PHYSIOTHERAPY (PFR)?

Pelvic floor rehabilitation (PFR) is rehabilitation of the 'waterworks and inner systems.' It involves treatment of the pelvic region (the area below your belly button and above your legs), including the pelvic floor muscles (PFM). A physiotherapist who had undergone extra education to assess and treat the pelvic floor applies various techniques including: biofeedback, electrical stimulation, manual therapy and retraining techniques to 'awaken and facilitate' normal strength and control of these hidden but important muscles. Other areas that can also be treated are the pelvis and surrounding ligaments, joints and myofascia. Core stability principles are also an integral component of care because the abdominal groups (including the diaphragm, obliques and rectus abdominus) are closely linked to the PFM.

WHAT are the PELVIC FLOOR MUSCLES (PFM)?

The pelvic floor muscles are muscles that form a 'sling' or 'funnel' shape at the base of your pelvis. Their main function is to keep all your pelvic organs and contents 'in the right place' (visualize the bottom of a purse or sack), and because they are so closely associated with the bladder and rectum, they also keep 'check' on your urinary and bowel systems. 'Kegel' exercises are tailored to recruit and retrain these PFM. They play a very important role before, during and after your birth.

As your body goes through a multitude of changes with pregnancy, so do the PFM. The hormonal changes, growing baby, and weight gain all change the strength and flexibility of the PFM. You may have noticed signs of these changes as an inability to stop your flow of urine when you have an 'urge' to urinate, which is commonly known as the 'key in the door syndrome' (Urge Urinary Incontinence –UUI) or occasional 'accidents' when your PFM are put on stress (i.e. when you sneeze, laugh, jump or exert yourself physically (Stress Urinary Incontinence – SUI). Don't panic though, as Urinary Incontinence (UI) – which is the involuntary loss of any amount of urine or difficulty controlling your 'waterworks' - is more common than many women realize. It's estimated that 3.3 million Canadians have some form of incontinence or difficulty with bladder control, including more than 50 percent of all women over the age of 55! This condition is particularly common amongst post–partum and pregnant woman; however, it is not "normal." Fortunately PFR is an effective and lasting treatment for incontinence.

WHO could BENEFIT FROM PFR?

Individuals with:

• Pelvic floor weakness (a feeling of soft-sagginess)
• Urinary incontinence and other bladder problems (even small 'leakages' can be treated)
• Pelvic pain and difficulty/pain with sexual intercourse
• Prolapses (i.e. bladder, rectal or uterus – aren't 'held in place' and descend down (i.e. 'heavy feeling')
• Rectal problems (problems evacuating and fecal incontinence) and other bowel system disorders
• Women who have undergone pelvic or abdominal surgery, and are experiencing problems related to scar tissue (which can interfere with fertility, normal menstrual cycles and intercourse)

Why PFR?

Many women are often performing 'Kegel' (PFM exercises) incorrectly. Recent research has shown that over half of the women that receive instructions on performing 'Kegel' exercises, including patients who believe they have mastered the technique, perform these exercises ineffectively. Studies have also shown that treatment by a physiotherapist trained in pelvic floor rehabilitation is also more effective than a woman attempting to learn how to do these exercises on her own.

Like all of our muscles, the PFM have a 'muscle memory' which is very important to post-partum recovery. After having a baby your body has gone through a grueling "marathon" and your body needs time and assistance in re-establishing healthy muscle tone and coordination. Performing your 'Kegel' exercise regime before your baby arrives facilitates your healing, but often more attention in this region is required for a complete post-partum recovery.

In summary, most women who have experienced pregnancy and birth can also experience urinary incontinence, or perhaps just a change in their normal pelvic tone. Working with a pelvic floor physiotherapist can speed return to normal, as well as empower a woman by allowing her to understand her body (including the inner-workings) better.