What is a Pelvic Floor Physiotherapy?

Physiotherapists trained in Pelvic Floor Physiotherapy are focused on assessing male and female pelvic conditions in order to treat pelvic floor muscle dysfunctions.  We assess the nervous system, connective tissues, the strength and length of the pelvic floor muscles, severity of the incontinence, prolapsed grade, and muscle tone. We use evidence-based and biopsychosocial resources to develop goals and individualize treatment recommendations.   

• Urinary incontinence, urgency/frequency issues
• Pregnancy and postpartum pelvic issues
• Organ Prolapse
• Pregnancy and postpartum recovery
• Painful sex
• Genital pain (penis, vaginal, clitoris ect)
• Painful Bladder Syndrome/ Interstitial Cystitis
• Chronic Nonbacterial Prostatitis
• Sciatica
• Irritable bowel syndrome
• Chronic constipation
• Chronic Pelvic Pain Syndrome (CPP

After a tissue is injured by some kind of physical trauma (i.e. sport injury, labour and delivery, surgery or repetitive movements from work) it should be fully healed between 4-12 weeks. Physiotherapists are exceptionally well trained to promote and support patient through this phase. But here's the truth, if your pain appeared one morning, or is persisting past this healing phase, our profession isn't well equipped to understand and help you. Physiotherapist that are trained in persistent pain understand that your pain isn't a tissue problem, it's so much more complex. We need stop giving you advice and start listening to your story. Understanding how this pain is impacting your life is the first step. Only then, can I start brainstorming with you an individual treatment plan that you can adhere to and succeed at achieving your goals.  

There are significant gaps and misconceptions in the health care community and fitness community that leaves many women without tools to take care of their pelvic health. You can no longer google search and find reliable information on pelvic floor, Kegels, diastasis recti and pelvic pain. It’s mainly outdated information from 20 years ago. Recent research on pelvic floor and diastisis recti management is pretty new, we're talking about 2016-2018. I take great pride in communicating and sharing updated knowledge with fitness instructors, midwives, family health teams specialized doctors and doulas so I can be part of the solution in the Niagara Region. If you're wondering if pelvic floor physiotherapy is right for you, here is 5 reasons that might convince you of the benefit. 

1) Prevention

Just like you take your acid folic before being pregnant to prevent spina bifida, you should have a pelvic health assessment to prepare your core for pregnancy. It’s a lot easier to carry the extra weight of a baby with an optimum posture and pelvic floor muscles that are strong and flexible. 

2) Understanding the pressure system

The 4 core muscles (pelvic floor muscles, diaphragm, multifidis and transverse abdominus) coordinate together to create stability of the spine through movement. Once you understand how they coordinate, a pelvic health professional can teach you how to apply that knowledge to safely lift, carry and exercise during pregnancy. There’s a lot of fear surrounding exercises and pregnancy on the internet, and I can reassure you that the female body is very strong. These are great tools for everyone, especially during and after pregnancy.  

3) Preparation for labour

Labour is one of the most gratifying challenges a women will face during her life. I like to compare it to an iron man challenge. Most women will have a 10-12 hours labour, where your core and uterus will be contracting intermittently, and you will be exhausted. Therefore, you have to be mentally and physically prepared to be satisfied of your birth experience. Pelvic health physiotherapist have amazing tools to teach you how to core breath and how to relax your pelvic floor muscles. More relax those muscles are, more space you will create for the baby to descend through your pelvis. Having knowledge about posture and core breath will optimize your pushing during labour. We're also trained in pain science, and understanding how to manage the intensity of the uterus contraction. I will probably dedicate an entire blog on this subject since it's just an amazing leap in science for women and labour. 

4) Correcting existing problems

3 signs that can predict a dysfunction with your pelvic floor muscles are pain with intercourse, if you leak when you laugh, cough, sneeze and exercise or go to the washroom more then 11 times per day. If you have any of these problems before or after your pregnancy, you should seek help from a physiotherapist that can assess your pelvic floor muscles. Kegels are only performed correctly 30% of the time, and the Society of Obstetricians and Gynecologists of Canada recommends that they’re confirm by internal palpation. Also, prescribing Kegel exercises without a proper assessment can make the symptoms worst.   

5) Correcting the mummy tummy

The mummy tummy refers to the pouch that’s present after pregnancy. Those women are exercising and eating well, and still have that last 5 lbs they think they need to lose. This pouch is caused by a fault in the abdominal pressure system since these women usually have a condition called diastasis recti. Physiotherapist can teach you how create tension in the abdominal wall to decrease or abolish that pouch. 

 1. Understanding the pain system.

When you have pain, you're driven to find out "why". Many will search for the diagnosis that will explain their pain. The idea is, once you have the correct diagnosis, you'll receive the correct treatment. Unfortunately, a diagnosis for persistent/chronic pain, isn't a one Latin word you can google and find the list of treatments. It's a diagnosis that's complex and needs to include the biology, emotional and social impact on your life. We call this the biopsychosocial approach. This mean we need to assess the biological impact : rule out any medical issues (heart issues, reproductive issues, digestive issues, infections, ect...), and then assess the muscles, joints, ligaments, tendons, and nerves. We need to assess the psychological impact : we need to listen and start understanding your emotions and stresses in your life before and after the pain. We need to assess the social impact : to know and build your circle of support, and understand the quality of your social interactions at work, and with your family and friends. It takes a multidisciplinary team of specialists, social workers, physiotherapists, massage therapists, dietitians and more to finally understand your persistent/chronic pain. 

2. Manual therapy and soft tissue techniques

These are techniques that are applied by health professionals in the rehab field. We used them for years because they've been showed to decreasing pain. We apply pressure to a joint or a muscle to optimize the movement of the tissue. They're efficient at increasing mobility and circulation to your the stiff muscles and joints. This promotes pain-free movements. More pain free movements you have, more confidence and motivation you'll have to start exercising consistently at home.

3. Specific Exercises

Manual therapy is a passive treatment, and it's hard for the patient to recreate these techniques at home. We need to follow this type of therapy with a home exercise program that will help you keep or increase these newly acquired free, comfortable movements. Your typical home exercise program will start with stretching and coordination exercises. Only after the muscles has gained their optimal length can we start strengthening. I hardly ever start on core strengthening exercises. They're usually one of the last step to lower back recovery.

4. Aerobic exercises

Research on aerobic exercises has shown to be one of the most important modality to improve our general health. Not one of my patient needs to be told, "you should exercise more, you'll feel better". The vast majority knows this fact. If you're not exercising daily, it means someone didn't listen to you, and understood why you can't achieve this goal. For you to be able to get out there, and exercise 15-20min a day, you need to consult with someone that will listen and understand the multiple barriers that are preventing you from achieving this goal. 

5. Food

Everyone has a different opinion of what a balance diet looks like. There's a lot of interesting research on diets and how different foods can affect sensitive organs. Their are pros and cons for many of them. If you think that your diet isn't optimal and changes to your daily food consumption could improve your health and ultimately your pain, consider consulting a health professional that has specific training on nutrition and diets.

6. Breathing and Relaxation

Taking the time to breath slowly and softly, will provoke beneficial biological and emotional changes to your body. Taping into your umbrella breath, will decrease tension in your core muscles. It's also a great way to activate your parasympathetic system. That part of your nervous system that increases innervation to your digestive, bladder, and reproductive system, and decreases the burden on the respiratory, cardiac and musculoskeletal system. It can also positively affect your emotions and calm down your mind and thoughts. 

7. Sleep

Taking the time to assess the quality of your sleep is essential to calm down your pain and emotional burden. This is fundamental to achieve your goals. Their's multiple strategies that can help you gain back your nights, and increase those very important restorative, deep sleep that your body is craving. You have to address it by assessing the environment where you sleep, the timing of your circadian cycle, stimulation to your nervous system, nap schedule and daily exercise routine. 

8. Stress management

Stress is a normal human experience, and it's healthy when it's there for a set period of time. However, most of us suffer from chronic stress, where we can never shut down our mind. We carry a lot of burden and we do it alone. Having chronic/persistent pain consumes time and energy, and your glass empties a lot faster. You're allowed to start making time for yourself. Connect with things you love, with people you love and with hobbies you love.  

9. Pacing

Pacing is so important with managing flare ups during your journey to recovery. Once you understand that persistent/chronic pain is a heavy burden to carry, you understand that you have a limited amount of energy during your day. Doing everything at once, isn't an option anymore. Slow and steady will win the race, once step at a time. No more doing all the dishes at once, no more folding all the laundry in one sitting, cutting vegetables can be done throughout the day, you can vacuum one room a day. You plan your life and your chores during a full week, not in 24 hours. It's one of the hardest goal to achieve for many people with chronic/persistent pain. 

This can be a lot to digest, and can be seen as a big mountain to climb. Climb this mountain one step at a time. You can even take breaks. Set small achievable goal at the beginning. Seeking help from family, friends and professionals to carry this burden can be life changing.  I really hope this little blog will shed light to you or someone you love suffering from persistent pain.