What is Pelvic Floor Physiotherapy and Why is it Important?
Awareness is spreading around pelvic floor health and the volume of individuals seeking Pelvic Floor Physiotherapy is growing year over year, but what is this niche service and why is it so important?
Pelvic Floor Physiotherapy (PFPT) is a specialized area of Physiotherapy that focuses on issues involving the muscles, ligaments, and connective tissues in the pelvic region. Pelvic Health takes a holistic approach, meaning that the assessment and treatment does not only focus on the pelvic area but involves the whole body as a system that works together.
Pelvic Floor Physiotherapists are Registered Physiotherapists (PTs), many with postgraduate Masters or Doctoral degrees in Physical Therapy, who go on to advance their skills through additional education in Pelvic Health.
Majority of the conditions that are treated through Pelvic Floor Physiotherapy involve the pelvic floor muscles.
The pelvic floor is a group of muscles that form a hammock-like structure at the base of the pelvis. Functions include supporting the pelvic organs (bladder, uterus, and rectum), controlling bowel and bladder continence, core stabilization, sexual health, and pumping lymphatic fluid through the pelvic region (in fact, it is the second biggest lymphatic fluid pump in the body). The pelvic floor muscles play a role in childbirth, as they are situated around the vaginal canal where the baby must pass through. Given the direct involvement of these muscles during the birthing process, care during and after pregnancy is especially important for maintaining the vital functions mentioned above.
What types of conditions do Pelvic Floor Physiotherapists treat?
When the pelvic floor muscles aren’t functioning properly, issues can arise such as:
Pelvic pain: Discomfort or pain in the pelvic region, which may be constant or intermittent.
Urinary problems: Urinary incontinence (involuntary leakage of urine), difficulty emptying the bladder, and/or a frequent urge to urinate including waking up in the night to pee.
Bowel issues: Constipation, straining during bowel movements, fecal incontinence, and/or difficulty controlling gas.
Sexual dysfunction: Pain during intercourse or other sexual activities, involuntary contraction of the pelvic floor muscles that prevents penetration, lack of or decreased sensation during sex, urinary incontinence during sex, and/or frequent post-coital UTIs.
Muscle spasms: Involuntary contractions or spasms of the pelvic floor muscles.
Factors known to contribute to pelvic floor dysfunction include:
Pregnancy and childbirth: The pelvic floor muscles can be stretched or weakened during pregnancy and delivery.
Chronic constipation or straining during bowel movements: This can lead to increased pressure on the pelvic floor.
Obesity: Excess weight can strain the pelvic floor muscles.
Surgery: Certain surgical procedures, especially those in the pelvic area, may impact the function of the pelvic floor.
Trauma or injury to the pelvic area: Accidents or injuries can affect the pelvic floor muscles and surrounding structures.
Where do Pelvic Floor Physiotherapists see patients?
Pelvic Floor PTs work in both inpatient and outpatient settings, meaning they can work in hospitals, rehab facilities, as well as private clinics.
What happens during a Pelvic Floor Physiotherapy appointment?
During a typical PFPT session, the Physiotherapist will perform a thorough assessment of the pelvic floor muscles and surrounding structures. This may involve internal and external examinations to evaluate muscle tone, strength, flexibility, and coordination. The PT will also assess other areas of the body relevant to the presenting issue (eg. hips, low back, core, neck). Based on the assessment, the PT will develop a treatment plan. Follow up usually involves 6-8 sessions, but can extend to a year or more depending on the issue being treated.
How is pelvic floor dysfunction treated?
Pelvic floor dysfunction is often treated using a holistic, whole-body approach, including:
Individualized exercise prescription and training to target involved areas of the body.
Education and Lifestyle Modification: Guidance on managing stress, water intake, posture, breathing, lifting techniques, microbiome and nutritional support, and more to support pelvic health.
Manual Therapy: Hands-on techniques to release tension and improve mobility in the pelvic floor and other areas of the body.
Biofeedback: Using technology to provide visual or auditory feedback to help individuals learn to control and coordinate their pelvic floor muscles.
Behavioral Strategies: Techniques to address habits or behaviors that may contribute to pelvic floor dysfunction, such as voiding habits.
Is Pelvic Floor Physiotherapy only for women?
This is a great misconception! Men can greatly benefit from Pelvic Floor Physiotherapy for conditions such as pelvic pain, bladder pain syndrome (interstitial cystitis), overactive bladder syndrome, nocturia, erectile dysfunction, non-bacterial chronic prostatitis, and post-prostatectomy issues among others. It is important for men to vocalize their symptoms to their healthcare provider and seek the necessary treatment (eg. referral to a Urologist and Pelvic Floor PT) in order to address these conditions that can worsen with time.
Is Pelvic Floor Physiotherapy covered by insurance?
Most insurance companies offer coverage for PFPT, as it a carefully regulated health care profession under the medical sciences. Pelvic Floor Physiotherapy is conservative and non-invasive. It can be a primary form of care, meaning you do not need a prescription from your doctor to see a PT (unless your insurance company requires it). PFPT can complement medical treatments as an essential component of a holistic approach to pelvic health. Individuals experiencing pelvic floor issues who are unsure about treatment options should consult with their healthcare provider to determine if PFPT is appropriate for them.
Looking to book a one-on-one session? My booking for private appointments will re-open in Fall/Winter 2024. If you are expecting, have recently given birth, or are experiencing pelvic floor issues, learn more about my online perinatal, postnatal, and rehabilitative yoga programs that can be done from the comfort of your home.
If you’re doing Kegels for pelvic floor recovery after birth, you could be causing pain with sex — here’s why.
When we think of pelvic floor (PF) training, Kegel exercises are commonly the first thing that comes to mind; however, these exercises make up only a small portion of the rehabilitation process for the pelvic floor muscles after birth.
During birth, the pelvic floor muscles are stretched quite significantly to accommodate for the baby passing through. It naturally takes several weeks after this event for the pelvic floor muscles to regain their contractile abilities again. This normally happens gradually and doesn’t require specific training.
We use our pelvic floor muscles to control our bowel and bladder, to support our pelvic organs (uterus, rectum, bladder), and we use these muscles during sex. These are some pretty important functions and so it's natural to see decreased function in these areas during this recovery period after birth. This can present as:
Urinary leakage
Pelvic pressure
Decreased sensation
Decreased connection with your pelvic floor
This is a vulnerable time for your pelvic organs. They are lacking support from the pelvic floor and are susceptible to uncontrolled pressures from lack of core coordination with our muscles of breathing.
This contributes to higher incidences of pelvic organ prolapse (POP) after childbirth — when the rectum, uterus, and/or bladder prolapses through the wall of the vagina. The main symptom of POP is a bulging sensation around the wall of the vagina and/or vulva. This may be accompanied by urinary leakage and/or abnormal bowel movements, but these symptoms naturally occur after birth due to the temporary loss in contractile function of the pelvic floor and so it is important to establish whether POP is present and whether you are susceptible to POP during your postpartum Pelvic Floor Physiotherapy check-up.
After the muscles start to regain their contractile abilities, things may not be restored to normal. The pelvic floor may not:
Contract in sync with our breathing the way we need it to (lack of coordination)
Contract strongly enough (lack of strength)
Contract fast enough (lack of speed)
Contract long enough (lack of endurance)
Maintain normal muscle tone
Maintain the same neuromuscular connections — eg. you might experience difficulty voluntarily contracting them and a loss of awareness of how to connect with and contract these muscles
If you start doing Kegels and only do Kegels to strengthen your pelvic floor after birth (especially when they are done incorrectly), you could wind up with high tone or shortened pelvic floor muscles that continue to have difficulty contracting and maintain the same loss of functions above. In addition, you could be presenting with POP or birth-related pelvic floor injuries that require specialized treatment through Pelvic Floor Physiotherapy.
Working on the coordination, lengthening, endurance, timing, and awareness of these muscles is equally as important as working on strength. If this is neglected during the first 6 weeks after birth, you may end up experiencing pain and/or a loss of sensation during intercourse despite being cleared to have sex by your healthcare provider. This can actually worsen over time as neural pain pathways become stronger in association with sex.
Sex doesn't have to be uncomfortable after birth. Make your experience a positive one by seeing a Pelvic Floor Physiotherapist & try my online Heal with Hayley postnatal program for pelvic floor and core training after birth. Read more below!
I encourage you to see your Pelvic Health Physiotherapist after birth and seek out programs that prioritize core and pelvic floor recovery. I created Heal with Hayley, my online postnatal recovery program, for this exact purpose because I could not find a program that combined fitness with recovery in this way.
Send an email to hayley@pelvicgoddess.ca if you have questions about recovery after birth. Both 2 month and 4 month options for the program are available depending on your unique postnatal recovery needs ✨