Understanding the Pelvic Floor
The pelvic floor is a group of muscles that form a supportive sling at the base of the pelvis. These muscles support the bladder, uterus (in women), prostate (in men), and rectum. They also play a vital role in bowel and bladder control, sexual function, and core stability.
When functioning optimally, the pelvic floor muscles contract and relax as needed, ensuring proper support and function. However, these muscles can become weakened, overactive, or dysfunctional for various reasons, leading to incontinence, pain, or organ prolapse.
Conditions Treated by Pelvic Health Physiotherapy
Pelvic health physiotherapists are trained to assess and treat a range of conditions, including but not limited to:
1. Urinary Incontinence
Incontinence, or the involuntary leakage of urine, is common but not normal. There are different types of urinary incontinence, such as stress incontinence (leakage with coughing, sneezing, or exercise) and urge incontinence (a sudden, strong need to urinate). Pelvic physiotherapy helps retrain the bladder and strengthen the pelvic floor muscles to improve control.
Urinary incontinence is particularly prevalent among women who have given birth. Studies show that up to one in three women experience urinary leakage after childbirth, and nearly 50% of women over the age of 50 report some degree of incontinence. Early intervention with pelvic health physiotherapy can significantly improve symptoms and quality of life.
2. Pelvic Organ Prolapse
Pelvic organ prolapse occurs when the pelvic organs (bladder, uterus, or rectum) descend due to weakened support structures. Symptoms may include a sensation of heaviness, bulging, pressure in the pelvic region, and difficulty evacuating your bladder or bowel, among others. There are many risk factors for prolapse, including genetics, how you gave birth, pelvic floor muscle injury and lifestyle factors like overweight or heavy lifting. Physiotherapy can help manage symptoms through muscle strengthening, lifestyle modifications, and using supports called pessaries. Some pelvic health physiotherapists have postgraduate qualifications to fit pessaries and help manage them with a woman’s GP or gynaecologist.
3. Pregnancy and Postpartum Recovery
Pregnancy puts considerable strain on the pelvic floor due to increased weight, hormonal changes, and childbirth trauma. Physiotherapy during pregnancy can help prepare the body for labour. At the same time, postpartum therapy focuses on recovery, addressing issues like diastasis recti (abdominal separation), incontinence, perineal pain and getting back to fitness in a healthy way.
Research suggests that nearly 50% of postpartum women experience some degree of pelvic floor dysfunction, including incontinence and pelvic pain. Seeking professional physiotherapy support can aid in quicker recovery and prevent long-term complications.
4. Pelvic Pain
Chronic pelvic pain can stem from conditions such as endometriosis, interstitial cystitis, painful bladder syndrome, or musculoskeletal issues among others. It is often complex, and many women and men have multiple issues, including other chronic conditions. Pelvic health physiotherapy can provide relief through manual therapy, exercises, relaxation techniques and mindfulness to ease muscle tension, improve function and achieve a patient’s goals. There is significant research focusing on the best management of pelvic pain with multi-modal physiotherapy, resulting in the highest level of evidence. Addressing your health goals can significantly benefit a person’s quality of life with multi-disciplinary care from a GP or gynaecologist, dietician, or psychologist.
5. Bowel Dysfunction
Conditions such as constipation, faecal incontinence, and irritable bowel syndrome (IBS) can be associated with pelvic floor dysfunction. Constipation affects approximately 20% of the population, with women experiencing it more frequently than men. In comparison, faecal incontinence impacts around 8% of adults, increasing with age and certain medical conditions.
Physiotherapists assess the factors that are contributing to the symptoms. Some simple techniques, including toilet posture, soluble fibre, and fluid management, can be very effective. Physiotherapists also help retrain bowel habits and improve muscle coordination to support proper elimination.
6. Sexual Dysfunction
Sexual dysfunction can manifest in various forms, including pain during intercourse (dyspareunia), vaginismus (involuntary tightening of vaginal muscles), erectile dysfunction, premature ejaculation, and reduced sexual sensation. These issues often stem from pelvic floor muscle dysfunction, hormonal imbalances, psychological factors, or medical conditions. Pelvic health physiotherapy can play a crucial role in addressing these concerns by using techniques such as education on sexual function, manual therapy, biofeedback, pelvic floor muscle training, relaxation exercises, and mindfulness. Depending on the specific dysfunction, strengthening or relaxing the pelvic floor muscles can improve circulation, reduce discomfort, and enhance overall sexual well-being. Additionally, therapists provide guidance on lifestyle modifications, stress management, and communication strategies with partners to foster a holistic approach to sexual health.
Assessment and Treatment Approaches
Comprehensive Assessment
Pelvic health physiotherapists conduct thorough assessments, including a detailed history and physical examination. This appointment may involve:
- Discussion of symptoms, lifestyle, and medical history
- Assessment of posture, breathing, and core stability
- External and internal evaluation of pelvic floor muscle function (with patient consent)
- Use of biofeedback or ultrasound to assess muscle activity
Treatment Techniques
Treatment is always individualised and may include:
1. Pelvic Floor Muscle Training
Depending on the patient’s needs, specific exercises are prescribed to strengthen or relax the pelvic floor muscles. Pelvic Floor Muscle exercises are commonly used for strengthening, while relaxation techniques help release tight or overactive muscles. One in two women do pelvic floor muscle exercises incorrectly. A trained physiotherapist can assess and teach a patient how to do this correctly.
2. Manual Therapy
Hands-on techniques, including massage and myofascial release, help relieve muscle tension and improve mobility in the pelvis and surrounding structures.
3. Breathing and Postural Training
The diaphragm, core, and pelvic floor work together. Learning proper breathing techniques and improving posture can enhance pelvic floor function and reduce strain.
4. Bladder and Bowel Retraining
Patients receive guidance on hydration, diet, and habits that promote healthy bladder and bowel function. Timed voiding and behavioural strategies help regain control.
5. Electrical Stimulation and Biofeedback
These tools assist in activating or relaxing pelvic floor muscles, providing visual or sensory feedback to enhance awareness and control.
6. Lifestyle and Activity Advice
Adjusting daily activities, improving toileting habits, and modifying exercise routines can significantly impact pelvic health and prevent symptom aggravation. Ultimately progressing so a patient can achieve their exercise or lifestyle goals.
Who Can Benefit from Pelvic Health Physiotherapy?
Pelvic health physiotherapy is beneficial for people of all ages and genders. Some individuals who may benefit include:
- Women during pregnancy, postpartum, or menopause
- Men experiencing post-prostatectomy issues or pelvic pain
- Athletes who place strain on their core and pelvic floor
- Individuals with chronic constipation or bladder urgency
- Anyone experiencing pelvic pain, discomfort, or dysfunction
Breaking the Stigma Around Pelvic Health
Despite the prevalence of pelvic health issues, many people hesitate to seek treatment due to embarrassment or lack of knowledge. It’s important to understand that these conditions are common, treatable, and not something to suffer through in silence. Raising awareness, promoting open conversations, and seeking professional help can improve the quality of life and overall well-being.
Conclusion
Pelvic health physiotherapy is a vital yet often under-recognised field that addresses conditions affecting the pelvic floor and surrounding structures. By providing evidence-based treatments, physiotherapists help individuals regain control over their bladder, bowel, sexual function, and overall pelvic health. Whether dealing with incontinence, pain, or postpartum recovery, seeking professional help can lead to significant improvements in comfort, confidence, and daily function.
If you or someone you know is struggling with pelvic health issues, consider consulting a qualified pelvic health physiotherapist to explore treatment options. Your pelvic health matters and support is available to help you live a healthier, more comfortable life.
