It is often thought that nothing can be done for those with incontinence, prolapse or pelvic pain. It is also thought that Kegels are the only treatment for pelvic floor dysfunction – this is absolutely not the case! Kegels are often not appropriate, and if they are indicated, they are frequently performed incorrectly.
The pelvic floor muscles are a group of muscles that attach to the front, back and sides of the pelvic bone and sacrum. They are like a hammock or a sling, and they support the bladder, uterus, prostate and rectum. They also wrap around the urethra, rectum, and vagina (in women). These muscles must be able to contract to maintain continence, and relax to allow for urination, bowel movements, and in women, sexual intercourse.
Pelvic floor dysfunction can be caused by HYPOTONICITY (weak pelvic floor muscles) contributing to Stress Incontinence, Urge Incontinence, and Pelvic Organ Prolapse. Incontinence is NOT a normal part of aging, nor is it normal post pregnancy.
Pelvic floor dysfunction can also be caused by HYPERTONICITY (tight pelvic floor muscles) and can contribute to Urinary and Fecal Urgency, Urge Incontinence, Chronic Pelvic Pain, Pudendal Nerve Irritation, Interstitial Cystitis, Chronic Prostatitis, Dyspaerunia, Vaginisimus, and Vulvodynia.
Other reasons to see a physiotherapist with pelvic floor training could include: Chronic Constipation, Irritable Bowel Syndrome, Coccydynia, Rectus Diastasis, Post-Prostatectomy, Pelvic Girdle Pain in pregnancy/post labour and delivery, pain during intercourse, difficulty starting urine stream, if you have unresolved low back, hip or pelvic pain or if you have pain in the vagina, perineum, rectum, bladder region, or penile, testicular or prostate pain.
A pelvic floor assessment includes a thorough history taking and evaluation of lumbopelvic function, abdominal stability and pelvic floor function which may include an internal examination. The goal of the assessment is to determine the cause of your incontinence or pain and which treatment would be most beneficial for you. Treatment may include education regarding normal bowel and bladder function (including dietary and lifestyle factors), pelvic floor muscle awareness and retraining exercises, manual therapy techniques, and myofascial trigger point and connective tissue treatment. Education about persistent pain may also be an important part of treatment as the pelvic area is often an area where we hold our stress.
Best Evidence Guidelines (Cochrane, 2010) state that Pelvic Floor Physiotherapy (using internal examination to teach the exercises) should be the FIRST line of defence against all forms of stress, urge and mixed incontinence before surgical consultation. Your physiotherapist will work with you to achieve your goals and improve your quality of life.