Women’s Health Physiotherapy is the therapeutic treatment of all disorders affecting the pelvis and pelvic floor.
From incontinence to prolapse, pelvic pain or constipation, there is growing evidence that physiotherapy can alleviate, and in many cases cure these symptoms. Most women don’t know that help is available and it can be an embarrassing topic so I hope that these pages are helpful in answering some of the questions you may have about your body and whether Women’s Health Physiotherapy can help you.
- How can Women’s Health Physiotherapy help my pelvic floor?
- How can Women’s Health Physiotherapy help me during pregnancy?
- How can Women’s Health Physiotherapy help me post-natally?
- What can I expect at my Women’s Health Physiotherapy appointment?
How can Women’s Health Physiotherapy help my pelvic floor?
The pelvic floor is a complex structure made up of a group of muscles that support the pelvic organs and form the the birth canal and passages for urine and stool.
The pelvic floor muscles are often described as a hammock lifting and supporting the pelvic organs above. These muscles need to be able to contract to keep us continent, but also they must relax to allow for urination, bowel movements, child birth and sexual intercourse.
Problems with the pelvic floor can occur when these muscles are too weak (hypotonic) or too tight (hypertonic). It is also possible for these muscles to combine a pattern of too much tension in some areas while too relaxed in others!
When the pelvic floor muscles are low- tone (hypotonic) the hammock becomes less effective at supporting the pelvic organs and symptoms such as urinary or bowel incontinence, urgency and pelvic organ prolapse can occur. These are NOT a normal part of aging and the muscles can become weak for many reasons.
The good news is that a structured exercise program to strengthen the pelvic floor muscles is effective in reversing the symptoms in 80% of women.
Following an assessment treatments for the symptoms of hypotonic pelvic floor muscles include:
- Pelvic floor re-training and exercises
- Provision of pelvic floor educators/muscle stimulators to improve your activation and power of your pelvic floor contraction
- Pilates based pelvic stability exercises to strengthen the abdominal muscles which play a supporting role in the strength of the pelvic floor
- Assessment and treatment of any low back/pelvic pain issues which can lead to weakness of the pelvic floor muscles
When the pelvic floor muscles are high-tone (Hypertonic) they can cause urinary frequency, urgency, hesitancy or incomplete emptying and painful urination as the muscles are unable to relax fully to allow the passage of urine down the urethra. You may also experience constipation or pain with bowel movements, unexplained pain in your low back, pelvic region or genital area, pain during or after intercourse, orgasm, or sexual stimulation due to the tension in these muscles.
Hypertonic pelvic floor muscles can also contribute to Interstitial Cystitis, Vulvodynia and Pudendal nerve Neuralgia. There are again many reasons for these changes to occur in the pelvic floor muscles but hypertonicity may follow trauma to the pelvic floor/pelvic organs (for example in childbirth), following gynaecological intervention or investigation, unresolved low back or hip pain or following an infection.
When the pelvic floor muscles are already in a state of increased tone you may find it difficult to initiate or hold a pelvic floor contraction and increase the tone any further. In this case it is important to relax the pelvic floor muscles fully and treat the tension before any underlying weakness. Once the muscles have reached a normal resting tone, and are able to relax fully, their strength is reassessed and strengthening exercises are prescribed. Following an assessment treatment for the symptoms of hypertonic pelvic floor may include:
- Internal manual therapy techniques to relax the pelvic floor muscles, including trigger point release, myofascial stretches, scar massage,
- Myo-fascial release of the connective tissue of the abdomen, hips and pelvis which support the pelvic floor
- Relaxation and breathing techniques
- Advice on toileting and positional modifications
- Provision of pelvic floor exercises and general exercise to assist in release and re-training of the pelvic muscles
- Provision of vaginal dilators, pelvic floor educators or muscle stimulators to assist in the release and relaxation of pelvic muscles
- Assessment and treatment of any unresolved low back, hip or pelvic pain
- As and when suitable pelvic floor muscle strengthening can begin